Pain Management

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.)

Can yoga help relieve chronic pain?

DEAR DOCTOR K: I've heard that yoga can help relieve chronic pain. What types of pain can yoga help?

DEAR READER: People have been practicing yoga for thousands of years. This mind-body exercise combines breath control, meditation and movements to stretch and strengthen muscles. But yoga places as great an emphasis on mental fitness as on physical fitness. Research finds that yoga may help relieve pain in people with a variety of chronic pain conditions, including arthritis, fibromyalgia, migraine headaches and low back pain.

Can ibuprofen reduce my heart attack risk as well as my pain?

DEAR DOCTOR K: I take ibuprofen every morning for my arthritis. My doctor wants me to take low-dose aspirin every day to reduce my heart attack risk. Ibuprofen and aspirin are both NSAIDs, right? So will the ibuprofen help my arthritis and my heart? Or should I take both?

DEAR READER: When joints ache, many people turn to nonsteroidal anti-inflammatory drugs (NSAIDs) for pain relief. Aspirin is a type of NSAID. So are ibuprofen (Advil, Motrin) and naproxen (Aleve, Naprosyn). NSAIDs are widely used because they perform double duty. They relieve pain and also reduce inflammation.

Is it normal to have pain from whiplash months after a car accident?

DEAR DOCTOR K: I was in a car accident several months ago and got whiplash. I still have neck pain. Is this normal?

DEAR READER: The neck contains a stack of bones (vertebrae) with joints between them. The bones are attached to muscles and ligaments that hold them together, and that hold the neck upright, allowing it to move as your head moves. Whiplash -- the term used to describe a group of symptoms and also the typical accident that leads to them -- can damage one or more of these delicate structures. Whiplash is most commonly caused by car crashes, particularly those in which another car plows into the back of your car.