Getting Your Doctor To Understand

"DOES IT FEEL LIKE?"

From a doctor, that's not an idle question.

What pain feels like not only provides clues to its cause but also helps physicians know what drugs are likely to help. A deep, aching, throbbing, gnawing or dragging pain is probably what doctors call nociceptive-- the nerve endings may have been injured by some disorder, such as degenerative arthritis. This kind of pain tends to respond well to standard analgesics, ranging from aspirin to morphine. Burning, shooting or tingling pain is probably neuropathic-caused by abnormal processes that may persist after an injury or disease. Diabetic neuropathy or past-stroke pain are examples. Standard analgesics often don't work, but "adjuvant analgesics"-drugs that aren't thought of as painkillers (like some antidepressants) but that often help in unexplained ways-may be a solution.

Pain Scale:
 
0 = No Pain  
2 = Mild Pain  
4 = Moderate Pain  
6 = Severe Pain
  8 = Very Severe Pain
10 = Worst Possible Pain  

"HOW BAD IS IT?"

Pain can't be objectively measured. So doctors provide pain-intensity scales, above, using faces, words and/or numbers-from, say, 0 (no pain) to 10 (the worst)-to help you indicate how badly you hurt. Another way to help a doctor understand how you feel is to keep a pain diary for a week. On a sheet of lined paper, make five columns: date and time (make entries every few hours); activity (what you were doing then); pain intensity (try the 0 to I0 scale); act/on (what, if anything, you did to fight the pain); and results (what, if any, improvement occurred).

Take this to your doctor. It will show how common and intense the problem is and may help you both spot useful patterns. Center suggests COX-2s might affect clotting in ways that raise possible heart attack/stroke concerns. But Dr. Singh points out that clinical trials involving more than 20,000 people did not show any increase in cardiovascular risk.

However, both NSAIDs and COX-2s may interact with many blood-pressure drugs (diuretics, ACE inhibitors, beta blockers, calcium channel blockers). But a next step on the arthritis pain treatment ladder does not. Called tramadol (brand name, Ultram), it can help age-related osteoarthritis--by far the most common kind of arthritis--at least as effectively as acetaminophen and NSAIDs. (Because it doesn't affect inflammation, Ultram doesn't always help inflammatory types of arthritis, such as lupus and rheumatoid arthritis.) It can also be used to relieve other types of non-inflammatory chronic pain, such as degenerative disk disease.

Ultram reduces the number of pain signals that get through to the brain, and it makes those that do less "noisy." Also, it can be used daily for years by many people without fogging the brain, the way narcotics can. As for side effects, the most common are constipation, dizziness, headache, nausea and sleepiness, which affect about one third of users.

If all these fail, some rheumatologists and many pain specialists no longer fear stepping up the ladder to strong opioids, like morphine (see the article entitled:  Don't Be Afraid of Narcotics).