

Diagnose source of chronic pain before treatment

5:57 PM, Sep. 20, 2013  |  Comments

Q: I've had shoulder pain for a couple of years, and the constant low-level agony is making me nuts. What should I do?

- Johnny M., Akron, Ohio

A: More than 100 million North Americans live with chronic pain, and, as you indicated, it does a lot more than just make you feel achy. Chronic pain is associated with a three- to fourfold increase in the rate of depression and anxiety, and most folks also have problems with sleep, memory, attention, high blood pressure and resulting cardio problems, not to mention sexual dysfunction. Chronic pain actually can damage your most valued relationships.

The most common sources (not related to cancer) are degenerative spine disease, lower-back pain, rheumatoid arthritis, osteoarthritis (perhaps in your shoulder), fibromyalgia, HIV, migraine, nerve pain and complications of shingles.

The first step is to get the right diagnosis from a specialist (maybe a second opinion, too). If pain medications are suggested, ask about a pain-management specialist who knows how to do nerve-dampening blocks and how to safely put you on (and take you off of) potentially addictive drugs.

Try mind-body therapies: guided imagery, cognitive-behavioral therapy, meditation, breath work, massage and acupuncture.

Get daily physical activity. You'll dispel stress and build strength. Work with a physical therapist to determine the safest, most effective exercise and to learn how to use the two best short-term pain relievers, heat and ice.

Adopt an anti-inflammatory diet to help put out the pain fire: Eliminate added sugars and syrups, any grain that isn't 100 percent whole, and trans and saturated fats, and go for lots of omega-3 DHA from salmon and ocean trout two to three days a week, and consider a daily 900-mg supplement.

Q: I just turned 50. I'm getting hot flashes, and I'm grumpy all the time. There's no second honeymoon in our house!

- Nancy J., Washington D.C.

A: Many women in their 50s feel ambushed by conditions related to menopause.

Fortunately, menopause symptoms don't have to put you on the sidelines of your life.

Don't rule out hormone therapy. If you're not at increased risk for heart disease or breast cancer, before age 60, up to five years of taking micronized progesterone and bioequivalent estrogen can banish symptoms. (Ask your doc about taking two baby aspirins a day while on hormones to protect you from potential heart problems.) And older women can safely use topical estrogen to restore vaginal health.

Lifestyle changes also help: Get sweaty - on purpose. Exercise can improve your quality of life and sometimes reduces hot flashes. Dropping just 10 percent of your weight can cut hot flashes and improve sleep.

And use focus and memory techniques: Keep distractions to a minimum; write down what you want to remember; repeat specifics out loud to yourself; and optimize your sleeping environment (keep it cool and quiet), because nothing improves brain power like a good night's rest.

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