Fairfield-Echo.com

Since pain is a complicated combination of emotional, chemical and physical components, treating and managing it often requires several approaches. Over-the-counter (OTC) or prescription medications, physical therapy, lifestyle changes, including quitting smoking, if you smoke and learning coping skills may all be recommended.

Other treatments include ice, meditation, self-hypnosis, acupuncture, chiropractic, electrical stimulation, trigger point injections, nerve blocks, epidural steroid placement, spinal cord stimulators and intrathecal pumps, which deliver small doses of pain-relieving medication directly to the pain receptors in the spinal cords, blocking the message to the brain.

There are many types of pain medications, both prescription and OTC remedies, to help you manage your pain.

• OTC remedies: Acetaminophen and most nonsteroidal anti-inflammatory drugs (NSAIDs), including aspirin, are pain-relief medications available without a prescription. Tylenol, which contains acetaminophen, reduces pain and fever and is usually safe to use with other medications if necessary, although caution should be used when using with alcohol. (Always check with your health care professional if you are taking other medications.)

Motrin, Advil and Aleve are examples of nonprescription NSAIDs that help reduce aches and pains. However, side effects can include stomach pain and diarrhea. Higher-strength forms of ibuprofen (and other NSAIDS) are available by prescription. Aspirin, available as Bayer, Bufferin and Ecotrin brands, is also an NSAID but is used primarily for relieving short-term pain.

In April 2005, the FDA issued a public health advisory that included important changes and additional warnings for prescription NSAIDs as well as for over-the-counter (OTC) NSAID products. Manufacturers of these products are being asked to revise their labels to include a boxed warning highlighting the potential for increased risk of cardiovascular (CV) events and gastrointestinal (GI) bleeding associated with their use. It is important to ask your health care professional for information about these recalls and safety information associated with pain relievers with your personal health in mind.

Prescription pain medications include:

• NSAIDs such as Naprosyn, Nalfon, and Trilisate, which are useful for moderate to severe pain

• Narcotic analgesics (opioids or opiates), a wide-range of medications that are typically used for eudynia after an injury or surgery.

• Antidepressants, medications used to treat depression, but also affect pain pathways in the brain

• COX-2 specific inhibitors (cyclooxygenase inhibitors), are a fairly new class of NSAIDs that include celecoxib (Celebrex), valdecoxib (Bextra) and mobic (Meloxicam). Rofecoxib (Vioxx), also a Cox-2 specific inhibitor, is no longer available because of safety concerns. (See below, "Cox-2 specific inhibitors," for more information.)

• Topical pain relief agents applied directly to the skin. Also available without a prescription.

Narcotics, such as morphine, also are used to treat cancer pain and other types of moderate to severe pain. Most people who take narcotics as prescribed by their health care professional for pain do not get high or become addicted to these drugs. Their bodies may become adapted to the narcotic, however, so they experience withdrawal if the narcotics are stopped abruptly.

Narcotic analgesics may be taken orally, by injection (intramuscularly), through a vein (intravenously) or by rectal suppository. There also are other methods of giving pain medicines for more continuous pain relief. Not all narcotics are available in each of these forms. Frequently prescribed narcotic pain relievers include:

• codeine

• hydromorphone (Dilaudid)

• levorphanol (Levo-Dromoran)

• methadone (Dolophine)

• oxycodone (OxyContin)

• oxymorphone (Numorphan)

• morphine

OxyContin, a form of oxycodone, was approved in 1996 for the treatment of moderate to severe pain associated with musculoskeletal conditions, and by 2001 it became the most frequently prescribed brand name narcotic medication for treating moderate to severe pain in the U.S. The narcotic has recently come under intense scrutiny by the U.S. Food and Drug Administration (FDA) and the U.S. Drug Enforcement Agency due to widespread abuse. Abusers can bypass the time-release aspect of the drug by crushing, chewing, snorting or shooting OxyContin pills to get a quick morphine-like high. However, the abuse of OxyContin is associated with serious consequences including addiction, overdose, and death. When the drug first became available, some health care professionals who prescribed it may not have been as diligent as necessary about managing patients taking OxyContin. Also, OxyContin may have been prescribed by some health care professionals who were not familiar enough with appropriate pain management strategies. In July 2001, the U.S. Food and Drug Administration required the manufacturer of OxyContin to include the agency's highest level of safety warning on the label. In addition, the FDA has since collaborated with the manufacturer to develop and implement a risk management plan to help detect and prevent abuse and diversion of OxyContin.

• Antidepressants.

  These medications affect pain by changing the levels of neurotransmitters (brain chemicals) and altering the pain messages reaching the brain. When a woman is depressed and also in pain, these medications can both reduce pain and improve mood. The tricyclic antidepressants help to restore the body's normal perception of pain and may be recommended as a treatment option even when a patient is not depressed. The selective serotonin reuptake inhibitors, such as Prozac and Zoloft, and atypical antidepressants, such as Wellbutrin, have not been shown to affect neuropathic pain, such as diabetic neuropathy, but do work on depression.

• COX-2 specific inhibitors

  (cyclooxygenase inhibitors) are a fairly new class of nonsteroidal anti-inflammatory prescription medications. They include celecoxib (Celebrex), mobic (Meloxicam) and Bextra (valdecoxib). COX-2 inhibitors are indicated for the relief of symptoms caused by arthritis, such as inflammation, swelling, stiffness and joint pain and are designed to cause fewer gastrointestinal side effects (such as ulcers and bleeding) than other types of NSAIDs. Celecoxib (Celebrex), is also approved for the treatment of nociceptive pain, including pain following surgery.

Rofecoxib (Vioxx), another COX-2 specific inhibitor, was voluntarily withdrawn from the market in September 2004 by its manufacturer after data from a study involving Vioxx indicated an increased risk for heart attack and stroke in patients participating in the study. Following the recall, the FDA began closely monitoring other drugs in this class of medications for similar side effects. In early April 2005, the FDA asked the manufacturer (Pfizer) to withdraw valdecoxib (Bextra) from the market because the overall risk versus benefit profile for the drug was found to be unfavorable. Pfizer has agreed to suspend sales and marketing of Bextra in the U.S., pending further discussions with the FDA. The FDA has also asked Pfizer to include a boxed warning about potential health risks in the celecoxib (Celebrex) label. For information about COX-2 specific inhibitors and the recalls, www.fda.gov.)

• Combination Drugs

  Some medications used for pain are actually combinations of acetaminophen and either oxycodone (ex, Vicadin, Percocet), a relaxant (ex, Fioricet) or an opioid (ex, Ultracet).

• Topical agents:

  these increasingly popular pain relief products are applied to the surface of the skin. Some are prescription while others can be purchased over the counter. Examples include: Capsacian and Lidocaine Viscous.

Some alternative or holistic pain management approaches include:

• Acupressure:

  the stimulation of healing sites (as in acupuncture) with finger pressure, rather than fine needles.

• Acupuncture:

  an ancient Chinese health practice that involves therapeutic insertion of thin, solid (generally metallic) needles in specific points along your nerve pathways, called acupuncture points. The traditional theory of acupuncture is based on the premise that there are patterns of energy flow called Qi (pronounced "chee") throughout the body. Qi also is believed to regulate spiritual, emotional, mental and physical balance. This energy must flow unobstructed and be balanced for optimal health. Traditional practitioners of acupuncture believe stimulating certain points in the energy channel helps improve the flow of Qi. While Western researchers are not sure how acupuncture works, several theories suggest that acupuncture may stimulate the release of endorphins, the body's natural pain relievers.

• Biofeedback:

  a technique used to gain control over a function that is normally automatic (such as blood pressure or pulse rate); the function is monitored, and relaxation techniques are used to change it to a desired level. Biofeedback uses electronic or electromechanical instruments to monitor, measure, process and feed back information about blood pressure, muscle tension, heart rate, brain waves and other physiologic functions.

• Cranial sacral therapy:

  this hands-on treatment involves gentle massage or manipulation of all bones of the skull (including the face and mouth), vertebral column, sacrum, coccyx and pelvis to ease restrictions to physiological motion. It's a spin-off of chiropractic and osteopathic medicine but differs because instead of adjusting the musculoskeletal and nervous systems, gentle massage is used to increase the flow of cerebrospinal fluids.

• Electrical stimulation:

  this therapy involves attaching a small transmitter to the skin around a painful area and emitting electrical impulses that block pain signals, giving you a tingling feeling rather than pain. It may work by stimulating the release of endorphins.

• Homeopathy:

  a natural, noninvasive system of medical treatment based on the theory that substances that cause certain symptoms in a healthy person can-in diluted amounts-cure those symptoms in an unhealthy person. The logic is that the similar substances promote healing by stimulating your body's natural healing mechanisms.

• Hydrotherapy:

  also called hydropathy and aquatic therapy, hydrotherapy literally means using water in the treatment of disease. Using water for pain management typically involves hot and cold compresses or tub soaks to relieve pain and decrease swelling. Aquatic therapy also refers to the use of a heated therapeutic pool for exercising without stress on the joints. It does this by relieving the pull of gravity.

• Hypnosis:

  a technique that induces a deeply relaxed and focused state of mind-a form of intense receptive concentration. While often used to modify behavior, hypnosis also helps reduce pain and may speed healing.

• Massage:

  massage involves rubbing or kneading muscles and other areas of the body to stimulate blood circulation, relieve pain and promote a sense of well being.

• Meditation:

  a process to increase concentration and awareness and a more relaxed state.

• Osteopathic medicine:

  focuses on the unity of all body parts, with special consideration to the musculoskeletal system as a key element of health. This discipline recognizes the body's ability to heal itself and stresses preventive medicine, eating properly and keeping fit.

• Reflexology:

  this technique is based on the belief that pressure applied to specific points on the extremities benefits other parts of the body. Massage of the hands or feet is typically used.

These approaches may be used as alternatives to medication or in conjunction with them.

Lifestyle changes may be necessary to help you relieve your pain.

• Exercise helps:

  • relieve pain

  • increase muscle mass, which reduces stress on joints

  • may lead to weight loss, which also reduces stress on joints

• A healthier diet may:

  • reduce swelling in joints, lead to better circulation

  • lower cholesterol levels and blood pressure.

  • assist in pain relief by providing a healthier body upon which medications can work

While exercise and modifying your diet and eating habits may be difficult lifestyle changes, they may help you to manage your pain. Always consult your health care professional before beginning a new diet or exercise program, especially if you are experiencing pain. Your health care professional may advise you not to exercise at all. However, if he or she recommends exercise, you should know that it might make your pain feel worse when you start. You may be afraid to exercise because of this increased pain. One strategy for managing this pain is to begin exercising very slowly and gradually increase your activity.

When to Consider Using a Pain Clinic

You might consider visiting a pain clinic if your pain does not go away after medical treatment within the expected timeframe provided by your treating practitioner. Persistent nociceptive or neuropathic pain, in addition to causing physical suffering, alters a person's ability to function, which, without intervention, may in turn lead to depression.

Pain clinics specialize in the prevention, evaluation, diagnosis and treatment of painful disorders. Treatment may include prescribing medication, physical and rehabilitative services, teaching and performing pain-relieving procedures such as massage and meditation, and counseling patients and their families.

Just as physicians differ by specialty, so do pain clinics. Some offer residential programs, where you stay at the facility. Others have outpatient programs. Generally, programs include a team of health care professionals from the disciplines of psychology, medicine, physiotherapy, occupational therapy, pharmacy and vocational counseling.

Most pain clinics will review of all your medical records and perform a medical evaluation, which includes a complete medical history, a physical examination and possibly medical testing, such as x-rays, if appropriate.

To treat your pain symptoms, choose a pain center that:

• offers a wide range of treatments; massage, acupuncture, and other options should be considered along with conventional therapies because a variety of choices offer better chances of successful pain relief.

• has health care professionals who are specialists in pain management and pain medicine. They should be Diplomats of the American Board of Pain Medicine.

• is staffed by caring, qualified people. If possible, get a list of references from the pain clinic of former or current patients. If possible, interview some of the staff-either in person or by phone

• includes physical therapy and exercise programs.

• is conveniently located.

• is accredited by CARF, the Rehabilitation Accreditation Committee. CARF is a private, not-for-profit organization that accredits programs and services in adult day services, behavioral health, employment and community services, and medical rehabilitation

A list of certified pain centers is available from the American Pain Foundation's Web site: Painfoundation.org.

A list of pain specialists is available from the American Board of Pain Medicine: abpm.org.

Common Pain-Causing Conditions

Women who feel they can do nothing to relieve their discomfort are more likely to be disabled by their pain and make more trips to a health care professional than those who feel they have some measure of control. Their lives may spiral to a point where daily routines revolve around their bed, the health care professional's office and the pharmacy.

Here are some typical health conditions that cause pain, along with some treatment options for them. Consultation with a health care professional is recommended for persistent nociceptive and neuropathic pain that doesn't subside.

Back Pain

Nearly 90 percent of back pain is muscular, caused by sprains, spasms and muscle imbalance. However, many women experience back pain during or before menstruation or during pregnancy.

Although it can be nagging (and even debilitating), most back pain clears up on its own. It can be eased or treated by modifying activity, using moist heat, such as hot showers, and with exercises that strengthen the abdominal muscles to provide more support for the back.

Other keys to back pain relief include:

• using over-the-counter (OTC) medications such as ibuprofen, acetaminophen or aspirin for mild or moderate symptoms

• applying a cold pack five to 10 minutes at a time within 24 hours after back symptoms start or using a heating pad or hot shower if symptoms last longer

• limiting bed rest to two to three days (prolonged bed rest weakens the back)

• wearing comfortable, low-heeled shoes

• using a chair with lower back support and working at a comfortable height

• keeping objects close to your body when lifting

• exercising to keep your muscles flexible and strong

• controlling your weight

• avoiding prolonged sitting in cars, at desks, and in front of computers or televisions

If you experience numbness in your hands and feet, or if the pain worsens or doesn't respond to OTC pain relievers, consult a health care professional.

Knee injuries

If you are athletic, you may be more prone to certain types of injuries that cause pain, especially in the knee. Anterior cruciate ligament (ACL) injuries, for example, are common in women who play sports that involve stops and starts and quick turns, such as basketball, skiing and tennis. Women also are more likely than men to have pain at the front of the knee, in the kneecap especially when going downhill or downstairs. Both a sedentary lifestyle and a vigorous exercise program can aggravate weakened knees.

Managing knee or ligament pain is often the same as the treatment for relieving back pain:

• use OTC medications such as ibuprofen, acetaminophen or aspirin for mild or moderate symptoms

• use ice to reduce swelling

• rest

• avoid squatting and kneeling

• wear comfortable, low-heeled shoes

If pain shoots down your leg or is associated with numbness, weakness or tingling, see a health care professional.

Headaches

Muscle tension, stress, anxiety, sinus infections and allergies can cause headaches. Certain foods, weather changes, hormonal cycles and emotions can also cause headaches. Although headaches can't always be prevented, there are things that you can do to reduce their frequency, including:

• sleeping and waking up at regular times

• not skipping meals

• maintaining a healthy lifestyle that includes eating a balanced diet and exercising

Over-the-counter analgesic medications, like acetaminophen, ibuprofen or aspirin can help relieve occasional headache pain. OTC pain-relief medications generally are safe when taken as directed, but if you drink alcohol or have specific medical conditions, be sure to tell your health care professional when discussing how to manage your headache pain.

If you want an alternative to medication, relaxation techniques, such as biofeedback, can be useful alternatives to drugs for both preventing headaches and relieving them.

Biofeedback is a learned skill and, with practice, it can help you relax deeply when pain increases. Biofeedback may be used to relax muscles, restore circulation and redirect attention from the source of pain.

Occasional headaches are examples of eudynia-they generally don't debilitate you. These types of headaches may be caused by lack of caffeine (if you generally use a lot of caffeine-containing products and for some reason decrease your intake), tension or from unknown sources. These headaches typically respond to OTC medication and stress reduction.

Migraines

Migraines are more than headaches-they can be completely disabling. Lasting from hours to days, they may be accompanied by such symptoms as throbbing pain and nausea, and visual symptoms, such as flashing lights, zigzag lines or partial loss of vision. Sensitivity to sound and smells can be another symptom experienced by migraine sufferers.

Nearly 75 percent of the 26 million migraine sufferers are women, according to the American Council for Headache Education. Migraines are an example of neuropathic pain. These severe headaches are a biologically based disorder. Symptoms are the result of changes in brain chemistry; they are not caused by an inability to manage stress.

There are several different types of migraines including: hemiplegic migraines, in which patients suffer temporary paralysis on one side of the body; ophthalmoplegic migraines, which cause pain around the eyes and is associated with a droopy eyelid, double vision and other sight problems; basilar artery migraines, which include vertigo, double vision and poor muscular coordination; menstrual migraines, which are caused by fluctuating hormone levels; and several others.

When discussing your migraines with your health care professional, ask these questions about your migraines and getting treatment for them:

• What can I reasonably expect from treatment?

• What drug and non-drug treatments do you recommend?

• Will I have to be on medication indefinitely?

• What are the possible triggers of my migraines?

• Could my migraines be a symptom of other illnesses? If so, what are they?

• Will they get worse or better as I get older?

• How can I alter my diet or lifestyle to reduce my migraines?

Infrequent migraines-occurring once or twice a month-are usually treated with a fast-acting, acute-type medication that responds to the headache once it has developed. This type of medication relieves head pain, nausea and sensitivity to bright light and/or sound. Women who have migraines more frequently need a different strategy; a preventive medicati

on is often recommended. If you have frequent headaches-three or more times a month-a daily medication aimed at preventing the migraine from starting may be recommended. Migraine-specific analgesics, as well as antidepressants, which adjust serotonin levels, are often prescribed. Heart medications such as beta blockers and calcium channel blockers are commonly used for migraine relief. Sometimes seizure-controlling medications may be used to control serotonin levels and minimize migraine occurrences. Your health care professional can advise you.

Triptans are one of the most commonly used class of drugs for migraines. These drugs act on the artery-constricting chemical serotonin. Another drug that provides relief of migraine symptoms is ergotamine tartrate, a drug that constricts blood vessels, helping to counteract the painful blood dilation stage of the headache. For optimal benefit, the drug is taken during the early stages of an attack. If a migraine has been in progress for about an hour and has passed into the final throbbing stage, ergotamine tartrate will probably not help.

Other drugs used to prevent migraine include:

• methysergide maleate, which counteracts blood vessel constriction

• propranolol, which stops blood vessel dilation

• amitriptyline, an antidepressant

• monoamine oxidase inhibitors, or MAO inhibitors, which are antidepressants that block an enzyme called monoamine oxidase that normally helps nerve cells absorb the artery-constricting chemical, serotonin

• papaverine hydrochloride, produces blood vessel dilation

• cyproheptadine, a drug that counteracts serotonin.

If you experience a headache unlike anything you've ever had or if you get a "thunderclap" headache that starts and becomes extremely intense within a few seconds or minutes get medical attention immediately. You should also see a health care professional if there's a change in the character of a headache or if you experience new headache symptoms.

It is also common to have "rebound" headaches. These occur in people who have daily headache and who take medications, even OTC medications, on a regular basis because they seem to provide relief. In actuality, this constant cycle of medication is causing the next headache. Frequently, stopping all medications for about two weeks gets rid of rebound headaches. Also, the NSAIDS, including the COX-2 inhibitors, do not cause rebound headaches, whereas other analgesics and the triptans do. So you shouldn't take any medication more than two days per week. If this doesn't relieve the headache, see a headache specialist.

Arthritis

Arthritis, one of the more prevalent chronic health problems, affects more women than men, according to the Arthritis Foundation. The term arthritis comprises more than 100 different diseases that affect the joints, causing pain, loss of movement and sometimes swelling.

Two types of arthritis include osteoarthritis and rheumatoid arthritis.

Osteoarthritis is the most common form of arthritis. It is the source of pain for nearly 60 million Americans, and it affects women more than men, according to the Arthritis Foundation. The main symptom is stiffness and achiness in the joints, especially first thing in the morning, or after using a joint for a long time. The hips, knees, back and fingers (especially closest to the tip), are the joints most likely affected.

Osteoarthritis usually begins in women between the ages of 45 and 60 and develops slowly over a year or more. Most commonly, osteoarthritis begins in joints on one side of the body and affects only some joints. Unlike other forms of arthritis, it doesn't cause inflammation or nausea.

Other risk factors include a family history of osteoarthritis, being overweight, joint injury or overuse, and inactivity, which causes joints to lose flexibility and weakens supporting muscles.

Acetaminophen is the first choice for treatment and long-term pain management for osteoarthritis. It is less likely than aspirin or other nonsteroidal anti-inflammatory drugs (NSAIDs) to irritate your stomach, and acetaminophen causes fewer negative drug interactions than NSAIDs, a consideration for older women who may take a variety of medications.

Topical creams such as capsaicin (a substance that blocks pain messages to the brain) are helpful too. Sometimes, however, these creams cause a burning feeling and temporarily worsen the pain before relieving it.

The COX-2 medications also are unlikely to irritate your stomach during the first six months they're used. After that, Celebrex, at least, is just as likely to irritate the stomach as any traditional NSAID. Vioxx, however, is safer longer than six months, and Bextra has no long-term studies yet, so we don't know its track record in terms of stomach irritation. These drugs provide more pain relief that the maximum dose of acetaminophen.

Other strategies for relieving osteoarthritis pain include using a cold pack to cool down a joint that is "hot" and inflamed, and using heat to increase blood circulation and loosen stiff joints before stretching and exercising them.

A Lidoderm patch, which contains the anesthetic lidocaine, can also help, especially if the arthritis is limited to one or two joints.

Longer-term goals for aiding in pain management include exercise and weight loss. Exercise helps relieve pain and increases muscle mass, which reduces stress on joints. But be sure to avoid high-impact activities, such as jogging; try walking, swimming and biking instead. Walking is especially good, because it helps keep bones strong. Don't forget to stretch, to keep joints flexible.

Losing weight also can make a significant difference in pain caused by osteoarthritis. Excess body weight stresses joints, making osteoarthritis pain worse.

Joint replacement surgery is recommended only for severe, disabling osteoarthritis that interferes with your ability to carry out ordinary activities, such as dressing, bathing or climbing stairs.

Rheumatoid Arthritis

According to the National Arthritis and Musculoskeletal and Skin Diseases, National Institutes of Health, more than 2.1 million Americans have rheumatoid arthritis (RA), 1.5 million of whom are women. RA generally affects women in their 40s and 50s, but can strike women in their 20s and even children. It is an autoimmune disease, a disease in which the immune system attacks healthy tissues. Lupus, arthritis, scleroderma, Sjögren's syndrome and insulin-dependent diabetes are examples of autoimmune diseases. RA is characterized by the inflammation of the membrane lining of the joint, called the synovium. Inflammatory cells release enzymes that may digest bone and cartilage.

Many people confuse osteoarthritis and rheumatoid arthritis. Although both are more common in women than in men, osteoarthritis may appear as early as age 45 but usually does not develop until age 55 or 60. Osteoarthritis only affects joints, and not internal organs. Rheumatoid arthritis-the second most common form of arthritis-affects other parts of the body in attacking the joints. It begins earlier than osteoarthritis, causes inflammation, and may make people feel sick, tired, and sometimes feverish.

Pain and swelling usually start in your hands and feet but also can affect your ankles, hips, knees shoulders and elbows. With RA, pain generally develops suddenly, within weeks or months, and affects the same joints on both sides of the body. Your joints will be inflamed, and you may feel fatigued, feverish and nauseous. You also may develop bumps on affected joints called rheumatoid nodules.

If you have these symptoms, see your health care professional. A diagnosis can be made based on your symptoms, your medical history, a physical examination and a few lab tests and x-rays. One test will examine whether you have rheumatoid factor, an antibody found in the blood of 50 percent of adults with RA.

Because of the differences between rheumatoid arthritis and osteoarthritis, you need to be as descriptive as possible when explaining your symptoms to your health care professional.

• Is the pain a burning sensation or cramping?

• Does sitting too long make it worse?

• Is there swelling?

• Does the pain radiate? Does it start in one place and spread or "radiate" to another place?

• Is it accompanied by fatigue?

Common treatments for RA include NSAIDs, COX-2 inhibitors, aspirin and analgesics to reduce pain, swelling and stiffness. Etanercept (Enbrel) and infliximab (Remicade) were approved in the late 1990s to treat RA; both medications are believed to stop the progression of RA. Methotrexate, a type of medication from a class of drugs known as disease modifying anti-rheumatic drugs (DMARDs) was commonly used for treating RA prior to the development of newer drugs, and still is an option. Other medications, including some chemotherapy drugs, used in much lower doses than for treating other diseases, also may be prescribed. Talk to your health care professional about which medication would best suit your needs.

Rest, exercise and physical therapy also should be part of your pain management plan. Surgery, while available, is only advised in extreme cases.

Fibromyalgia

Fibromyalgia syndrome (FMS) is a pain-processing disorder of the central nervous system that causes mild to severe pain throughout the body. It does not affect joints. Fibromyalgia, which results in pain in the muscles, ligaments and tendons, is especially confusing and often misunderstood. Its symptoms are common to many other conditions.

Aching or burning pain and fatigue are the most common and prominent FMS symptoms. Pain usually comes in the form of tender points on the body where pain is the greatest. About 90 percent of fibromyalgia sufferers have trouble sleeping, which leads to fatigue. Other symptoms include decreased attention span, abdominal pain, gas, nausea, headaches, depression and increased sensitivity to noise, odors and light. Feelings of numbness and tingling in hands, arms, feet, and face and diarrhea are also common.

Physical or emotional trauma, hormonal changes, muscle abnormalities or common illnesses like influenza can cause FMS. If you have had pain in multiple areas of your body for more than three months, tenderness at specific locations on your body, and fatigue, talk to your health care provider about the possibility of FMS.

Although currently there is no cure for fibromyalgia, often the pain can be effectively controlled with a combination of treatments including:

• antidepressants and muscle relaxants to relax muscles and improve mood and sleep

• exercise to reduce pain and fatigue, and to strengthen muscles

• relaxation techniques and massage to ease muscle tension

Cancer Pain

Pain, in general, is undertreated. Nowhere is this fact more significant than in cancer pain management. There are many causes of cancer pain. Bone pain is one of the most common. Tumors pressing on nerves also can cause pain, as can treatments such as chemotherapy, radiation and surgery.

Many patients and health care professionals fear that using narcotics for pain relief leads to addiction. According to the American Pain Foundation, developing such an addiction is rare. It is important to take pain medication regularly to keep pain under control. Furthermore, cancer patients have become a model for the medical management of pain. Pain management for patients with cancer has shown that using a variety of analgesics, especially opioids-narcotics such as morphine that dull the senses and relieve pain-can be given continuously without addiction becoming a major concern. If you take opioids for pain, you may need increasing doses over time. Narcotics must be discontinued slowly because people who have used them for long periods can experience withdrawal symptoms if the medication is stopped abruptly.

Non-prescription Pain-Relief Primer

With all the different types of nonprescription pain relievers available today, it's hard to know which is best for which ailment. Pain relievers fall into the four categories described below. Remember to follow directions on the label as well as your health care professional's recommendation. If symptoms worsen, contact your health care professional.

Sources:

McNeil Consumer Health Care, Tylenol, www.tylenol.com

American Pain Foundation, 1-888-615-PAIN, Painfoundation.org

"Approval of Napraxon," Food and Drug Administration News, www.fda.gov

www.drugs.com