Chronic Pain

Easing Chronic Pain With Anti-Inflammatory Drugs
Even mild chronic pain, whether from arthritis, migraines, or another condition, can be debilitating. So it makes sense to take a pain reliever to make the hurt go away. But when you walk down the aisle of your local drug store, there are many pain pills to choose from. How do you know which pain pill to choose? And just what is the difference between aspirin, acetaminophen, and ibuprofen?

Aspirin and ibuprofen belong to a large class of drugs known as non-steroidal anti-inflammatory drugs, commonly called NSAIDs. NSAIDs and acetaminophen can block pain and reduce fever. Together, they make up the most widely used group of drugs for treating pain conditions. Here's information you can use in working with your doctor to find out if these pain pills are right for you.

How Do Anti-inflammatories, or NSAIDs, Differ From Acetaminophen?
The primary difference between NSAIDs and acetaminophen (Actamin, Pandadol, Tylenol) lies in the way each relieves pain. Acetaminophen works primarily in the brain to block pain messages and seems to influence the parts of the brain that help reduce fever. That means it can help relieve headaches and minor pains. But it's not as effective against pain associated with inflammation.

Inflammation is a common feature of many chronic conditions as well as injuries. NSAIDs reduce the level of certain chemicals called prostaglandins that are involved in inflammation. Treatment with NSAIDs can lead to less swelling and less pain.

What Are Some Examples of NSAIDs?
You are probably already familiar with several types of NSAIDs. For instance aspirin is a widely used pain pill and at one time, aspirin was the only NSAID available without a prescription. Other NSAIDs, such as ibuprofen or naproxen sodium, began as prescription drugs. Now they are sold, usually at a lower dose, as over-the-counter pain pills.

Other examples of NSAIDs include:

diclofenac (Cambia, Cataflam, Voltaren)
etodolac (Lodine)
fenoprofen (Nalfon)
flurbiprofen (Ansaid)
naproxen (Anaprox, Naprosyn)
oxaprozin (Daypro)

Some pain pills, such as Excedrin Migraine, combine an NSAID, in this case aspirin, with acetaminophen.

Another kind of NSAID, available only by prescription, is known as a COX-2 inhibitor. These medicines provide pain relief like other NSAIDs, but they are less likely to cause stomach problems. The only COX-2 inhibitor available in the U.S. is celecoxib (Celebrex).

How Do I Know Which NSAID Will Work for My Chronic Pain?
The effectiveness of any particular pain medication varies from person to person. So it may be necessary to try several different medicines at various dosages. Side effects, and their severity, vary from person to person. You may not be able to take a particular NSAID because your body can't tolerate it. At the same time, your neighbor may take it and have no problem at all.

Whether you should take an over-the-counter pain reliever or a prescription-strength NSAID also varies from person to person. Remember, over-the counter painkillers are still medicines. They may be cheaper than prescription medicines and you don't need a doctor's prescription to buy them, but they can still have major effects on you. That's especially true if you are going to take a pain pill long term for chronic-pain. If you need pain medicine for more than 10 days, talk to your doctor to see which one is right for you.

How Do I Know Which NSAID Will Work for My Chronic Pain?
Your doctor should know all the medicines you take. Your doctor can advise you if the NSAID may interact with other medications you take. Also, your doctor can suggest the right dose for you. As you continue to take the medicine, your doctor can also monitor its effect, and raise or lower the dose as needed.

Before recommending a specific pain pill, your doctor will want to consider:

your medical history
past surgeries
your current health concerns
allergies and past reactions to drugs
other medicines you take
the functioning of your liver and kidneys
the drug's expense
your overall treatment plan and goals
When you talk with your doctor, be sure to ask about anything you don't understand.

Are There Side Effects and Special Cautions Associated With NSAIDs?
Specific side effects vary from drug to drug. For instance, some NSAIDs are harsher on the stomach than others. But there are certain side effects that are common to NSAIDs as a class. Serious side effects include:

bleeding problems
damage to the stomach and small intestine lining that can lead to ulcers
kidney disease
elevated blood pressure
muscle cramps
hearing problems

Other less serious side effects include:

dizziness or headache
nausea
excess gas
diarrhea or constipation
extreme tiredness or weakness
dry mouth

Your doctor or your pharmacist can give you specific information about the side effects of the particular drug you are taking.

In addition to side effects, there are serious health risks associated with NSAIDs. It is important to talk with your doctor before taking NSAIDs if any of the following apply to you:

You are allergic to aspirin or any other pain reliever.
You have more than 3 alcoholic drinks a day.
You have stomach ulcers or bleeding in your digestive tract.
You have liver or kidney disease.
You have heart disease.
You take blood-thinning medicine or have a bleeding disorder.

Although aspirin taken in low doses with a doctor's supervision can help protect some people from heart attack, certain NSAIDs can increase your risk of heart disease and stroke. They can also interfere with blood pressure medicine, making it less effective.

Children and teenagers under the age of 18 should not take aspirin unless their doctor says to. There is a risk of Reye's syndrome, a potentially fatal disease.

So Should You Take an NSAID to Manage Your Chronic Pain?
Anti-inflammatory drugs have a long history of success. Many people are able to manage their chronic pain quite well using NSAIDs as part of their management plan. For most, side effects, if any, are minor. But all medications have associated risks. All medications also have benefits. Deciding to take an NSAID or any medication involves weighing the risk against the benefit.

Eli Lilly, of Eli Lilly and Company once stated, "A drug is not a drug, unless it has a side effect."

Belly Fat

Excess accumulation of belly fat is more dangerous than excess fat around your hips and thighs. Belly fat is associated with serious health problems, such as heart disease, stroke, and type 2 diabetes. Your genes can contribute to your being overweight and help determine where you carry this extra fat, but poor lifestyle choices are likely to worsen the issue.

Eating high-fat foods is not helpful, but excess calories of any kind can increase your waistline and contribute to belly fat. Still, there is no single cause of belly fat. Genetics, diet, age, and lifestyle can all play a role. Changing dietary habits can help you fight the battle of the bulge and fight belly fat: Read labels, reduce saturated fats, increase the amount of fruits and veggies you eat, and control and reduce your portions.

Excess calories, whether from alcohol, sweetened beverages, or over-sized portions of food, can increase belly fat. Our bodies need calories, yet gram for gram, alcohol has almost as many calories as fat.

Alcohol does seem to have a particular association with an increased waistline, though. In general, that’s because when you drink alcohol, your liver is too busy burning off alcohol to burn off fat, leaving you with a beer belly. Studies show that alcohol can cause you to feel hungry by affecting hormones that regulate a sense of satiety.

Researchers at Wake Forest University found that trans fats, which are created by partially hydrogenated oil, increase the amount of fat around the belly and redistribute fat tissue to the abdomen from other parts of the body. Trans fats may be found in such foods as margarine, pastries, cookies and crackers, and fried and convenience foods.

Green tea, in combination with exercise, could help you lose weight, according to the Journal of Nutrition. Researchers think substances in green tea known as catechins stimulate the body to burn calories and enhance loss of belly fat. Blueberries also show promise, albeit in rodents. In one study, rats bred to become obese were fed either a high-fat diet or a low-fat diet rich in blueberries. Rats fed a blueberry-rich diet had less abdominal fat.

Many fast food options are typically high-fat, calorie-dense foods that are eaten in large portions -- all of which contribute to over-consumption of calories, weight gain, and an increase in belly fat when eaten frequently. Many fast food restaurants don’t provide nutritional information, but studies have shown that when this is available, people tend to pick lower-calorie meals.

According to the American Heart Association, “soft drinks and other sugar-sweetened beverages are the No. 1 source of added sugars in the American diet.” Added sugars mean added calories, something you want to avoid to help with weight loss and cut down on belly fat. Yet, high-fructose corn syrup has gradually replaced refined sugar as the main sweetener in soft drinks and has been blamed as a potential contributor to the obesity epidemic.

Does switching to diet sodas help? Although some research has suggested that people who drink artificially sweetened sodas as part of a calorie-restricted diet do lose weight, other studies have suggested that diet soft drinks could even lead to weight gain. For now, there’s no conclusive evidence either way.

To trim your waistline, add whole grains to your diet. For example, choose brown or wild rice instead of white rice. Refined and other highly processed foods can contribute to weight gain and interfere with weight loss. A study in the American Journal of Clinical Nutrition showed that a calorie-controlled diet rich in whole grains can trim extra fat from the waistline of obese subjects.

Couscous, spaghetti, and corn flakes are made from refined grains (though whole grain options may be available). But popcorn is a whole grain food that can boost fiber. The best way to prepare popcorn is with an air-popper, which requires no oil for cooking. Read labels to see what oils have been added to microwave popcorn.

All else being equal, though, whole grains are better than refined grains because they tend to be high in fiber and take longer to digest. This satisfies your hunger better and helps lower blood glucose levels and reduce fat.

Overall, men tend to store fat in the abdominal area more than women do, thanks to sex hormone differences. Before age 40, women tend to store most of their fat in the hips, thighs, and buttocks. After 40, as estrogen levels drop, body fat is redistributed to the abdomen.

When you lose weight, you’re much more likely to lose it in your midsection. Losing weight on a well-balanced plan will melt body fat, including belly fat. The best way to decrease your waist size is through healthy eating and regular exercise.

Mouth Devices for Sleep Apnea

If you have been diagnosed with obstructive sleep apnea -- a condition in which relaxation of the muscles around the tongue and throat causes the tissues to block airflow to the lungs while you sleep
 -- there are a number of treatment options to discuss with your doctor. Two of the most widely used and most effective are continuous positive airway pressure (CPAP) and dental appliances, or mouth guards.

CPAP (Continuous Positive Airway Pressure)

The most effective treatment for obstructive sleep apnea, CPAP blows air down your throat at night to keep your airways open while you sleep. The treatment is done using a CPAP machine, which consists of three main parts:

• Mask that fits over your nose -- or your nose and mouth -- and is held in place with straps while you sleep
• Motor that blows air
• Large tube called a cannula that connects the motor to the mask

CPAP machines are small, lightweight, and fairly quiet. If you travel, you should take your CPAP with you.

Benefits of CPAP include keeping your airways open while you sleep, easing snoring, improving sleep quality, relieving daytime sleepiness, and lowering blood pressure.

Although you will likely feel better rested and alert once you start CPAP, getting used to the device can take some time. Some people have difficulty sleeping the first few nights of treatment.

Side effects of CPAP use are minor and may include:

• Feelings of confinement from the face mask
• Sore or dry mouth
• Nasal congestion, runny nose, sinusitis, or nosebleeds
• Irritation and sores over the bridge of the nose
• Stomach bloating and discomfort
• Discomfort in chest muscles, which usually gets better after a while

If you are having any of these or other problems, speak to your doctor. An adjustment to your CPAP machine may make it more comfortable. Some CPAP machines have special features such as heated humidifiers to reduce problems such as drying of the airways. Other possible fixes include using a cushioned face mask, chin straps, and nasal saltwater sprays. Your doctor may have additional suggestions.

Mouth Devices

If you have mild to moderate obstructive sleep apnea and can't tolerate or haven't been helped by CPAP, oral appliances may be an effective treatment option.

These devices, which must be fitted by a dentist or orthodontist, and worn in the mouth at night include:

Mandibular advancement device (MAD). The most widely used mouth device for sleep apnea, MADs look much like a mouth guard used in sports. The devices snap over the upper and lower dental arches and have metal hinges that make it possible for the lower jaw to be eased forward. Some, such as the Thornton Adjustable Positioner (TAP), allow you to control the degree of advancement. 

Tongue retaining device. Used less commonly than MAD, this device is a splint that holds the tongue in place to keep the airway open.