NON-DRUG TREATMENTS

Why bother with "non-drug treatment," such as exercise and relaxation training, if you're already taking painkillers? The simple answer is to limit any side effects and reduce the chance of becoming dependent on them. And there's more.

Think of pain as a pathway--like train tracks leading to the brain. If you wham your thumb with a hammer, the pain train takes off, racing along nerve ways to the spinal cord, then up to the brain where it delivers its message and you say "ouch."

But how much it hurts--your pain threshold--seems to be controlled from the brain. Thoughts, emotions and even distractions can close or open a gate to let all, some or none of the train's "cars" into the spinal cord. No entry, no pain.

That's why your emotional state often affects how much you hurt. For example, if you feel abandoned by friends or frantic about finances, bad pain can seem worse. On the other hand, being surrounded by a close, supportive family and doing things you enjoy can make pain go away. So successfully managing chronic pain often means helping not just the pain but the person.

"Besides, if you rely solely on medications, your life can start to revolve around taking the next pill warns Jaimala Thanik, MD, medical director of the pain management center at Highland Hospital in Rochester, NY. But if you also address outside factors that affect pain, you shift from being a passive pill taker to all active pain manager.

NEW ARTHRITIS ANSWERS

Aspirin and other NSAIDs have long been the workhorses of arthritis relief, but these drugs have a dark side. About 20 percent of people develop gastrointestinal problems, from mild heartburn and ulcers to (rarely) life threatening intestinal bleeding. And the older you are, the greater the risk. It's no surprise that the American (Geriatrics Society urges extreme caution in using NSAIDs steadily to relieve chronic pain.

The problem is that NSAIDs block an enzyme nicknamed COX (for cyclooxygenase). It affects hormone like substances that can be helpful (protecting the stomach lining) or harmful (inflaming joints). But researchers have found that there are two types of COX enzymes: Number 1 is the good guy and number 2 is the bad guy.

`This knowledge has produced a big leap forward: new formulations called COX-2 inhibitors or "super aspirin" They block the bad guys but pretty much leave the good ones alone—and your stomach in peace. Celebrex, the first of these long-awaited drugs, is already on the market, and another brand, Vioxx, should arrive in a few months.

In studies, both relieved arthritis with relatively few gastrointestinal side effects. "COX-2s will have a major impact on arthritis care, offering the pain relief of NSAIDs to people whose stomachs couldn't tolerate them says rheumatologist, Gurkirpal Singh, MD, clinical assistant professor of medicine at Stanford University Medical Center.

However, while COX-2 inhibitors markedly reduce stomach troubles, they don't totally eliminate them and they don't solve less common NSAID side effects (such as possible kidney or liver damage). Also, some very early research at the University of Pennsylvania Medical Center.