Pain Management

I’m still in pain after a car accident. Why won’t my doctor prescribe more pain medication?

DEAR DOCTOR K: I have been in pain since a car accident a few years ago. My doctor is very conservative in prescribing pain medication. Why not just give me what I need to feel better?

DEAR READER: I don't know the particulars of your case, but I think you are talking about narcotic (opioid) pain medicines. And your doctor probably is reluctant to prescribe opioid medicines for chronic pain -- the kind I assume you now have if your accident was a few years ago.

Is it safe to take ibuprofen after an angioplasty?

DEAR DOCTOR K: I had angioplasty with a stent recently. I need to take aspirin and Plavix every day. I used to take ibuprofen for pain, but a neighbor said I shouldn't take it if I'm on aspirin and Plavix. Is that right?

DEAR READER: Taking aspirin and Plavix after angioplasty and stent placement is standard care. Both aspirin and clopidogrel (Plavix) attach to blood cells called platelets to make them less sticky. You need these drugs to prevent the formation of a blood clot inside the stent. If a clot forms in the stent, it can suddenly cut off the blood supply and cause a major heart attack.

Can massage therapy help to relieve a sore back?

DEAR DOCTOR K: My back is always sore. A friend suggested that massage therapy might help. Massages are expensive, so I want to make sure there's some evidence behind this. Is there?

DEAR READER: Massage used to be considered an indulgence. But it's now recognized as a legitimate therapy for some painful conditions -- including back pain.

Could hypnotherapy help relieve my chronic pain?

DEAR DOCTOR K: I am in near-constant pain because of arthritis. My doctor suggested that I try hypnotherapy. My first reaction was that it sounds like hokum, but now I'm wondering if it could help. What do you think?

DEAR READER: Hypnotherapy may in fact help with pain management. These days it is used to treat many mental and physical health problems. I spoke to my colleague Dr. Max Shapiro, a psychologist with Harvard-affiliated Massachusetts General Hospital. He explained that hypnotherapy is most effective in treating problems that require stronger control over the body's responses. Pain is a good example; insomnia is another.

Will a special pillow or other sleep adjustments improve my neck pain?

DEAR DOCTOR K: I tend to have a lot of neck pain. Would it help to buy a special pillow, or make any other adjustments to the way I sleep?

DEAR READER: As with so many things, an ounce of prevention may be worth a pound of cure when it comes to neck pain. And how you sleep at night can make a big difference. Two sleeping positions are easiest on the neck: on your side or on your back. Whichever you prefer, choose an appropriate pillow. If you sleep on your back, choose a rounded pillow to support the natural curve of your neck, with a flatter pillow cushioning your head. You can achieve this by tucking a small neck roll into the pillowcase of a flatter, softer pillow.

When is the right time for a knee replacement?

DEAR DOCTOR K: I have osteoarthritis that's gotten worse over the past few years. My doctor has explained the pros and cons of knee replacement, but it seems like the timing is up to me. How will I know when the time is right to replace my joint?

DEAR READER: If your experience with a knee replacement is like that of most of my patients, you'll know when the time is right only after the time has passed. I've rarely met a person who had a knee or a hip replacement who did not say, after the surgery, "I should have had the surgery long before I finally did." That surely was my experience with hip replacement due to osteoarthritis. Looking back, I should have had the surgery at least two years before I did.

Why am I still experiencing pain six months after my stroke?

DEAR DOCTOR K: I've been in pain ever since I had a stroke about six months ago. What will relieve it?

DEAR READER: Pain is a frequent complication of stroke. It generally falls into one of two types, local or central. Local pain results from joint and muscle problems. Strokes can make some muscles weak and stiff. That, in turn, can make the muscles hurt when they move (or are moved). It also can cause the bones in a joint moved by those muscles to shift out of their proper place, producing pain in the joint.

I’m having knee pain, can you describe the anatomy of the knee so I can understand more?

DEAR DOCTOR K: I've been having a lot of knee pain. Would you describe the anatomy of my knee so that I can understand more when I see my doctor about it?

DEAR READER: Joints are places where two or more bones meet, to allow a part of your body to move. And the knee joint is a remarkable structure. It is a complicated network of bones, cartilage, muscles, tendons and ligaments. These structures, working together, allow us to walk, kick, squat, stand back up and do the Twist. (I know that's a dated reference!)

Should I take a steroid for my sciatica pain?

DEAR DOCTOR K: I have terrible sciatica pain from a slipped disk, but I've hesitated to take steroid pills. What do you think about this treatment?

DEAR READER: Your spine is essentially a column of interlocking bones called vertebrae. A disk tucked in between each pair of vertebrae acts as a shock-absorbing cushion. Sciatica often occurs when a disk becomes displaced (herniated) in the lower spine and injures or compresses the sciatic nerve. This causes sciatica, a severe, shooting pain, tingling, numbness or weakness that runs from your lower back through the buttock and into the lower leg. (At the end of this post, I've put an illustration showing common causes of sciatica.)