Read an Excerpt

ONE
Aches and Pains:
“Oh, My Aching Body!”
Athletic Injuries
Backache
Fibromyalgia
Headache and Migraines
Dsteoarthritis (see Chapter 10)
Rheumatoid Arthritis (see Chapter 10)
Shingles
Sprains and Strains
WHEN OUR BODIES are in pain, the whole world feels out of balance. It’s difficult to concentrate on anything more than simply making the pain disappear as fast as possible. Often we must learn which non-drug therapies, over-the-counter products, and prescription drugs best manage the pain. If you’re thinking, “I don’t want to manage it, I want to wrap it up and toss it out with the garbage”—that is certainly understandable. But some chronic conditions like arthritis and migraine headaches require us to take a different approach because, unfortunately, the pain cannot be eliminated altogether. Pain is near-constant, making common life activities very difficult. Incorporating a variety of treatments into pain management allows us to learn to use the whole body to overcome the mental and physical stress that the hurtful condition brings. Let’s look at some of these painful conditions and see which treatments seem to work best.
Athletic Injuries
Q. I have two sons who play most of the sports offered at their school. How can I best treat sports injuries that may happen?
A. Your worry is not only common but also well founded. Each school year there are over one million injuries reported just from playing high school football—and that number doesn’t take into account those kids who are hit by baseballs or tear their knees while scrambling for a basketball rebound. The information provided here can help them avoid many of these injuries. You’ll also be better prepared just in case someone comes home with a swollen ankle from a misplaced soccer kick.
What Are Some Common Athletic Injuries?
There are as many different athletic injuries as there are sports. Injuries to the body from sports almost always involve either the bones, or the muscles, ligaments, tendons, and tissues surrounding the bones. Here are a few of the more common athletic injuries and their physiological explanations:
Dislocation. Dislocation is the painful stretching and sometimes tearing of a ligament that holds two bones together in a joint (such as a shoulder or a thumb). Often during hard physical contact, bones that are normally safely in a joint are abruptly popped out of joint. They either go back into their proper sockets on their own or must be manually (and painfully) put back into place.
Muscle cramps. When we ask our muscles to perform at peak efficiency, they obey. That is, until the muscle runs out of necessary minerals or fluids. The muscle gives a last great contraction, but can’t stretch out again. Ouch! A muscle cramp just occurred.
Shin splints. As any runner knows, the constant slamming of your foot against a hard surface creates stress on the muscles. The muscles involved in shin splints are located on either side of the shinbone. Small tears over time create pain whenever the person walks, runs, or jogs.
Sprains and Strains. When you sprain, say, your ankle, you stretch the ligaments that connect bone to bone along a joint. A strain, in contrast, involves the muscle itself. The muscle may be stretched, or even torn. (See “Sprains and Strains,” page 25.)
Tendonitis. When you use one muscle a great deal, the tendon often pays the price. The tendon connects the muscle to the bone, so it must take the force of the muscle each and every time the muscle expands and contracts. Tendons don’t have the blood supply that muscles do, so the healing time for inflamed tendons (tendonitis) is much longer.
Tendons and Ligaments
Many people, athletes included, have difficulty distinguishing what it is that tendons and ligaments do. While both are tough, fibrous tissues that you want to take very good care of, they connect to different parts of your body. Tendons handle the stress from a muscle, while ligaments control the big-bone movements. Here is an easy way to remember this:
Tendons connect muscle to bone (TMB—tendon/muscle/bone).
Ligaments connect bone to bone (LBB—ligament/bone/bone).
Tennis elbow. Small but progressive tears in the muscles and tendons that connect the wrist to the elbow are to blame for tennis elbow. Muscles are able to heal faster, but the tendons and ligaments may stay inflamed for weeks.
How Are Athletic Injuries Treated?
Unfortunately, even with the best conditioning, injuries occur. In treating athletic injuries from minor muscle cramps to complete dislocations, the key is prompt medical attention.
The Drug Lady Recommends . . .
If your children are participating in school athletics, it is a good idea to come to a practice or two to size up the situation. Sports-injury experts say that a large number of injuries could be prevented if a few rules were followed. At your child’s athletic events, make sure that
your child is playing with others of his/her level of physical strength or development.
proper stretching and conditioning methods are emphasized; warmer muscles are less likely to be hurt.
children are encouraged to listen to their bodies; if something hurts, the adults in charge or their peers should get them to stop immediately.
Non-drug treatments
No athlete in training ever likes to hear this, but when most sports injuries occur, the best treatment is to rest the affected body part and give it time to heal. Contrary to what you may think, massage may not always be a good idea. It can be wonderful for releasing tight muscle cramps, but if the muscle or tendon is injured, massage may cause further injury. A better choice is hot-tub therapy for sore muscles. It provides heat, to bring blood into the muscles, and the water jets stimulate muscles without requiring them to exert effort.
Many sports-injury professionals recommend the “RICE” treatment for both sprains and strains. No, this does not involve sitting down and eating a bowl of rice after you hurt yourself. “RICE” is an easy way to remember what to do without having to go find this book:
R: rest. Stop all activity and rest the affected muscle, ligament, or tendon.
I: ice. Put ice on the hurt area immediately.
C: compression. Put a snug elastic bandage on the hurt part of the body.
E: elevation. If the injury involves the lower extremities, put your feet or legs up, slightly higher than your hips. Stay off your feet as much as possible, as gravity causes blood to pool around the injured area and swelling will be greater. You should follow the RICE method as soon as possible, preferably right after the injury occurs and certainly within the first 24 hours. After 24-48 hours (or when the swelling has gone down), you can use heat to help increase circulation to the injured tissue and make muscle movement less rusty.
Antioxidants, like vitamin E and vitamin C, show promise as protectants against muscle damage during heavy workouts. Adding a multivitamin with extra E and C to your daily routine is an easy way to take care of this nicely.
OTC treatments
Pain-relieving rubs like Ben-Gay or Icy Hot work by a method called counterirritation. Counterirritation causes a mild inflammation in the area of skin above where the muscle pain originates. The theory is that this irritation crowds out the feeling of deeper muscle pain. The active ingredient, methyl salicylate, is the most commonly used counterirritant. When these rubs are applied directly to the sore muscle area, the nerve endings are stimulated and a feeling of warmth quickly appears. Blood flow increases to the muscle tissue and a warm/cool sensation on the skin provides the feeling that the pain is less intense. Menthol and camphor are milder counterirritants that provide a cooling sensation to the skin. These don’t actually help heal the muscle, but they do relieve the pain a bit.
Anti-inflammatory medicines may help a great deal in bringing down painful joint, muscle, or tendon inflammation. Aspirin, ibuprofen, ketoprofen, and naproxen are classified as non-steroidal anti-inflammatory drugs, or NSAIDS for short. The characteristics of these drugs are that they bring down swelling (inflammation) commonly associated with muscle, tendon, and joint pain. NSAIDs also interfere with the body’s sensation of pain, effectively decreasing the way pain is felt. Look for brand names like Aleve (naproxen sodium), Orudis KT (ketoprofen), or Motrin IB (ibuprofen) for fast muscle-pain relief. House brands (or generics) of these medicines work just as well and may save you quite a bit of money. Take these with food as they can cause stomach upset.
It’s also a good idea to keep hot and cold packs around the house, as well as a supply of bandages, braces, and splints to ease the pain of those bumps and bruises acquired during the sports seasons.
Bandages, Braces, or Splints?
Bandages are for covering a wound; they protect against bacterial infection and from bumping into objects that would hurt an open wound. For small cuts or scrapes, a Band-Aid works fine.
Bandages should be changed often. To keep bandaged fingers and toes dry, look for waterproof bandage covers or latex gloves.
Braces can be used to support a weak area of the body, like your ankle or knee, for instance. Many athletes put on a brace, both to protect themselves and to support the site of an old injury. Wrist braces by Futuro are a way for carpal-tunnel-syndrome sufferers to find some relief and prevent further damage. Back and waist braces are a must for those who do heavy lifting and need to give their back muscles some assistance. Fitting a brace requires taking body measurements of the area and using the package guide to determine which size is most appropriate. Taking a tape measure with you to the store isn’t a bad idea. This will avoid having to return or exchange the brace if it doesn’t fit.
Splints are used to completely immobilize an area of the body when moving it could cause further injury. Broken arms are immediately put into splints until a cast can be made. Splints are great for small appendages like broken fingers or toes. Finger splints, found in your local drugstore, are usually made of metal or hard plastic and can be taped for extra support. In a pinch you can even make one out of a plastic spoon and some athletic tape.
Prescription treatments
If the athletic injury results in severe pain, or for pain lasting longer than forty-eight hours, it is a good idea to have it checked by a doctor right away. While it may be a minor sprain or a bruise, it might also be a broken bone that must be set.
Your doctor may prescribe a pain medication, like Vicodin, which contains a combination of pain relievers: acetaminophen and the stronger narcotic hydrocodone. Muscle relaxants, like Flexeril (cyclohenzaprine) may also be called for. These medicines can make you very sleepy and groggy, so use care when doing any activities that require concentration, like driving or operating heavy machinery.
Muscle pain that persists, or tendons that become irritated and inflamed, may be treated with prescription corticosteroids, like methylprednisolone, which can bring down the swelling and quickly relieve the pain. Corticosteroids can cause stomach upset, so be sure to take them with food—and exactly as prescribed by the doctor.
Backache
Q. My back aches constantly. I do some light lifting at work, which hurts, and picking up my two-year-old daughter can be very painful. Also, I stand up most of the day. I’ve been to the doctor and he says there’s nothing physically wrong, just to take an over-the-counter painkiller. Which one is the best?
A. It certainly sounds like you have a busy life! The constant pain of a backache is often enough to take the joy out of everyday events, and that’s not good with a two-year-old to play with and care for. Let’s find out what drug treatments seem to work best—and even explore ways to stop the pain without taking medication.
What Causes a Backache?
A backache can be a sign of a serious problem or simply the body’s way of saying, “Take it easy for a while.” We depend on our back muscles for everything from support in sitting to lifting a bag of groceries. If you’ve already been to the doctor and ruled out a more serious medical problem, maybe it’s time to find the source of your aches.
Backache can be caused by many factors, including weight gain, weak abdominal muscles, poor posture, or lack of exercise. Combine those factors with standing all day and the strain of sudden lifting (like picking up and hugging your little daughter) and you often get back pain.
How Are Backaches Treated?
Non-drug treatments
One of your first (and ongoing) steps should be to very gently stretch and strengthen your abdominal muscles. This will provide the back with the muscle support it needs to carry its everyday load without strain. Try some abdominal crunches every morning when you get out of bed. These are easy: Lie flat on the floor on your back, pulling your knees up to a comfortable bent position, with your feet flat on the floor. Cross your hands over your chest or abdomen and gently lift your head and chest up to your knees for a count of three, then slowly roll back down. Start slowly and gradually until the number of repetitions you can do is twenty or more at one sitting. You will be surprised at how quickly your stomach muscles are able to support your frame without strain or pain.
Before you go off to the pharmacy aisle to stock up on pain relievers, you may want to try moist heat on the aching area of the back, or a nice warm bath with Epsom salts, sprinkled with lavender or St. John’s wort aromatherapy oils. These provide a relaxing time-out from a sometimes hectic lifestyle. It has been shown that many people respond as well to these forms of relaxation as they do to medicines. It certainly won’t hurt to give them a try! If your schedule doesn’t permit the luxury of these “complementary” healing methods or if you’re still skeptical, there is still quite a bit to choose from in the pain-reliever category.
OTC treatments
There are many types of pain relievers and it seems that more brands are being produced each day. Aspirin, acetaminophen, ibuprofen, ketoprofen, and naproxen are the main staples of the over-the-counter analgesic (or pain-reliever) category. They are not, however, equally effective for your specific back pain.
Acetaminophen is effective as a pain reliever for muscle and backaches and may be easier on your stomach, but it has no ability to bring down painful inflammation or swelling. Acetaminophen and alcohol don’t mix well, either. There is a danger of liver damage for those who take acetaminophen and consume more than three alcoholic beverages a day.
Only aspirin, ibuprofen, ketoprofen, and naproxen are classified as nonsteroidal anti-inflammatory drugs or NSAIDS for short. These drugs have the characteristic of bringing down swelling (inflammation) commonly associated with tendon, muscle, and joint pain. NSAIDS also help to decrease the body’s sensation of pain by blocking chemicals called prostaglandins. Using NSAIDS for long periods of time may cause stomach irritation and even lead to stomach and GI bleeding. Taking these medications with food may prevent both stomach upset and possible ulcers. Look for brands like Aleve (naproxen sodium) with twice-a-day dosing (once every 12 hours). Now in your busy day you only need remember to eat at 12-hour intervals!
Prescription treatments
If these OTC medications don’t help your back pain, I would advise going back to your doctor or another physician for a second opinion. There are muscle relaxants (like cyclobenzaprine) or pain relievers (like Vicodin) that may be prescribed. For severe pain, your doctor may try to treat the pain with a direct injection of a steroid into the painful area. In cases that fail to respond to all drug therapy, surgery may be required.
The Drug Lady Recommends . . .
Before turning to prescription muscle relaxants or painkillers that may leave you groggy and feeling “spaced out,” you might want to try a chiropractor. These health practitioners are specially trained in the adjustment and realignment of the back. Chiropractors spend many years perfecting their therapy and often can find exactly where some forms of back pain originate and move the body back into the proper alignment for relief. This therapy isn’t appropriate for every type of back pain, but it may be an alternative to consider. After speaking with your doctor, of course.
Fibromyalgia
Q. After many months of pain, my wife was diagnosed with fibromyalgia. We don’t know much about it. Are there any effective treatments? Can it be cured?
A. The pain your wife is experiencing is shared with nearly six million other people, mostly women between the ages of twenty-five and forty-five. Medical science often has a unique way of working: Trace a disease to a cause, then find a cure for that cause. But because we don’t know exactly what causes fibromyalgia, there is little available in the way of a cure. That doesn’t mean the symptoms can’t be treated and eased, but this pain will probably be with her for some time. The good news is that there is no long-term damage caused by this condition and with proper treatment the symptoms can be decreased a great deal.
What Is Fibromyalgia?
This condition of muscle pain, stiffness, and fatigue very closely resembles chronic fatigue syndrome (CFS). The pain may be in the form of a deep ache or a burning sensation. Certain areas of the body, like the rib cage, the back, and muscles at the back of the head, may be sensitive and painful to the touch. Other symptoms that may accompany fibromyalgia are the inability to sleep (insomnia), depression, swollen glands, and abdominal pain. Some of those who suffer from this condition notice that certain smells, bright lights, or loud noises seem to make it worse. As of yet there is no known cause for fibromyalgia; the scientific community has speculated on everything from poor circulation to a condition where chemicals in the brain slowly change form, causing intense muscle and joint inflammation.
Diagnosis is made by referring to a list of eighteen regions of the body—such as the second rib, base of the neck, or the middle of the knee—and determining where muscles, tendons, or bones are tender or painful. If eleven of the eighteen areas are checked, the doctor diagnoses fibromyalgia.