In the summer of 2014, Carolyn Slutsky was walking to a friend’s graduation party when she felt a sudden burst of pain. The sensation radiated down her lower back to her right leg and worsened with each step she took. By the time she arrived at the party, she could barely stand. She went to an urgent-care center on the Upper West Side of New York City the next morning, where a doctor injected her with what she described as “some heavy pain medications” and gave her the name of a massage therapist.
The massage therapist “pounded on my back,” Slutsky recalls. “He kept saying, ‘See? Better!’ But it was not better.” She tried over-the-counter pain relievers, which helped for a few weeks until one morning the pain returned with a vengeance. She went to a back specialist who recommended an MRI, which revealed a ruptured spinal disk. The doctor then gave Slutsky a list of physical therapists.
The first one passed her off to his students, who did a poor job explaining the exercises. Slutsky quickly abandoned the treatment and started her own quest to find relief. Following the suggestions of friends, she tried self-help books and acupuncture. Neither worked.
Eventually, she picked another physical therapist from her list who turned things around. He recommended a special pillow to help her sit properly and taught her exercises that in time eliminated her pain. “Going through this made me feel fallible,” she says of her experience. “I was in this situation that felt out of control.”
Persistent pain can be as frustrating as it is debilitating. As Slutsky or anyone else with prolonged suffering can tell you, there’s never a convenient time for a spinal injury, a migraine, or an arthritis flare-up. Pain can take over your life with little notice. It can disappear suddenly, then return just when you think you’ve beaten it. In some cases, the cause is clear; in others, it’s a mystery. Yet when your head is pounding, your joints are aching, or your back is sending lightning bolts of agony up your spine, it’s a natural impulse to reach for the first thing you can find that will make the pain go away.
That’s why Americans spend some $300 billion on pain relief treatments and care each year. And then there’s the cost of lost productivity, which according to a 2011 Institute of Medicine report runs about $315 billion annually.
“Pain is a part of all of our lives at some point,” says Robert D. Kerns, Ph.D., a professor of psychiatry, neurology, and psychology at Yale University and the former national program director for pain management for the Veterans Health Administration. “But for too many Americans, it’s a hugely underappreciated problem that deeply impacts quality of life.”
• Pain Management: Which Treatment Is Right for You?
• Addictive Pain Medication: How to Protect Yourself
• Does Medical Marijuana Work?
• Treating Neck and Shoulder Pain
• Treating Joint Pain
• How to Get Rid of Lower Back Pain
• Migraine Treatment, Prevention & Relief
• Tension Headache: Treatment and Prevention
America is in the midst of a national conversation about pain and pain relief. There’s broad recognition that overuse of opioid painkillers such as Percocet and Vicodin have led to an epidemic of overdoses and addiction. More than 14,000 Americans died of overdoses involving prescription opioids in 2014, according to the Centers for Disease Control and Prevention (CDC), and each day more than 1,000 people are treated in emergency rooms for misusing those drugs.
In March the CDC issued its first-ever guidelines for prescribing opioids for chronic pain, advising doctors to initially try nondrug treatments or use medications other than opioids for people in chronic pain. Other than for those with cancer or those who require palliative or end-of-life care, the CDC also advised doctors to use opioids only for patients when the benefits outweigh the risks, and even then, to use the lowest effective dose. President Barack Obama’s proposed budget for the 2017 fiscal year includes $1.1 billion to go toward treatment for prescription drug and heroin abuse. And in an unprecedented move, the Food and Drug Administration (FDA) announced in February an initiative that includes changes in how it regulates and approves opioid drugs.
The aim of the guidelines is to curb inappropriate prescriptions of opioids, says Roger Chou, M.D., a professor of medicine at Oregon Health & Science University in Portland, who helped write them. He notes that they’re targeted to primary care providers, who are responsible for almost half of all opioid prescriptions in the U.S. “People with treatable conditions are not getting the relief they need,” he says, “and they are dying taking the drugs their doctor prescribed for them.”
As we acknowledge the dangers of prescription painkillers, we must also come to terms with a more nuanced understanding of pain itself. It isn’t something to simply get rid of; it’s your body’s way of telling you that something is wrong, often a strong signal to stop what you’re doing and correct course accordingly.
Beyond the immediate warning, pain triggers a cascade of responses from within. Inflammation at the point of injury alerts the body’s immune system to get to work on healing. Other chemicals are then notified and rush in to ward off infection, devour dead cells and tissue, and keep inflammation in check.
For most aches or injuries, pain goes away with treatment and time. When it doesn’t, the situation can get tricky. Doctors may find themselves at a loss, and patients can get caught in a cycle of treatments or succumb to the promise of unproven remedies. Others may handle it with a long-term prescription.
But real pain relief isn’t measured in doses. It’s about listening to what your body is trying to tell you, then patiently addressing the underlying cause. For Carolyn Slutsky, that meant finding the right physical therapist and changing her daily routine. “I try not to lift heavy things,” she says. “I lighten my bag by carrying only what I need. And I get out of bed putting the weight on my hands rather than my lower back.”
If you’re in pain, don’t just mask it or ignore it; do something. We’ve put together a glossary of treatments to help you understand the options. We’ve also looked closely at the best scientific evidence to create a step-by-step treatment guide to the most common causes of pain, including back, joint, neck, and head pain from tension headaches and migraines.
It’s difficult to find the right words to describe pain intensity. That’s why getting the right treatment starts with effective communication.
Pain treatment isn’t one size fits all, so doctors often press patients for more details. “Pain is subjective,” says Kathleen Cowling, D.O., director of the residency program at Central Michigan University and an emergency physician at the Covenant Medical Center in Saginaw, Mich. “I can’t measure it like I would blood pressure.” Here’s what to tell your doctor:
How Intense It Is: You’ll first be asked to rate your pain, usually on a scale of 0 (no pain) to 10 (the worst you’ve ever had). Otherwise, say that it feels mild, moderate, intense, or the maximum—the worse pain possible.
What It Feels Like: Is the pain sharp and stabbing, a dull ache or throbbing? It could be from injuries to muscles, tendons, bones, or ligaments, such as a pulled muscle, a torn tendon, or an inflamed joint. Tingling, burning, pinpricks, or shooting pain that feels like a shock can indicate pinched or damaged nerves.
It Hurts Where: Identify where it hurts and pain spreads to other areas. Neck pain that radiates to your left arm could signal a problem with disks that cushion your spinal column.
What Makes It Better: If you’ve had pain for a while, explain what methods you’ve used to treat it and whether they worked.
When It Started: The last piece of information to give your doctor is about the first time you noticed the pain. Be precise, and describe what you were doing at the time you first noticed it. For example, neck pain that worsens during exercise could be a clogged artery.