By Dr. Caroline K. Stratz
One of the most common reasons people come to see me is because of complaints of pain. Whether it’s a strained muscle or a chronic condition, taking the right pain reliever is paramount in getting relief. What are the safest, most effective medications, and which alternatives might be worth trying? Let’s look at the most common types of pain and their appropriate treatments.
Osteoarthritis. More than 20 million Americans suffer from this degenerative disease, wherein cartilage breaks down, causing bones to rub together. Non-steroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen and naproxen can relieve the pain and inflammation but can also cause gastrointestinal (GI) bleeding.
The last remaining COX-2 inhibitor, Celebrex - the others, Vioxx and Bextra were taken off the market last year - is gentler on the GI tract and also effective. Other options include the dietary supplement glucosamine, which can help slow down joint degeneration. For more severe cases, injections of corticosteroids are very effective, especially in the knee.
Pulled muscles. Starting with an NSAID is often the best approach to reduce inflammation of the injured muscle and relieve pain. Icing the muscle shortly after injury helps reduce the amount of inflammation. These injuries often heal on their own within about two weeks.
Migraines. Each year, 28 million people suffer from migraines, which are characterized as severe headaches often associated with vision changes and/or nausea and vomiting. Triptans, a class of medications specifically for migraines, often relieve the pain and other symptoms. But these drugs shouldn’t be taken if you have uncontrolled hypertension or coronary artery disease.
NSAIDs can help some people, while others respond better to combination pills that include aspirin, acetaminophen and caffeine. Whichever pain reliever you choose, be sure to take it at the first sign of pain in hopes of alleviating the headache.
Sciatica. This condition is caused by either direct nerve injury or compression of the nerve by a herniated disk. Sciatica causes pain, burning, tingling or numbness along the sciatic nerve, which runs from the lower back through the buttocks and into the lower leg. The majority of cases heal on their own within three months. NSAIDs can relieve the pain and inflammation. If the pain is persistent, oral corticosteroids or a localized injection may be necessary
Flu. Fever, chills and body aches are the classic symptoms of a viral illness such as the flu. (Flu season is approaching - remember to get your flu shot.) Viral illnesses need to run their course - usually about seven days - but we can treat the symptoms.
Analgesics, such as aspirin or acetaminophen, can help reduce fever and body aches in adults. (Children should never be given aspirin.) Most important, you need to rest and drink plenty of fluids to help speed recovery. Antiviral drugs such as Tamiflu can relieve symptoms and shorten the duration of the illness but must be taken within 48 hours of the onset of symptoms.
Lower-back injury. Most adults will experience back pain during their lifetimes. The good news is that lower-back pain usually goes away on its own within six weeks. NSAIDs and rest are first-line treatments. More severe attacks may require a muscle relaxant to help relieve spasms.
Applying ice to the area for the first 48 hours can reduce the inflammation and pain. Thereafter, switching to heat can promote blood flow and recovery. Physical therapy can also be beneficial if the pain persists.
Caroline K. Stratz, M.D., is an internist in private practice near El Camino Hospital. Her practice focuses on personalized health care that emphasizes comprehensive medical histories and examinations, health risk and lifestyle appraisals, and making herself accessible to her patients. For more information, call 988-9975.
