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Pain Management: One Size Doesn’t Fit All

When it comes to treating chronic pain such as arthritis or low back pain, it’s important to remember that what works for one patient may not work for the next patient. Some people are able to control their pain by taking a nonprescription medication such as acetaminophen (Tylenol), while others may need an opioid (also known as narcotics). Tablets or capsules containing the opioid hydrocodone plus acetaminophen (known as Vicodin or Lortab) are among the most commonly dispensed medications in the US. But remember: just because this medication is popular doesn’t make it the best pain reliever for everyone!

For example, a recent study showed the older adults who were prescribed a short-acting opioid such as hydrocodone or oxycodone (e.g., Percocet) were twice as likely to break a bone in the following year compared to those on a long-acting opioid or a different pain medication altogether. How can doctors tell which pain medication to prescribe to best treat your pain, without increasing the risk of side effects? People also frequently turn to their pharmacist for medication advice – how does the pharmacist know what to recommend for your pain?

It all starts with a careful description of your pain. When you talk to your doctor or pharmacist, it’s important to completely describe your pain. Questions your doctor or pharmacist should ask regarding your pain are shown below. And if you aren’t asked, you should volunteer this information!

• Where is the pain, and does the pain move to any other areas in your body?
• Do any activities bring the pain on or make it worse such as walking, working, or lying down?
• Do any activities relieve the pain or make it better such as heat or cold application, resting or rubbing the area?
• What medications have you tried to treat the pain? How well did the medication work, and did you have any side effects from the medication?
• Describe what the pain feels like – is it sharp, stabbing, shooting, throbbing, burning or is there another word that describes it?
• How severe is the pain? On a scale of zero to ten (where zero is no pain and ten is the worst pain you can imagine), how bad is your pain right now? What is the best the pain is during an average day? The worst? On average?
• Is the pain there all the time or does it come and go during the day? If it comes and goes, how many times a day do you have the pain? How long does it last when you have the pain?
• What does the pain keep you from doing (such as work, shopping, playing with your children, gardening, sleeping, and so forth)?

This information, along with a physical exam and perhaps other testing will help your health care team determine the best pain medication for you. Remember – if your doctor or pharmacist doesn’t ASK you all these questions about your pain, you should bring it up. Remind them – “it’s your JOB to listen to my pain story!”


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One Response to “Pain Management: One Size Doesn’t Fit All”

  1. Hello Dr. Mary Lynn,
    I was hoping that you’d also share information in this posting about non-pharmaceutical therapies for pain. Modern pain management includes a wide variety of therapies (including but NOT exclusively drugs).

    As a heart attack survivor with ongoing chest pain caused by inoperable coronary microvascular disease, my cardiologist had exhausted a long list of possible drugs, more drugs and combinations of drugs (and even repeat visits to the cath lab to double-check that “stent failure” wasn’t the culprit behind my debilitating symptoms) before referring me to our Regional Pain Clinic and the pain specialist there who – lucky me! – happened to have completed a 2-year fellowship in Sweden studying the treatment of refractory angina associated with MVD!

    What we settled on was a non-drug, non-invasive, inexpensive therapy that has considerably reduced my need to take nitroglycerin PRN for pain.

    It’s called “Transcutaneous Electrical Nerve Stimulation” or TENS. Emerging cardiac research is showing that, just as the TENS unit works on improving blood flow and healing for an injured knee or shoulder in your physiotherapist’s office, it may bring the same relief to heart patients with MVD chest pain. I now wear a small portable battery pack TENS unit clipped to my belt, its electrodes strapped over my heart, all day, every day, from morning to night.

    But the Pain Clinic also offers complementary therapies that all physicians should be aware of while they’re busily writing the opioid scrips. For example, programs like Health Recovery Tai Chi, Yoga, and Meditation are offered free to all Pain Clinic clients. Support groups for specific diagnoses (migraine, back pain, etc) are also offered.

    My pain specialist also maintains that, because I have responded so well to my portable TENS unit,I would also be an “excellent candidate” for something called a “Spinal Cord Stimulator Implant” procedure IF (and only IF) required in the future. This simple surgical procedure is already done on some pain patients – but rarely heart patients outside of Europe, where it is more commonly seen as an effective non-drug pain therapy for MVD. More on this, including links to four journal articles (e.g. “Spinal Cord Stimulation Improves Functional Status and Relieves Symptoms in Patients With Refractory Angina Pectoris”) are at: “My Love-Hate Relationship With My Little Black Box” —
    http://myheartsisters.org/2010/08/26/tens-for-chest-pain/

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