Help yourself: Learn how to rate and manage pain

Pain is the main complaint for about 40 percent of patients visiting primary-care doctors with roughly half of the people with chronic or recurrent pain failing to get adequate relief. In many ways pain remains a medical mystery, but here’s what to do for occasional, severe, and recurrent pain:

Self assess. First, assess how bad the pain is. Rate it on a scale of 0 (no pain) to 10 (the worst pain you could imagine). For pain that you rate 5 or less, start by self-treating with nondrug measures. For example, use heat to help ease back pain or cramps. You can also use over-the-counter pain relievers, which typically suffice for this level of pain.

How to choose an over-the-counter. Choose a drug based on the type of pain and your risk factors. Acetaminophen (Tylenol or generic) is often a good option. At recommended doses it's reasonably safe and effective for most people. People who drink heavily or have a liver disorder should avoid acetaminophen, since it's toxic to the organ. Ibuprofen and naproxen are often good over-the-counter choices if acetaminophen isn't enough. They not only ease pain but also quell inflammation. Both drugs are probably safer than aspirin, which poses a higher risk of bleeding. And while long-term use of any NSAID poses serious gastrointestinal and possibly coronary risks, the short-term use of recommended doses is generally safe for most people who don’t have heart, kidney, or stomach problems.

Severe-pain solutions. If you rate your pain at 6 or higher, it doesn’t improve with nondrug steps and OTC drugs, or it lasts longer than a few days, see your doctor. He or she might suggest a prescription NSAID, because a different or stronger formulation may yield additional relief. Another approach can be a prescription opioid such as oxycodone (Oxycontin and generic). You or your doctor might resist using such drugs because of addiction concerns. But physical dependence typically requires several weeks of use, and psychological dependence in patients with acute or severe pain is unlikely because they rarely experience euphoria from the drugs.

Medications that pair an opioid with acetaminophen, aspirin, or ibuprofen may be an even better choice. Those can provide greater relief, since the two ingredients work in different ways, and they reduce the risk of side effects because the combination permits smaller doses of each.

Recurrent pain. Even when the pain is relatively mild, chronic or recurrent pain from arthritis, headaches, or other sources can seriously interfere with everyday activities. Since chronic pain often ebbs and flows, rating your discomfort on the 0 to 10 pain scale can help you decide, day to day, how to manage the problem.

For more information, see Consumer Reports’ Best Buy Drug report on opioids.

Comments

[Kym B.]

For six months I participated in a drug study for the combination of Tramadol Ultram and Mobic for the treatment of arthritic pain. The study was to last for a year, but was cut short when the drug company deemed it would not be profitable to continue.

I was stepped down to half doses for a week, then completely cut off from the Tramadol (I continued the Mobic because I had been on that prior to the start of the study). I then entered in to a very intense, agonizing period of withdrawal from the Tramadol.

I ended up in an urgent care facility where I was prescribed ambien and advised to take it with benedryl so I could get the sleep I'd missed the previous three to four days due to the Tramadol withdrawal.

I offer up my story as a caution to anyone considering a prescription pain killer. Don't make my mistake which was not to research the drug and ask informed questions before taking it. I was told the drug was not habit forming. I was not warned of any withdrawal symptoms.

Please, do your research. Seek non-pharmaceutical ways to manage your pain before even considering medicating yourself. However, if you have no other choice, be informed, ask questions and don't let your doctor brush you off.

[Denzyl]

As a pharmacist who dispensed thousands of pain pills every DAY, I strongly recommend attempting non-drug pain relief such as heating pads, yoga, meditation, muscle rubs, TENS units, only take the pills when you truly need them, and avoid doctors that will write anything you ask for.

According to a study posted in Hepatology journal, acetaminophen (Tylenol) is a factor in HALF of all liver transplants!

KEEP YOUR MEDICINE LOCKED UP! I talk to patients everyday that have their medication stolen by their children or "friends."

[Gary]

I have long term pain management for arthritis. Be sure to question the doctor or pharmacist when a new medication is prescribed. These medical providers do not (actually in my case- seldom) check to see what you already are taking- especially from other doctors. I was prescribed a new medication that contained a drug I was already taking. The doctor did not tell me to stop the medication I was already taking, and as a result I overdosed and ended up in the emergency room. Also be sure to read the information that comes with a new medication (although this information is not easily understood by the patient).

[L Craig]

I have pain that comes and goes due to Thoracic Outlet Syndrome which causes pain in my neck and shoulders plus Osteoarthritis in my hips,knees,elbows and spine. I had read that creams usually don't help much but I tried Aspercreme and it does wonders in a few minutes! I only use it when I have discomfort and it's gone in a few minutes, plus I don't have to worry about overdosing like with pills. Now after taking fish oil for about three months,I rarely have any discomfort, have they done studies on fish oil and pain?

On the subject of wrong meds, I use Vaniqa, which is for reducing facial hair for women. The last time I ordered some, they gave me Vanacream (which is for babies, I think) I took it back and said this it the wrong product and the young man did not even check the record, he just argued with me and insisted it was the right product! I had to go to another window and talk to another person to get it exchanged!

[Kat]

I had a two level lumbar spinal fusion with instrumentaion in 1/2003, and had the instrumentation removed in 11/2003 due to continued pain and muscle spasms. The second surgery did not did not stop or reduce my low back pain as hoped.
I tried many other drug and non drug therapies prior to and after my surgeries including; a TENS unit, steroid injections, physical therapy, ice, heat, capsacin creme, NSAIDS, anti-convulsants and anti-depressants. I also was a evaluated by a chiropractic doctor who declined to treat me after seeing my MRI.
I now use the generic fentanyl patch for pain relief. It reduces my pain from a regular 7 - 8 to a 5-6 using a scale of 1 to 10. Some days are worse others better.
For me, the unappealing fact of physical dependence and risk of tolerance are worth the benefit of pain relief that the patch provides. To be brutally honest I do not know how long I would find the courage to face every day without the prospect of pain relief. It wears you down physically, emotionally, and socially.
I hope science provides a better way. I do feel lucky that I have this medication as I know of others who suffer either because they will not take it or their doctor will not prescribe it due to a well meaning but ill informed fear addiction.

[buy cheap tramadol]

Hi! Good article. Thanks.