Pain Relief Pharmacy

When To Call a Doctor

Call a doctor about chronic pain if:

• Your pain has lasted more than 3 months without a clear reason.
• You are feeling down or blue or are not enjoying the activities or hobbies that you have enjoyed in the past. You may be experiencing depression, which is common with chronic pain.
• You are unable to sleep because of the pain.
• You had an illness or injury that healed, but the pain has not gone away.
• You have a family member or friend who appears to be suffering from chronic pain, and you would like information about treatment.

Watchful Waiting

Watchful waiting is a period of time during which you and your health professional observe your symptoms or condition without using medical treatment. If you are able to control occasional, mild to moderate pain with exercise, healthy eating, massage, and pain relievers—such as acetaminophen or nonsteroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen or aspirin—you may not need further treatment from a health professional. However, watchful waiting is not appropriate if your pain is severe or if persistent pain interferes with your life. If you delay treatment, the pain may get worse.

Who To See

If you have mild to moderate recurring pain that cannot be managed at home, you may need to consult one of the following health professionals:

• Family medicine doctor
• Internist
• Nurse practitioner
• Physician assistant
• Doctor of osteopathy

If your chronic pain is moderate to severe and constant, or if treatment does not control the pain, your primary health professional may recommend that you see a specialist, such as one or more of the following:

• Pain management specialist
• Physiatrist
• Physical therapist
• Neurologist
• Obstetrician or gynecologist (for chronic pelvic pain)
• Anesthesiologist
• Psychiatrist, psychologist, or a licensed mental health counselor
• Orthopedic surgeon
• Rheumatologist
• Chiropractor

Often more than one specialist will treat your chronic pain. For example, a primary physician may manage your medicines, and a physical therapist may help you restore function through exercise or other therapies. A professional counselor may help you with coping and depression, and a complementary medicine practitioner may provide alternative therapies such as acupuncture or yoga.

If chronic pain persists and interferes with your daily life despite treatment, you may want to seek an evaluation at a pain management clinic. A pain management clinic is a setting where you receive treatment and learn to cope with chronic pain. Treatment is usually provided by a team of health professionals who work together to address all the possible causes of your chronic pain.

Menstrual cramps can cause mild discomfort to severe pain in the lower abdomen, back, or thighs. The pain usually starts right before or in the beginning of your period. During this time, you may also have headaches, diarrhea or constipation, nausea, dizziness, or fainting.

Not every woman has menstrual pain, but it is a normal part of how the body works.

To help relieve menstrual cramps:

• Apply heat to your abdomen with a heating pad or hot water bottle, or take a warm bath. You might find that heat relieves the pain as well as medicine does.
• Lie down and elevate your legs by putting a pillow under your knees.
• Lie on your side and bring your knees up to your chest. This will help relieve back pressure.
• Try sexual activity. This may relieve pelvic cramping and backache.
• Try using sanitary napkins instead of tampons.
• Get regular exercise. You might find that it helps relieve pain.

Over-the-counter medicine usually relieves menstrual pain.

• Nonsteroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen (Advil), help relieve menstrual cramps and pain.
• Start taking the recommended dose of pain reliever when discomfort begins or 1 day before your menstrual period starts.
• Take the medicine for as long as the symptoms would normally last if you did not take the medicine.
• If an NSAID does not relieve the pain, try acetaminophen, such as Tylenol or Panadol.

Be sure to follow all labels and instructions. If you are pregnant or trying to become pregnant, talk to your health professional before using any medicine. Do not take aspirin if you are younger than 20 because of the risk of Reye’s syndrome.

Prescription medicine is a good choice if over-the-counter medicine does not bring you relief. Birth control hormones help relieve menstrual pain and lighten bleeding for most women. They also prevent pregnancy. Talk to your health professional about trying the birth control pill, patch, or ring. With most types of hormone birth control, you take the hormones every day for 3 weeks, then take a week off. This is when you might get a menstrual period. There are some types of pill that you can take over 3 months, or even every day of the year. With these, you might have unexpected spotting or bleeding, especially during the first year.

How is Cancer Pain Treated?

Cancer pain is very treatable. Approximately nine out of 10 cancer pain patients will find relief using a combination of medications. Although cancer pain is usually treated with medicine, other treatments such as radiation therapy, surgery, relaxation, biofeedback, imagery and other non-drug treatments can be used with medicine to give even more pain relief.

The following page lists the general types of pain medicine and the methods by which they are taken. Ask your doctor, nurse or pharmacist for advice before you take any medicine for pain.

Types of Pain Medicine

Many medicines are used to treat cancer pain, and your doctor may give you one or more to take. The following list describes the broad groups of pain medicine and the kind of pain each works on. Information on specific pain medications and their side effects is located elsewhere on this website.

For mild to moderate pain
Nonopioids:Examples are acetaminophen and nonsteroidal anti-inflammatory drugs (NSAIDs), such as aspirin and ibuprofen. You can buy many of these over-the-counter (without a prescription). Others need a prescription.

For moderate to severe pain
Opioids:Examples are morphine, hydromorphone, oxycodone, hydrocodone, codeine, fentanyl and methadone. A prescription is needed for these medicines. Nonopioids may also be used along with opioids for moderate to severe pain.

For tingling and burning pain
Antidepressants:Examples are amitriptyline, imipramine, doxepin and trazodone. A prescription is needed for these medicines. Taking an antidepressant does not mean that you are depressed or have a mental illness.
Antiepileptics:Examples are gabapentin and other medications. A prescription is needed for these medicines. Taking an antiepileptic does not mean that you are going to have seizures.

For pain caused by swelling
Steroids:Examples are prednisone and dexamethasone. A prescription is needed for these medicines.

How Pain Medicine is Taken

Most pain medicine is taken by mouth (orally). Oral medicines are easy to take and usually cost less than other kinds of medicine. Most oral medicines are in tablet (pill) form, but sometimes they are liquids that you drink. If it is hard for you to swallow and you cannot take a tablet or liquid for some other reason, there are other ways to get these medicines. These include:

Rectal suppositories
Medicine that dissolves in the rectum and is absorbed by the body.

Transdermal patches
Patches that are filled with medicine and placed on the skin.

Many kinds of injections can give pain relief. Most injections use a tube or needle to place medicine directly into the body. Types of injection include:

Subcutaneous- medicine is placed just under the skin using a small needle.
Intravenous- medicine is placed directly into a vein through a needle that stays in the vein. This method includes a type of pain managment called patient-controlled analgesia (PCA). PCA lets patients adjust how much medicine they receive according to their level of pain.
Epidural or intrathecal- medicine is placed directly into the back using a small tube. Most of these injections give pain relief that lasts for many hours.
Subdermal and intramuscular- commonly known as “shots,” these injections are placed more deeply into the skin or muscle using a needle. These injections are not recommended for long-term cancer pain treatment. Constantly having shots into the skin and muscle can be painful.

Topic Overview

What is low back pain?

Low back pain can affect the back anywhere below the ribs and above the legs. The lower back is the connection between the upper and lower body, and it bears most of the body’s weight. Because of these roles, it is easily injured when you lift, reach, or twist.

Almost everyone has low back pain at one time or another. The good news is that most low back pain will go away in a few weeks with some basic self-care. But if your pain is severe or lasts more than a couple of weeks, see your doctor.

What causes low back pain?

Low back pain is often caused by overuse, strain, or injury. For instance, people often hurt their backs playing sports or working in the yard, being jolted in a car accident, or lifting something too heavy.

Aging plays a part too. Your bones and muscles tend to lose strength as you age, which increases your risk of injury. The spongy discs between the bones of the spine (vertebrae) may suffer from wear and tear and no longer provide enough cushion between the bones. A disc that bulges or breaks open (herniated disc) can press on nerves, causing back pain.

In some people, low back pain is the result of arthritis, broken vertebrae (compression fractures) caused by bone loss (osteoporosis), illness, or a spine problem you were born with.

Often doctors don’t really know what causes low back pain. But it is more likely to become long-lasting (chronic) if you are under stress or depressed.

What are the symptoms?

Depending on the cause, low back pain can cause a range of symptoms. It may:

• Be dull, burning, or sharp.
• Be felt at a single point or over a broad area.
• Come on gradually or suddenly.
• Occur with muscle spasms or stiffness.
• Cause leg symptoms, such as pain, numbness, or tingling, often extending below the knee. These symptoms can occur on their own or along with low back pain. Leg symptoms are often caused by lower spine problems that place pressure on a nerve that leads to the leg.

A rare but serious problem called cauda equina syndrome can occur if the nerves at the end of the spinal cord are squeezed. Seek emergency treatment if you have weakness or numbness in both legs, or loss of bladder or bowel control.

Doctors say back pain is:

• Acute if a spell (or episode) of pain lasts less than 3 months. Most back pain is acute and goes away with 4 to 6 weeks of home treatment.
• Recurrent if acute symptoms come back. Most people have at least one episode of recurrent low back pain.
• Chronic if your back bothers you most of the time for longer than 3 months.

How is low back pain diagnosed?

The doctor will ask questions about your past health, symptoms, and work and physical activities. He or she will also do a physical exam. Your answers and the exam can help the doctor rule out a serious cause for the pain. In most cases, doctors are able to recommend treatment after the first exam.

Most people do not need further testing. Imaging tests such as X-rays, CT scans, and MRIs are not helpful for diagnosing most episodes of low back pain. In most cases, they are only used if the doctor suspects a serious problem, such as a herniated disc, a broken bone, or cancer, or if surgery is being considered or planned. You might also have imaging tests if worker’s compensation or a lawsuit is involved.

How is it treated?

Most low back pain will improve with the following treatment:

• For the first day or two, rest in a comfortable position. Try lying on your side with a pillow between your knees. Or lie on your back on the floor with a pillow under your knees. Do not stay in one position for too long, though. Every 2 to 3 hours, take a short walk (about 10 to 20 minutes), then rest in a comfortable position again.
• Take over-the-counter pain medicine if needed, such as acetaminophen (Tylenol, for example) or an anti-inflammatory drug such as aspirin or ibuprofen (Advil or Motrin, for example). These medicines usually work best if you take them on a regular schedule instead of waiting until the pain is severe.
• Try using a heating pad on a low or medium setting, or a warm shower, for 15 to 20 minutes every 2 or 3 hours. You can also buy single-use heat wraps that last up to 8 hours. You can also try an ice pack for 10 to 15 minutes every 2 to 3 hours. There is not strong evidence that either heat or ice will help, but you can try them to see if they help.
• As soon as possible, get back to your normal activities. Staying in bed for more than 1 or 2 days can weaken your muscles and make the problem worse.

Walking is the simplest and maybe the best exercise for the lower back. It gets your blood moving and helps your muscles stay strong. Start with easy walks of 5 to 10 minutes a day, and gradually increase your time. Walking in water up to your waist or chest is also good exercise.

A doctor or physical therapist can recommend more specific exercises to help your back muscles get stronger. These may include a series of simple exercises called core stabilization. The muscles of your trunk, or core, support your spine. Strengthening these muscles can improve your posture, keep your body in better balance, and lower your chance of injury.

Some people get relief from pain by using treatments such as massage, spinal manipulation (chiropractic or osteopathic manipulation), or acupuncture. Certain treatments work for some people but not for others. You may need to try different things to see which work best for you.

If your symptoms are severe or you still have them after 2 weeks of self-care, see your doctor. You may need stronger pain medicines, or you might benefit from physical therapy.

Having ongoing back pain can make you depressed. In turn, depression can have an effect on your level of pain and whether your back gets better. People with depression and chronic pain often benefit from both counseling and medicine. A cognitive-behavioral therapist can teach stress management and pain control skills. Antidepressant medicines may help too.

Only a few people with low back pain need surgery. Surgery may help if you have a herniated disc or back pain along with symptoms of nerve damage, such as numbness in your legs. Even in these cases, most people will improve without surgery. Having surgery does not guarantee that all your pain will go away. Before you have surgery, it is a good idea to get a second opinion.

How can you prevent low back pain from returning?

After the first time you have had low back pain, you are likely to have it again. To help keep your back healthy and avoid further pain:

• Practice good posture when you sit, stand, and walk.
• Get regular, low-impact exercise. Walk, swim, or ride a stationary bike. Stretch before you exercise.
• Wear low-heeled shoes with good support.
• Sleep on your side. A medium-firm mattress may put the least stress on your back.
• Watch your weight. Being too heavy, especially around your waist, puts extra stress on your back.
• Don’t try to lift things that are too heavy for you. When you must lift, bend your knees and keep your back straight, keep the object you are lifting close to your belly button, and avoid lifting and twisting at the same time. See a picture of proper lifting technique.

If you sit or stand for long periods at work:

• Pay attention to your posture. Sit or stand up straight, with your shoulders back.
• Make sure your chair has good back support.
• Take regular breaks to walk around.

If your work involves a lot of bending, reaching, or lifting:

• Talk to your human resources department to see if there are other ways you can do your work.
• Don’t depend on a “back belt” to protect your back. Studies have not shown these belts to be effective in reducing back injuries. The most they can do is to help remind you to use good techniques for lifting.

Treatment Overview

Spinal cord stimulation (SCS) is a procedure that uses an electrical current to treat chronic pain. To treat chronic low back pain, a small pulse generator, implanted in the back, transmits electrical pulses to the spinal cord. These pulses interfere with the nerve impulses responsible for leg pain due to nerve damage (sciatica).

Implanting the stimulator is considered to be a simple procedure, typically done using a local anesthetic and a sedative. Your doctor usually will first insert a trial stimulator through the skin (percutaneously) to give the treatment a trial run. (A percutaneous stimulator tends to move from its original location, so it is considered temporary.) If the trial is successful, your doctor can implant a more permanent stimulator. The stimulator itself is implanted under the skin of the belly (abdomen), and the small coated wires (leads) are inserted under the skin to the point where they are inserted into the spinal canal. This placement in the abdomen is a more stable, effective location. Most stimulator batteries must be replaced every 2 to 5 years.

After this outpatient procedure is complete, you and your doctor determine the best pulse strength. You are then given instructions for using the stimulator at home. A typical schedule for spinal cord stimulation is to use it for 1 or 2 hours, 3 or 4 times a day.

When in use, the spinal cord stimulator creates a tingling feeling, rather than the pain you have felt in the past.

What To Think About

Spinal cord stimulation may be recommended for a small subset of people suffering from certain types of chronic pain such as pain from a nerve root injury.

Most spinal cord stimulator batteries must be replaced every 2 to 5 years.