Mint

Infuse mint into your tea or ice water to refresh and rejuvenate. It also helps relieve headaches and general aches and pain. Grow this vigorous perennial herb in a container so it won’t overtake your other plants.  And at the end of the season, root a few cuttings to start new plants to grow indoors. All you need are a sunny window, quality potting mix, and regular watering.

Hot Peppers

Capsaicin, the spicy element in chili, jalapeno, habanero, and cayenne peppers, is a great pain-fighting tool and is often used in topical creams to help treat backaches, arthritis, and muscle pain.  Plant hot peppers after the soil and air warm, at the same time you are planting sweet peppers and tomatoes. They are ready to harvest when they are fully colored. Purchase extra hot peppers to dry and enjoy year-round.

Cherries

Manage muscle pain and inflammation with sour cherries. They are loaded with disease-fighting chemicals and antioxidants and help fight inflammation and relieve pain. Purchase plenty of cherries to juice, dry, and preserve so you can enjoy their health benefits all year long. And consider planting a sour cherry tree in your backyard. Montmorency is the most popular sour cherry needing only 700 hours of air temperatures between 34 and 45 degrees to initiate flowering for fruit development.  New hardier dwarf introductions from the University of Saskatchewan can be grown in colder regions including zone 2. Although it takes several years for cherry plants to start producing fruit, you’ll enjoy watching your tree grow into maturity and bear its first crop. Just make sure to cover the plants with netting so the birds don’t eat your harvest.

Ginger

Ginger helps reduce inflammation and combat migraines, muscle pain, arthritis, and post-workout or post-gardening soreness. All this plus it helps fight nausea. Although it’s a tropical plant you can find plants or rhizomes (the part you eat) online. Or join other enthusiastic gardeners who have had success rooting the rhizomes they purchased at the grocery store to start new plants. Grow your ginger in a pot outdoors or sunny window alongside your other indoor plants.

Sage

Sage tea has long been used to soothe scratchy and irritated throats and showed positive results in a 2006 clinical trial. Harvest a few sage leaves, add hot water, and brew a bit of sore throat relief.   Grow this herb in the garden or a container. It thrives in a sunny spot with well-drained soil. Harvest leaves as needed throughout the season. Regular harvesting encourages more growth for future harvests. You can remove as much as one-third of the plant at one time for preservation.

So next time you’re feeling a bit of pain, pass by the medicine cabinet and look to the garden for a bit of relief. Even the simple act of tending your garden and harvesting produce can elevate your mood, lower your blood pressure, and start you on the road to feeling better.

Photo credit:  photo courtesy of MelindaMyers.com

Melinda Myers has written more than 20 gardening books, including the recently released Midwest Gardener’s Handbook, 2^nd Edition and Small Space Gardening. She hosts The Great Courses “How to Grow Anything” instant video and DVD series and the nationally syndicated Melinda’s Garden Moment TV & radio program

If you’re aware you spend many of your waking hours in a chair, you’re certainly not alone. According to the U.S. Centers for Disease Control and Prevention, about 25% of adults sit for more than eight hours a day. The problem is, our bodies were made to move—not sit all day, Chang explains. When we do, it often leads to pain in various areas of our spine, including the neck, upper back or lower back

“There’s no escaping that modern life requires us to sit a lot, whether in a car, at the office, or even at home,” says Kaliq Chang, MD, is an interventional pain management specialist at Atlantic Spine Center in West Orange, NJ. (For more information, click here.)

“But standing upright is the body’s natural position, helping bones stay stronger, exercising the muscles, and boosting circulation. On the other hand, sitting forces our spine into unnatural positions. It’s no wonder we end up with back pain from sitting too much—but there are ways we can fight back.”

How sitting hurts our back

According to Chang, several things happen to our spine, surrounding muscles and nerves, and our bodies overall when we sit for hours that can result in—or worsen—back pain. These include:

• Poor posture: Hunched in a chair, we often form a slouch or C-curve in our spine. This can lead to a tense and tight neck and a strained trapezius muscle in the upper back and shoulder area. “The longer you’re seated, the more you tend to slouch, which can increase muscle stiffness and pressure on spinal discs,” Chang says. “It also overstretches ligaments, tiring them out.”

• Muscle weakness: Staying seated for prolonged periods sets off a chain reaction in muscles surrounding the spine that can prove very damaging, Chang says. By sitting, we stop using muscles that normally support our body when we’re standing upright. In turn, these muscles aren’t working to support the lower back, which causes an imbalance in the weight that’s pressing on spinal discs. This imbalance can lead to bulging discs, which can press on nerves in the back and neck and cause pain.

• Pinched nerves: Sitting for hours on end can cause spinal discs to compress, pinching nerves and triggering symptoms that include neck and back pain along with sciatica, which leads to radiating pain down the legs. “Spinal discs can only absorb nutrients from blood when we’re moving,” Chang explains. “Sitting actually deprives them of this nourishment, so they’re more easily damaged.”

• Weight gain: A downstream but very real effect of too much sitting is gaining extra pounds. Since many people tend to gain weight around the belly and lower back, it makes sense that the spine would suffer from the extra pressure. “There are lots of great health reasons we should try to control our weight, but we shouldn’t forget that maintaining spine health is among them,” Chang says.

Try these tactics

How can we avoid back pain from sitting so much? With habits that better support the spine while in a chair, as well as by moving more. There are several ways to make this goal easier to achieve and to maximize the benefits to spine health. According to Chang, these include:

• Practicing better posture: Sitting is inevitable, so make sure your posture is impeccable while doing so. This means keeping your back straight, shoulders back, and having your buttocks positioned to meet the back of the chair. Ideally, this sitting position will replicate the spine’s natural curvature while also keeping your neck straight.

• Taking more breaks: Get up from your desk or chair at least every 20 to 30 minutes and walk around (say, to get a cup of coffee, fetch the mail or talk to a colleague). Bonus points if you stretch your back out during these breaks, bending backward slightly to ease the pressure on spinal discs from extended sitting sessions.

• Exercising: Any form of movement is good for the spine, but exercises that strengthen the muscles, ligaments and tendons surrounding it can help forestall further back problems. “Aim for exercise that strengthens your core, which includes not only the back, but abdominal, hip and buttock muscles,”  Chang advises. “Strong core muscles do the best job of supporting the spine and keeping it in proper alignment.”

• Trying a standing desk or a treadmill desk: Either gets you on your feet, and one gets you moving at the same time. “The less time you spend sitting, the better,” Chang says. “Your spine can only benefit.” 

Monkeypox, however, is an entirely different virus. It is not a respiratory illness like COVID-19, notes Omai Garner, PhD, director of clinical microbiology for UCLA Health.

“It’s a different disease and it’s not the kind of thing that transmits like COVID does,” Dr. Garner says. “Still, it’s a new outbreak and we need to take the lessons we learned from COVID and use them now.”

Access to vaccines to protect against monkeypox is expanding across the country, including in Los Angeles County, where some 24,000 doses are now available.

Given the limited supply, vaccines are being offered by the county department of public health to select individuals: People who’ve had high-risk contact with infected individuals; those who’ve attended an event where there was high risk of exposure to someone with a confirmed case of monkeypox; and gay or bisexual men and transgender adults who have been diagnosed with gonorrhea or early syphilis, take HIV pre-exposure prophylaxis medication or attended or worked in a venue where they had anonymous sex or sex with multiple partners.

People who meet these criteria should contact their primary care physician to learn more about getting vaccinated.

Here’s what you need to know about monkeypox:

What is monkeypox?

Monkeypox is a zoonotic disease originally transmitted from animals to humans. The virus is endemic in West and Central African countries and cases are often found near tropical rainforests where animals may carry the virus. These animals include squirrels, rodents such as dormice and the Gambian pouched rat and different species of monkeys, according to the World Health Organization.

Monkeypox is rare in humans and causes symptoms similar to but milder than those of smallpox, which was declared eradicated in 1980.

Is monkeypox a new virus?

Monkeypox is not a new disease, but it is rare and cases don’t typically occur in the U.S. Typically, infections in the U.S. are associated with travel to West or Central Africa or contact with imported animals that are infected.

The recent outbreak of monkeypox in nations where the virus isn’t ordinarily found appear to have spread through human-to-human contact.

Monkeypox is far less transmissible than COVID-19 or other respiratory illnesses, says Dan Uslan, MD, co-chief infection prevention officer for UCLA Health.

Human-to-human transmission generally occurs through direct contact with skin lesions, bodily fluids or contaminated items, such as sheets or clothing, that have been in contact with fluids or sores.

The virus can also be transmitted through respiratory droplets, but these droplets typically don’t travel more than a few feet and prolonged face-to-face contact is required. Transmission through brief contact, such as walking past an infected person, has not been reported.

Many of the monkeypox cases reported in Europe, Australia and North America have occurred in people who self-identify as men who have sex with men. These individuals have presented with lesions in the genital area.

As of July 25, there have been 162 confirmed cases of monkeypox in Los Angeles County and at least 3,400 cases in the United States, prompting fears of another coronavirus-style outbreak.

Monkeypox, however, is an entirely different virus. It is not a respiratory illness like COVID-19, notes Omai Garner, PhD, director of clinical microbiology for UCLA Health.

“It’s a different disease and it’s not the kind of thing that transmits like COVID does,” Dr. Garner says. “Still, it’s a new outbreak and we need to take the lessons we learned from COVID and use them now.”

Access to vaccines to protect against monkeypox is expanding across the country, including in Los Angeles County, where some 24,000 doses are now available.

Given the limited supply, vaccines are being offered by the county department of public health to select individuals: People who’ve had high-risk contact with infected individuals; those who’ve attended an event where there was high risk of exposure to someone with a confirmed case of monkeypox; and gay or bisexual men and transgender adults who have been diagnosed with gonorrhea or early syphilis, take HIV pre-exposure prophylaxis medication or attended or worked in a venue where they had anonymous sex or sex with multiple partners.

People who meet these criteria should contact their primary care physician to l

learn more about getting vaccinated.

Here’s what you need to know about monkeypox:

What is monkeypox?

Monkeypox is a zoonotic disease originally transmitted from animals to humans. The virus is endemic in West and Central African countries and cases are often found near tropical rainforests where animals may carry the virus. These animals include squirrels, rodents such as dormice and the Gambian pouched rat and different species of monkeys, according to the World Health Organization

Monkeypox is rare in humans and causes symptoms similar to but milder than those of smallpox, which was declared eradicated in 1980.

Is monkeypox a new virus?

Monkeypox is not a new disease, but it is rare and cases don’t typically occur in the U.S. Typically, infections in the U.S. are associated with travel to West or Central Africa or contact with imported animals that are infected.

The recent outbreak of monkeypox in nations where the virus isn’t ordinarily found appear to have spread through human-to-human contact.

Monikeypox istransmissible than COVID-19 or other respiratory illnesses, says Dan Uslan, MD, co-chief infection prevention officer for UCLA Health.

Human-to-human transmission generally occurs through direct contact with skin lesions, bodily fluids or contaminated items, such as sheets or clothing, that have been in contact with fluids or sores.

The virus can also be transmitted through respiratory droplets, but these droplets typically don’t travel more than a few feet and prolonged face-to-face contact is required. Transmission through brief contact, such as walking past an infected person, has not been reported.

Many of the monkeypox cases reported in Europe, Australia and North America have occurred in people who self-identify as men who have sex with men. These individuals have presented with lesions in the genital area.

What are the symptoms of monkeypox?

The onset of monkeypox symptoms is typically five to 21 days after exposure. Symptoms often begin with fever, swelling of the lymph nodes, body aches and fatigue. Ultimately, symptoms include a rash of bumps and blisters, which may begin on the face or hands and spread to other parts of the body. With this outbreak many of the lesions have been confined to the genital area.

Monkeypox lesions may go from being flat to bumps to fluid-filled blisters that can be painful. The lesions eventually scab over and fall off. The illness typically lasts two to four weeks.

Monkeypox blisters are generally larger than those associated with chickenpox.

Testing requires clinical evaluation, Garner says. Testing is readily available at UCLA.

Individuals who think they might have monkeypox should contact their primary care doctor, who can assess symptoms and possible exposure and refer them for testing..

What happens if someone tests positive for monkeypox?

Most cases of monkeypox do not require hospital admission and individuals recover at home.

Ideally, sleep is an escape from the hard stuff happening every day, not another reason we face more difficulties. But sometimes the way we sleep – the positions we start the night in and those we twist ourselves into during the wee hours – end up triggering disturbing neck and/or back pain.

If you already deal with lingering back or neck pain – whether from age, injury or another reason – it’s important to understand that your sleep position can make this situation better or worse.

There’s no question that back or neck pain can make falling or staying asleep harder, but changing your sleep position can also take some stress off your spine and make it more likely you’ll get restorative shuteye.

How sleep position affects the spine

Why does your sleep position matter to your spine? For the simple reason that sleeping in certain positions places additional pressure on parts of your neck, shoulders, hips and lower back. All of these areas, of course, can end up suffering from the “wrong” position, leading to an aching neck or back.

The top offender? Sleeping on your stomach. The belly-down pose flattens the natural curve of the spine and necessitates rotating your neck, which can trigger pain at the base of the neck between the shoulders.  

On the other hand, there’s one action you can take that almost always benefits the spine: frequently changing your sleep position throughout the night.

Sometimes we’re aware we’re moving about, rolling over or adjusting our pillow during those hazy moments of sleep. Shifting position definitely helps take pressure off the spine. If you’re able, try to move your body as one unit when rolling over – not twisting or bending at the waist while your face is aimed in another direction. This too will cut down on spine strain.

Tips to tackle position-related pain

Beyond those basics for modifying sleep position to avoid aggravating your back or neck, I offer these tips for less pain:

• Back sleeper? You can place a pillow under your knees to help maintain your spine’s natural curve.
• Side sleeper? Pull your legs up slightly toward your chest and sleep with a pillow between your knees.
• Stomach sleeper? Place a pillow under your lower belly to ease back strain.

If you’re noticing that a well-placed pillow can help optimize spine position regardless of sleep style, then it’s also wise to understand how much your pillow choice matters when in its normal place, under your head. Along those lines, I recommend choosing a pillow that’s not too high or too low, but feels as if it’s simply supporting the natural curve of your neck. Some people achieve more comfort by using two pillows or taking one away.

It’s a red flag when you wake up with neck or back pain. If you do, pay close attention to your sleep position and pillow use, as those are huge elements leading to aches and pains. Since we spend about a third of our lives asleep – or hope to! – tweaking these factors is time well spent.

Atlantic Spine Center is a nationally recognized leader for endoscopic spine surgery with several locations in NJ and NYC. http://www.atlanticspinecenter.com, www.atlanticspinecenter.nyc

Kaliq Chang, MD, is an interventional pain management specialist board-certified in anesthesiology at Atlantic Spine Center. 

Continued increases in pain as generations age may challenge a healthcare system already struggling to treat chronic pain.

The study examined trends in pain, both nationwide and internationally, across adults of different ages.

Pain serves as an important warning that something is not right in the body. It can help keep people safe by causing them to take certain actions and avoid others. But long-lasting pain can damage both physical and emotional health and lower quality of life.

More than 50 million adults in the U.S. live with chronic pain, which is pain that lasts for more than three months. Current treatments are largely ineffective for many people. And opioids, when overprescribed for pain, can actually make chronic pain worse.

Recent surveys taken across age groups in the U.S. have shown an unusual pattern of pain nationwide, in which older adults report less pain than the middle aged. In other countries, reports of pain tend to rise steadily with increasing age.

To better understand patterns of pain, Drs. Anne Case and Angus Deaton from Princeton University and Dr. Arthur Stone from the University of Southern California examined data from six large surveys that covered the U.S. and 20 other wealthy countries. Two American and two international surveys took repeated “snapshots” of pain, asking people in different age groups about their current pain levels. In these studies, it was possible to track birth cohorts (groups) in successive snapshots. The two other studies were longitudinal, following specific participants over a period time.

To model trends in pain over time, the researchers examined data from adults aged 25 to 79 years. The study was funded by NIH’s National Institute on Aging (NIA). Results were published in the Proceedings of the National Academy of Sciences.

The research found that the prevalence of pain in the U.S. increased with age until people were in their late 50s. It then decreased, leveling off around age 70. In contrast, data from other rich countries did not show a midlife peak in pain. Instead, pain rose slowly but steadily with the age of the survey participants.

Results from tracking birth cohorts over time showed that, within a birth cohort, pain rose with age into old age. However, since the group born in 1940, each successive group born over 5-year periods in the U.S. reported more pain at any given age than previous groups. This difference between birth groups was largely confined to those without a four-year college degree.

For example, among those without a bachelor’s degree in the U.S., 32% of people born from 1955-1959 reported pain at age 52, compared with 40% of people born from 1965-1969. A similar trend wasn’t seen in other rich countries.

Across age groups in the U.S., people with less education were more likely to report pain than those with more education. On closer examination, the researchers found that the peak in pain during midlife found in the U.S. snapshot data was largely confined to people with less than a bachelor’s degree.

Rising obesity can explain some, but not most, of the rise in pain in U.S. adults. Younger Americans today may be more comfortable reporting minor pain than previous generations. However, this doesn’t explain the differences in pain seen by education level.

“Pain undermines quality of life, and pain is getting worse for less-educated Americans,” Deaton says.

“The connection between less-educated Americans and pain is shaped by a number of factors, and matches patterns we observe in rising deaths of despair,” Case adds. “It’s of great concern to us, as researchers, that it seems to be worsening.”

Most breast pain is cyclical – linked to hormonal fluctuation associated with the reproductive cycle. Women describe cyclical breast pain as the breasts feeling heavy, tender, swollen, and achy. It is caused by increases in estrogen and progesterone that occur before the menstrual period and cause the breasts to swell. Cyclical breast pain generally affects both breasts, intensifies in the week or two leading up to the menstrual period, then recedes. It most often affects women during their childbearing years and as they are approaching menopause. Breast tenderness can be eased with over-the-counter pain relievers and by reducing salt, fats, and caffeine in the diet. Birth control pills – or switching to a different formulation – can also help.

The breasts may remain tender during the first trimester of pregnancy in response to increased hormone levels and that continuing breast soreness often accompanies a missed menstrual period as an early sign of pregnancy.

Fibrocystic breast disease, also triggered by hormones, is characterized by dense, lumpy breast tissue that may become painful in response to the monthly cycle. The lumps are fluid-filled cysts and can be clearly differentiated from more dangerous lumps composed of a solid mass of cells that may signify a benign or malignant tumor. Cysts may resolve on their own but any lump in the breast must be evaluated by a doctor via mammogram, ultrasound, or aspiration – drawing fluid from the cyst.

Non-cyclical breast pain — unrelated to reproductive hormones – most often occurs in one breast and in a localized area though the pain may spread throughout the breast. There are several causes:

Mastitis is most common in breast-feeding women (lactation mastitis) but can occur at any time. It is characterized by inflammation of the breast tissue that causes swelling, redness, pain, and warmth and sometimes fever and chills. During lactation, mastitis is usually caused by a blocked milk duct or by bacteria entering the breast through an opening in the skin or a cracked nipple. It is generally treated with antibiotics.

Injury to the breast can be from a previous surgery, from an accident, or from sports. There may be a sharp pain at the time of the trauma followed by tenderness for days or weeks. A doctor should be seen if pain doesn’t subside or if there is redness and warmth, which could indicate the presence of infection, if there is severe swelling, or if there is a bruise that doesn’t go away.

Support issues are most often experienced by women with large, heavy breasts but poor support can cause the ligaments to stretch and cause pain in breasts of any size, particularly after exercise. Pain may also affect the neck, back, and shoulders. A properly fitted, supportive bra should be worn at all times and a sports bra when exercising.

Medications can cause breast pain as a side effect. Hormonal therapies used in infertility treatment, birth control pills, and hormonal replacement after menopause can cause breast tenderness. Some psychiatric medications and those used for coronary disease can also have this effect.

Many women worry that breast pain might be a sign of breast cancer. While this is unusual, it’s not impossible. Inflammatory breast cancer, which accounts for 1%-5% of breast cancers does cause pain as well as redness, swelling, and thickened or dimpled skin. The important thing for women to know is that while most breast pain isn’t dangerous, any condition that doesn’t resolve over the course of the menstrual cycle or a week or two should be evaluated by a doctor. In the vast majority of cases, treatment will be rapid and effective.”

Constance M. Chen, MD, is a board-certified plastic surgeon with special expertise in the use of innovative natural techniques to optimize medical and cosmetic outcomes for women undergoing breast reconstruction. She is Clinical Assistant Professor of Surgery (Plastic Surgery) at Weill Cornell Medical College and Clinical Assistant Professor of Surgery (Plastic Surgery) at Tulane University School of Medicine. www.constancechenmd.com  

These include:

Where does it hurt?

When did the pain start? Does it come and go?

What does it feel like? Is the pain sharp, dull, or burning? Would you use some other word to describe it?

Did it begin suddenly, or have you been experiencing it for some time?

Do you have other symptoms?

When do you feel the pain? In the morning? In the evening? After eating?

Is there anything you do that makes the pain feel better or worse? For example, does using a heating pad or ice pack help? Does changing your position from lying down to sitting up make it better?

What medicines, including over-the-counter medications and non-medicine therapies, have you tried, and what was their effect?

Overall, there are two kinds of pain, the NIA says. Acute pain begins suddenly, lasts for a short time, and goes away as your body heals. You might feel acute pain after surgery or if you have a broken bone, infected tooth, or kidney stone.

Pain that lasts for three months or longer is called chronic pain. This pain often affects older people. For some people, chronic pain is caused by a health condition such as arthritis. It may also follow acute pain from an injury, surgery, or other health issue that has been treated, like post-herpetic neuralgia after shingles.

Your doctor or nurse may ask you to rate your pain on a scale of 0 to 10, with 0 being no pain and 10 being the worst pain you can imagine. Or, your doctor may ask if the pain is mild, moderate, or severe. Some doctors or nurses have pictures of faces that show different expressions of pain and ask you to point to the face that shows how you feel. Your doctor may ask you to keep a diary of when and what kind of pain you feel every day.

Everyone reacts to pain differently. Some people feel they should be brave and not complain when they hurt. Other people are quick to report pain and ask for help.

Worrying about pain is common. This worry can make you afraid to stay active, and it can separate you from your friends and family. Working with your doctor, you can find ways to continue to take part in physical and social activities despite having pain.

Some people put off going to the doctor because they think pain is part of aging and nothing can help. This is not true.

It is important to see a doctor if you have a new pain. Finding a way to manage pain is often easier if it is addressed early.

Talk with your doctor about how long it may take before you feel better. Often, you have to stick with a treatment plan before you get relief. It’s important to stay on a schedule. Sometimes this is called “staying ahead” or “keeping on top” of your pain. Be sure to tell your doctor about any side effects. You might have to try different treatments until you find a plan that works for you. As your pain lessens, you can likely become more active and will see your mood lift and sleep improve.

For more information from the NIA on pain-related issues, click here.

The study, published in the Journal of Pain, included authors from the National Center for Complementary and Integrative Health (NCCIH), part of the National Institutes of Health (NIH); the University of Montreal; and McMaster University in Hamilton, Ontario, Canada.

The use of opioids over other approaches goes against clinical recommendations for the use of nonopioid pain approaches and nonpharmacologic approaches, according to the NIH.

“Particularly when the patient is experiencing pain that may become chronic, that first clinical encounter can set the course for patient care moving forward,” said Helene Langevin, M.D., director of NCCIH. “This study was designed to assess the ways in which real-world practice compares and contrasts with practice guidelines for these initial patient encounters.”

Specialists were less likely than family physicians to prescribe opioids.

Study authors analyzed data from the National Ambulatory Medical Care Survey (NAMCS), conducted between 2007 and 2015. The survey data are collected by the Centers for Disease Control and Prevention’s (CDC) National Center for Health Statistics and represent how medical care services are used in the United States. The results concur with the high prevalence of chronic musculoskeletal pain in the United States, with an average of 36.8 million initial visits (for a new chronic pain problem) per year or approximately 11.8% of the population.

Overall, on an initial visit, patients were prescribed nonopioid medication 40.2% of the time, opioids 21.5%, counseling 15.2%, other nonpharmacologic treatments 14.3%, and physical therapy (PT) least often, at 10%. The most common nonopioid medication prescribed was nonsteriodal anti-inflammatory drugs (NSAIDs), prescribed at 31.1% of initial visits. Nonpharmacologic treatments included counseling, prescribed at 15.2% of initial visits, exercise at 11.7%, diet and nutrition at 6.4%, complementary approaches at 6%, and weight reduction at 3%.

The study identified multiple patient-related factors that affected the likelihood of patients being prescribed opioids versus physical therapy, counseling, and other nonpharmacologic approaches including age, sex, body mass index, smoking status, race and ethnicity, and payer status.

The study also found that provider specialty was associated with treatment approaches.

Internists, orthopedists, and neurologists were less likely than family practitioners to prescribe opioids.

Oncologists, general surgeons, and orthopedists were also less likely to prescribe other types of medication compared to family physicians.

Orthopedists and neurologists referred patients to PT more than family doctors did.

General surgeons were less likely to prescribe other nonpharmacologic treatments.

Compared to physicians with an M.D. degree, those with a D.O. degree were more likely to prescribe nonpharmacologic treatment other than PT or counseling.

The study also found that physicians using electronic medical records were more likely to prescribe opioids than those using paper records, though authors noted it was a novel finding that would need to be confirmed with additional study.

“In recent years, we’ve seen greater awareness of the risks of opioid prescribing, especially as a first-line treatment, and current guidelines reflect the risks and benefits for patients of prescribing opioids versus other approaches,” said Richard Nahin, Ph.D., M.P.H., lead author and senior epidemiologist at NCCIH. “This study serves as a benchmark for clinicians to assess how much progress we’re making toward integrating guidelines, including the CDC Guideline for Prescribing Opioids for Chronic Pain, into clinical practice and offers insight on where to focus efforts to close gaps in care during that critical first patient visit.”

The researchers in this newest study used data from the nationally representative Medical Expenditure Panel Survey (MEPS) to examine the impact of pain-related interference — a measure of pain’s impact on normal work activities — on people’s health status and health care use.

The full study was conducted by the National Center for Complementary and Integrative Health (NCCIH), part of the National Institutes of Health (NIH); Social & Scientific Systems, Inc., Silver Spring, Maryland; and Yale University School of Medicine, New Haven, Connecticut. The findings were published in the Journal of Pain.

The analysis showed that the number of U.S. adults age 18 and older suffering from at least one painful noncancer health condition increased substantially from 120.2 million (32.9 percent of those surveyed) in 1997/1998 to 178 million (41 percent of those surveyed) in 2013/2014.

And the use of strong opioids, like fentanyl, morphine, and oxycodone, for pain management among adults with severe pain-related interference more than doubled from 4.1 million adults (11.5 percent of those surveyed) in 2001/2002 to 10.5 million (24.3 percent of survey participants) in 2013/2014.

The number of U.S. adults age 18 and older suffering from at least one painful noncancer health condition increased substantially over the past two decades.

 

“We took a unique approach with this study by simultaneously examining long-term trends in the overall prevalence of noncancer pain in the U.S., the impact of this pain, and health care use attributable directly to pain management,” said Richard L. Nahin, Ph.D., first author on the study and NCCIH lead epidemiologist. “To address these gaps, we used data from MEPS to identify trends between 1997 and 2014.”

The study showed that by 2013/2014, about one-third of individuals (68 million) with a painful health condition reported moderate or severe pain-related interference with normal work activities. The researchers also found that people with severe pain-related interference were more likely to use strong opioids, to have had four or more opioid prescriptions, and to have visited a doctor’s office six or more times for their pain compared to those with minimal pain-related interference.

As with other studies, this analysis showed an increase in the overall use of opioids between 1997 and 2014, with a peak use observed between 2005 and 2012. Since 2012, however, there has been a slight decrease in opioid use tied to a reduction in use of weak opioids and in the number of patients reporting only one opioid prescription.

Additionally, the study shows small changes in the prevalence of ambulatory office visits, emergency room visits, or hospitalization for pain. Ambulatory office visits for pain plateaued between 2001/2002 and 2007/2008, then decreased through 2013/2014. In addition, the researchers found a decrease in the number of pain-related emergency room visits and overnight hospital stays among those reporting at least one painful condition.

The authors noted that the study had several limitations. First, while MEPS includes comprehensive information on health conditions and types of medical care used, when surveyed, people often vary in how much they accurately remember. In addition, it is possible the survey did not capture everyone with noncancer painful health conditions. Finally, due to MEPS survey methodology and study design, direct links cannot be made between the level of pain-related interference and use of health care.

“The data show a substantial increase not only in the number of U.S. adults with painful health conditions, but also in overall use of opioids and in the number of people receiving multiple opioid prescriptions,” says Helene Langevin, M.D., NCCIH director. “This long-term picture of pain management is of critical importance as NIH addresses the opioid crisis. It offers insights that can help improve decision-making by stakeholders—from patients and providers

Chronic pain sufferers, in particular, may want to get a second opinion. Researchers at Johns Hopkins have reported that 40 to 80 percent of chronic-pain patients are misdiagnosed. Being misdiagnosed can lead to ineffective treatments and perhaps surgery the patient did not need.

One way to save time, money and worry – and most importantly, to receive the right treatment – is to find the source of the pain.

You treat the source, not the symptoms Finding the source of pain can help cure a problem using non-surgical means, and it can change someone’s life.

It comes down to peeling back the layers to figure out what is contributing to the pain. Finding and treating the source of an injury helps determine whether surgery is warranted at that time.

I use a patient evaluation tool called Autonomic Motor Nerve Reflex Testing (AMNRT) to identify the source of symptoms. Sometimes patients are surprised to learn the origin of their pain.

The body compensates for injuries. For instance, a patient may have shoulder pain because they are adapting their stance to accommodate a back injury. Pain in one area of the body is often associated with an injury on the other side.

Also, obstructed breathing – for instance, if you have a cold, allergies, or a deviated septum – will contribute to weakness and pain in your back, shoulders, and hips. Believe it or not, improving your breathing – with nasal sprays or rinses and allergy medication, or fixing your crooked nose – will help improve your strength and relieve your pain.

Here are five common physical ailments that produce chronic pain, some possible sources for the pain, and non-surgical remedies to relieve it:

Tennis elbow. Why are you using more force on that elbow for gripping or lifting? Dr. Testing could reveal the hand is weak from carpal tunnel syndrome. Fix your carpal tunnel problem and your elbow pain will begin to heal on its own. For therapy, I suggest self-manipulation of your wrists, grabbing the back of the hand while resting a forearm on your stomach, then pulling on the wrist and bending it downward.

Slumping shoulder. Shoulder weakness can be associated with neck or back problems and obstructive breathing disorder. Lower back stretches and a pelvic stabilizing program can help.

Runner’s knee. The medical term is patellofemoral pain syndrome, felt as vague pain around the kneecap from prolonged sitting or more strenuous activities like stair climbing. The injury is thought to come from overuse, excess weight, or arthritis, but the true source for, say, right knee pain is often a weakness in the right hip flexor. Physical therapy, stretching the outside structures and strengthening the inside muscles are often better solutions than surgery.

Sciatica. This affects about 40 percent of the population at some point. It’s characterized by pain in the lower back going down the leg. There can be several non-obvious sources, such as obstructed breathing and its associated back problems or a tilted pelvis. I suggest a variety of stretches in yoga, along with rotational and hip flexion stretches.

Achilles tendinitis. Sometimes the source can be foot maladies in the same or opposite foot such as peroneal neuropathy and Morton’s neuroma. The peroneal nerve ends on the top of the foot; Morton’s is the nerve branch between the third and fourth toe. Stretching and strengthening exercises for the calf muscles can help heal it.

You’re going to keep on getting hurt and have pain unless you find and fix the source of the problem.

Dr. Victor Romano s an orthopedic surgeon in Oak Park, Ill., and the author of Finding The Source: Maximizing Your Results – With and Without Orthopaedic Surgery. He is board-certified in orthopedics and sports medicine with over 25 years of experience in the field. He graduated cum laude from the University of Notre Dame and completed medical school at the University of Loyola-Chicago.