CR.ORG GUIDE TO WELLNESS 21is quite similar to most drug
therapies,” says Roger Chou,
M.D., professor of medicine
at Oregon Health & Science
University in Portland.
If you’ve thrown outyour back and are in agony,
try over-the-counter ibu-
profen (Advil and generic)
or naproxen (Aleve and
generic) for a week or two,
Chou says. These may be a
better choice than acetamin-
ophen, which the ACP didn’t
find to be effec tive. Recent
research has also found that
people who stay gently ac-
tive—walking and stretching—
have a faster recovery and
less discomfort than people
who stay in bed.
If pain lasts longer thana week or two, see your
doctor, who can prescribe
physical therapy or, in
some cases, a limited course
of spinal manipulation
(three to four weeks) with a
licensed chiropractor.
For chronic back painthat’s not responding to these
measures or to prescription-
strength nonsteroidal
anti- inflammatory drugs
(NSAIDs), the ACP recom-
mends the prescription pain
pill tramadol (Ultram and
generic) or the anti-depres-
sant duloxetine (Cymbalta
and generic). But both have
a small effect; you’ll still need
to use nondrug methods.
Postsurgical Pain
If you’re having surgery,
your plan for managing pain
afterward should begin
before the operation: Ask
your surgical team whether
it’s possible to get regional
anesthesia (instead of gen-
eral), including a peripheral
nerve block. Both can help
reduce the need for opioids
post surgery, says Stavros G.
Memtsoudis, M.D., Ph.D.,
direc tor of critical care
services in the anesthesiol-
ogy department at the Hos-
pital for Special Surgery in
New York City.
While opioids may be a
useful part of a post surgical
pain plan in the short term,
they are not a cure-all. New
research on more than
1.5 million surgical patients
found that those who got at
least two other forms of pain
medication, such as acet-
aminophen and an NSAID,
along with an opioid did bet-
ter overall. In general, you
should take opioids only as
necessary to relieve break-
through pain and for no lon-
ger than three weeks after
a procedure.
People coming out of sur-
gery should also “have real-
istic expectations—they can’t
expect to go home from the
hospital feeling absolutely
pain-free,” Memtsoudis says.
“But they should be able
to read without being dis-
tracted by pain.”Headache
For people prone to mi-
graines, first-line treatment
is usually a class of drugs
called triptans, which reduce
inflammation and constrictblood vessels. But these
need to be prescribed with
caution for anyone who al-
ready has heart disease, high
blood pressure, or other
risk factors. Opioids have
not been shown to improve
migraine symptoms and may
make triptans less effec-
tive, says Alan M. Rapoport,
M.D., clinical professor of
neurology at the David Gef-
fen School of Medicine at
UCLA in Los Angeles.
If you have the dull ache
of a tension headache—the
most common type—once
or twice a month, treat
it with an OTC pain reliever,
such as ibuprofen or acet-
aminophen. Exercise or re-
laxation can help, too. But
if you’re getting headaches
more frequently—say,
every week—see your doctor.
People who self-treat more
than twice a week can de-
velop a medication-overuse
headache, Rapoport says.
For frequent headaches
of any kind, research has
found that complementary
therapies, such as acu-
puncture, massage, and
biofeedback, may be effec-
tive in some cases. Others
benefit from a daily pre-
ventive, such as a tricyclic
antidepressant or the blood
pressure drug propranolol
(Inderal and generic).Joint Pain
Arthritis is common, and the
most common form is osteo-
arthritis, where cartilage
in joints breaks down, caus-
ing pain, swelling, and stiff-
ness. But research has shown
that opioids should generally
not be used to treat OA;
the poten tial harms outweigh
the benefits.
Instead, try wrapping a bag
of ice in a towel and applying
it to the affected area for up
to 20 minutes at a time—cold
can help ease acute joint
pain. If a joint feels stiff but
not painful, apply a heat-
ing pad to the area for 15 to
20 minutes. Then try some
low-impact activ ity, such as
walking, which can relieve
pain as effec tively as an over-
the-counter NSAID, such
as ibuprofen or naproxen.
Naproxen appears to be
the most effective oral pain
reliever for joint pain, but
don’t use it for more than a
week without consulting your
doctor. Yoga, tai chi, and
swimming can also help.
If these steps don’t help,
consider trying a topical pre-
scription NSAID. But think
twice about using diclofenac
(Voltaren and generic),
which has been linked to
an increased risk of heart
attack and stroke.
You can also help deter
OA by trying to stay at a
healthy weight. Research has
shown that for those who are
overweight or obese, losing
weight can help reduce pain
and inflammation.For many
types of pain,
opioids are
not more
effective than
non-opioid
medications.