Pain Management

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.

Why should I use mind-body therapies for my chronic pain?

DEAR DOCTOR K: I suffer from chronic pain. My doctor suggested that I look into mind-body therapies. Why? Is it possible to think your way out of pain?

DEAR READER: I wouldn't describe mind-body therapies as "thinking your way out" of any kind of suffering. But mind-body therapies surely can help reduce chronic suffering, including chronic pain. Pain signals sent up the nerves from your body register in pain centers deep inside your brain. But signals from those pain centers then are processed by the "thinking part" of your brain. That part, in turn, is affected by your emotions, which come from a different part of your brain.

What can I do to ease the discomfort of hemorrhoids?

DEAR DOCTOR K: What can I do to ease the discomfort of hemorrhoids?

DEAR READER: Hemorrhoids are quite common, and they're not a "serious" medical problem. But, figuratively and literally, they're a real pain in the butt. Hemorrhoids develop when veins in the anus and rectum swell and widen. (I've put an illustration below) They can be extremely painful and uncomfortable, causing bleeding and painful bowel movements. There are surgical treatments that can help when you have recurrent, painful flare-ups of hemorrhoids.

What are alternative therapies for rheumatoid arthritis pain?

DEAR DOCTOR K: I have rheumatoid arthritis. Medications have helped, but only up to a point. Can you discuss alternative therapies that might help to further relieve my discomfort?

DEAR READER: Rheumatoid arthritis (RA) is a long-term disease in which the body's immune system attacks healthy tissue lining the joints. This causes swelling, pain, redness and stiffness in joints throughout the body. Drug treatments slow the effects of the disease, but alternative approaches can also help to reduce inflammation and relieve pain.

What happens during chiropractic treatment — what types of pain can it relieve?

DEAR DOCTOR K: I've been having back problems, and frankly, my regular doctor hasn't come up with treatments that help me much. So I'm wondering: What happens during chiropractic treatment? What types of pain can it relieve?

DEAR READER: Regular readers of this column know that I'm not very stuffy. I think treatments that are called "complementary" or "alternative" medicine should not be dismissed out of hand. Instead, those treatments that many people have found helpful -- and that are not clearly dangerous -- should be studied in the same way that traditional medical treatments are.