Pain Management

Catastrophizing and Pain Expectations Related to Time with Nonspecific Back Pain

Spinal pain, or back pain, is very common in the Western world. In fact, it affects up to 80 percent of people at least one time in their life. Usually, the pain is nonspecific, not caused by any particular trauma or injury, or there isn't any body part or tissue that has been noticeably injured.




Improving the Safety of Pain Pumps After Knee Surgery

Pain pumps are often used after joint surgery to deliver a controlled amount of anesthetic and narcotic. This device provides good pain relief. Patients use less narcotic medication. But previous animal studies have shown that some drugs (lidocaine, bupivacaine) actually cause chondrocytes (cartilage cells) to die.




I went to see the nurse practitioner at our local clinic about my neck pain. She didn't really ask me about anything else. Should I have mentioned my shoulder, back, and elbow pain, too? I thought about it afterwards and wondered.

It's easy for both the patient and the practitioner to get focused on one site of pain. But, in fact, studies show that most patients have multiple sites of pain and symptoms. This information can be very important when evaluating a patient's condition.

A single site of localized pain can be a very different medical problem than one of widespread involvement. Joint pain or musculoskeletal pain and symptoms from more than one area suggests a systemic problem.




Whenever I go see the osteopath, she always asks me to color in on a diagram where my pain is located. I have trouble with this because it feels like it's in more than one place. I can't really put my finger on an exact spot. Am I so unusual from the average patient? Can everyone else color in these charts?

You are actually much more of a typical case than not. Very few people with musculoskeletal pain really have just one pinpoint area of pain. When asked, most have widespread pain and symptoms. That's why a drawing of this type is helpful.

Instead of focusing on one problem area, you can let your physician know the whole picture. This can be helpful when evaluating a problem or prescribing treatment. Diagnosing and treating local pain only addresses a small part of the problem.




Local Pain Is Really Rather Rare

When patients report back pain, neck pain, shoulder pain, or other local sites of body pain, it's rare that they don't have pain in other parts of the body as well. But most studies focus on an individual (local) area of pain. So the idea that low back pain is really present as part of a widespread pain pattern gets lost.




Cochrane Review Updates Information on NSAIDs

Health care professionals depend on good sources of information to keep up-to-date on evidence-based medicine. One of the most reliable publications comes from the Cochrane Collaboration. Everyone pays attention when they publish a study.




I am a nurse in an outpatient clinic. I notice that more and more patients are being given narcotics for pain control. I thought this was a big no-no because of the potential for abuse and addiction. What's the current thinking on this?

There is still much argument and debate among health care professionals about the use of potentially addictive medications such as opioids. When these drugs are prescribed for chronic pain problems, there is concern that more and more drug will be needed to maintain the same level of pain control.

Becoming dependent on a narcotic makes it more difficult to withdraw from opioid therapy. This is true even when pain control is so poor there seems no point in taking the drug.




I'm surprised at how quickly and easily it was to get strong narcotic drugs for my mother when she was diagnosed with terminal cancer. I thought these were strongly regulated.

The regulation of narcotics such as opioid therapy for cancer pain has been softened since the late 1990s. There just wasn't enough evidence to support the idea that opioid treatment always led to severe addictions. And there were many chronic pain patients (including cancer patients) who really needed to benefit of these medications.




Is there any way to tell if someone is misusing their prescription pain meds? I'm concerned that my mother might be addicted to her prescription (narcotic) pain reliever.

When used as prescribed, narcotic medications can be very effective without creating dependence and/or addiction. Signs that there may be a problem with misuse and/or abuse include:

  • Seeking drugs from multiple doctors
  • Losing the prescription (more than once)
  • Stealing or borrowing similar drugs
  • Forging prescriptions



  • My brother has had a significant drinking problem. Now he's on prescription narcotics for back pain. Isn't this a no-no?

    Managing disabling back pain is a major challenge for health care specialists. The use of opioids for pain control is very controversial. There's no doubt these drugs are effective. But they do come with their own set of problems. Drug dependence and addiction are the biggest concerns.




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