Pain Relief
Pain Relief "Rub it," Mama says when her bambino falls down and goes bump. It''''s a common mom command. Like "Stand up straight" or "Eat your veggies," it''''s one of those mom-isms that has turned out to be medically correct.
The father of medicine would have made a good mother, too. "The physician must be experienced in many things but most assuredly in rubbing," said Hippocrates, "for rubbing can bind a joint that is too loose and loosen a joint that is too rigid."
The way rubbing works actually tells us a lot about the way pain--and pain relief--travel through our bodies, according to Margaret A. Caudill, M.D., Ph.D., co-director of the Arnold Pain Center at Deaconess Hospital in Boston, assistant clinical professor of medicine at Harvard Medical School and author of Managing Pain before It Manages You.
Say you bark your shin on a low coffee table. Three different kinds of fibers--all serving various functions--immediately come into play.
First, pain receptors on your skin yelp the news to sensory nerves rich in A-delta fibers that pick up the message. The yelp speeds along the nerve highway at the equivalent of 40 miles per hour and swerves into your spinal cord, which rockets the pain message to other nerves or to your brain.
Right after that sharp flash, you feel another kind of pain--a low, aching, dull throb. That little number is made up of a power brigade of signals that tread along the nerve highway of C fibers at a more placid three miles per hour.
But suppose you rub your shin as soon as you hit it. The rub sets off touch fibers--the A-betas. "Those fibers race at 200 miles an hour to the spinal cord and, theoretically, compete with the pain message," says Dr. Caudill. You''''ll know those touch fibers won the race when the rub soothes away the pain.
The Chemistry of Pain
But pain is useful, too. Pain warns you to take your hand off the stove burner, to take care of your back or to find out why your head aches. Often what makes you hurt also
You can feel some kinds of "referred pain" in surface areas of your body that are far away from the organ that''''s actually hurting. The illustration above shows where referred pain can be felt on the front of your body. | /td> | 
Some skin regions on the back of your body also get referred pain from internal organs, as shown above. If these areas hurt frequently, be sure to alert your doctor. |
starts to cure you. Those pain messages provoke production of a chemical that sounds like an old sitcom--bradykinin. This powerful chemical unleashes a torrent of inflammatory chemicals, such as histamines and prostaglandins. They heal but they also hurt.
Once you''''ve been warned, and pain has your attention, your body''''s phenomenal pharmacy starts to kick in. Scientists have discovered that every one of us can make at least eight natural morphinelike opiates, all stronger than the opium from any poppy plant in China. In fact, narcotics such as morphine and codeine work by mimicking our inborn opiate action.
Endorphin is one brain chemical in our home-brewed batch--it''''s responsible for the famed runner''''s high. Enkephalin is another. "Actually, we found the morphine receptors in the body before we found the opiates. We wondered why in the world they were there, until we found endorphin," says Dr. Caudill.
Endorphin and its sisters start to loosen the pinch of pain. Another brain chemical, serotonin, dubbed the "feel-good" chemical, starts tamping down the pain, too. Normally, that''''s the typical tale of pain. As we get better, the pain diminishes.
When Pain Keeps Preying
Sometimes, though, pain settles in and gets stuck on the replay button. That''''s the case with more than 45 million Americans who suffer from chronic headaches and another 22 million who have recurring back or neck pain--our most common problems.
"What happens with chronic pain is that the pain mechanism itself goes awry. The symptom itself becomes the disease," says Dr. Caudill. Often chronic pain has no clear-cut cause or source. But researchers are discovering the mechanics of chronic pain: an injured pain nerve that gets stuck on go, "like a broken thermostat," she says.
Chronic pain can bring in its wake even more symptoms--exhaustion and sore muscles (if they haven''''t shown up already) and even insomnia and depression. Luckily, most pain doesn''''t reach that stage. No matter what kind of pain plagues you, there are remedies that you can try at home. (See your doctor if they don''''t provide relief.)
Rub-A-Dub-Dub
Massage may be the most ancient and natural pain reliever of them all. Even in 2598 B.C., massage was known--and mentioned in a Chinese tome, The Yellow Emperor''''s Classic of Internal Medicine. Temple carvings in India show the great Buddha himself in a state of bliss as he gets a massage.
"Everybody is capable of doing massage on herself or others," says Joan Johnson, author of The Healing Art of Sports Massage and director of Sports Massage of the Rockies in Boulder, Colorado. Here are a few of her self-massage pain-relief techniques.
Play lower-back tennis. To loosen a stiff back, lie on the floor with your knees bent, your feet apart and your hands on your chest. Then position a tennis ball directly under the area you want to massage. Rest as much of your body weight on the ball as you can without feeling uncomfortable. Roll your back in a small circle around the tennis ball, then reposition the ball on other areas of your back for more self-massage. Massage each spot for a minute or two--but let your body be your guide.
Be nice to your neck. To massage a stiff neck, stand up straight and reach your right hand over your right shoulder and around to the back of your neck as shown on the opposite page (top left). Press four fingers firmly into the area of your neck directly below your skull, about an inch from the big knob that you can feel on your backbone. The points you want to massage, midway between the bottom of your skull and the top of your shoulder blade, are part of the trapezius muscle.
Hold your fingers at the starting point for a few seconds, then slowly tilt your head away from your hand while you drag your fingers down closer to your shoulder. Repeat on your
For a great neck massage, press and drag your fingers in the area shown while tilting your head away. | /td> | 
To massage the tension out of taut shoulder muscles, rock your fingers back and forth as indicated by the arrow. |
left side using your left hand. Do this massage for several minutes, alternating sides. Rock your shoulders. Sometimes your shoulders are so tense, you can almost feel the weight of the world pressing on them. To banish that burden, stand up straight, reach your right arm across your chest and press the fingertips of your right hand into the muscle at the top of your left shoulder as shown (top right). Rock your fingertips backward and forward to massage the muscle. Then repeat using the left fingertips on your right shoulder. Continue to massage for several minutes.
Putting the Pressure On
Western medicine is slowly accepting the hallowed pain-relief methods of the Chinese: acupuncture and its do-at-home variation, acupressure. Both forms rely on stimulating any of the body''''s 361 acupoints, which lie along 14 lines of energy that the Chinese call meridians. In Eastern therapy, pressure at any of these points restores the proper circulation of the body energy called qi (pronounced chee), says Patrick J. LaRiccia, M.D., director of the acupuncture pain clinic at the Hospital of the University of Pennsylvania in Philadelphia.
"The Western theory is that acupressure releases endorphins, the body''''s own painkillers," says Dr. LaRiccia. Researchers have found that many acupoints correspond to neuron motor points, where large nerves meet muscle or bone. And meridians may be what scientists now call nerve pathways. In any case, numerous studies have found the venerable practice helps 56 to 85 percent of people with chronic pain.
Here are some ways to find relief.
Heal your head. Next time you have a headache, use this acupressure technique from David Nickel, O.M.D., doctor of oriental medicine, licensed acupuncturist and author of Acupressure for Athletes. Sit down and loosely cup your hands over your ears and the sides of your head. Position your thumbs at the base of your skull, about 1½ inches from the center of the back of your head.
Using your thumbs, apply pressure slowly, gradually increasing force. "Press for five seconds and gradually release for five seconds," says Dr. Nickel. "Exhale forcefully through your mouth as you press, and inhale gently through your nose as you release. If you notice significant relief, that''''s all you need to do. If you want to induce more relaxation or if you didn''''t get quick results, keep your thumbs in position and repeat the routine.
Harass heel pain. If your heels ache after too much standing or walking, Dr. Nickel recommends this exercise.
Sit down on a rug or mat with your legs comfortably open and move the foot that hurts close to your body--but not uncomfortably so. Grasp that foot with both hands.
Relieve heel pain by pressing as shown on the acupressure point on the sole of your foot. | /td> | 
Pinch the area around your kneecap as shown to help relieve the pain of knee injury. |
Your fingers should be on the top of your foot and your two thumbs on the bottom--over the end of the heel bone that''''s closest to the center of your foot. Position one thumb over the other for more pressure, then press for five seconds and release for five seconds. Continue for up to a minute, using Dr. Nickel''''s breathing technique at the same time--exhaling through your mouth as you press, inhaling through your nose as you release. Rework runner''''s knee. If you''''ve injured your knee while running or jumping, here''''s an exercise from Dr. Nickel to press away the pain.
Sit down on a chair with your legs bent at the knees. If your right knee hurts, use your left hand to pinch your knee with your thumb and forefinger at the base of your kneecap as shown above.
Your thumb and finger should be about 2 ½ inches apart. Using Dr. Nickel''''s breathing technique--exhaling through the mouth, inhaling through the nose--alternately apply and release pressure for five seconds each, for up to a minute.
Ice your ivories. The acupoint on your hand for tooth  |
| The acupressure point called Ho-ku is located on the "web" of your hand. |
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| To relieve toothache pain, press the Ho-ku point with a wrapped-up ice cube. |
pain is in the "web" of skin between your thumb and index finger. With your right thumb, feel along the web of your left hand until you''''re pressing an area near the bone, as shown on the opposite page (top). That''''s the point the Chinese call Ho-ku. At that point, press the area for five-second intervals, again using Dr. Nickel''''s breathing technique. Press that area with an ice cube that''''s wrapped in a napkin or paper towel, as shown on the opposite page (bottom).
Folding and Holding
If you bruise a bone or twist a joint, the muscles around the injury tense up like fullbacks guarding the painful spot. Those hunched-up muscles fire off pain messages, too.
But there is a way to calm down those muscles. "Essentially, you first relax the muscle, pamper it, let the muscle rest and then ask it to gently stretch," says Dale L. Anderson, M.D., biomechanical medicine physician on the complementary (alternative) medicine committee of Park Nicollet Clinic in Minneapolis and author of Muscle Pain Relief in 90 Seconds. "What you''''re really doing is cooperating with Mother Nature and unleashing the ''''physician within.'''' "
Here''''s the technique.
1. Find the tender spot. For most aches and pains, you can usually find a small area of the body that feels very tender. "That''''s the epicenter of the pain--the zinger," says Dr. Anderson.
To find the zinger, press into and around the general area that hurts until you touch the point that hurts most. Then "fold" your body as comfortably as you can around the spot in the direction of the pain. That shortens and relaxes the muscle as much as possible. The muscle will start to feel comfortable and the pain will start to leave.
| The Painkillers Stretching, acupressure, massage and positive attitudes are among the best natural pain soothers. But sometimes the natural remedies don''''t help. Enter medication. Of course, many pain-soothing medicines have been around for a long time, and many have their origin in natural substances. Hippocrates, the father of modern medicine, advised ancient Greeks to chew on willow bark whenever they hurt or felt feverish. It turns out that white willow bark was full of salicylic acid--unrefined aspirin. Even the powerful prescription drug morphine is derived from a flower--the poppy. The Master Medicines There are an abundance of choices among prescription and over-the-counter drugs. Here''''s what some of them can do for you. Acetaminophen. Like aspirin, acetaminophen is an analgesic--that is, a painkiller. Unlike aspirin, it''''s not an anti-inflammatory. Acetaminophen products such as Tylenol work by blocking pain messages to the brain. They''''re a good aspirin substitute for people who have tricky stomachs, according to Tim Covington, Pharm.D., Bruno professor of Pharmacology at Samford University in Birmingham, Alabama. Antidepressants. Tricyclic antidepressants (such as Elavil) work by affecting brain chemicals that control the perception of pain, says Richard M. Linchitz, M.D., medical director of the Pain Alleviation Center in New York City. Doctors often prescribe them for headaches, arthritis pain and neuropathy, a type of nerve pain that is often caused by diabetes. The tricyclics may take days or weeks to become effective. Also, they can cause side effects such as dizziness, dry mouth, increased appetite and weight gain. Aspirin. This century-old wonder drug relieves pain by quickly blocking production of prostaglandins, the chemicals in your body that contribute to pain and inflammation. It can relieve the inflammatory pain of joint injuries or arthritis flare-ups as well as headache. The drawback is that aspirin can upset your stomach, and long-term use can cause internal bleeding. If your stomach is sensitive, use buffered aspirin--but be aware that it takes longer to work, because it slips through the stomach and isn''''t absorbed until it reaches the intestine, says Dr. Covington. Ibuprofen. With product names like Advil and Nuprin, ibuprofen is an anti-inflammatory--and the pill of choice for menstrual cramps and toothaches. Like aspirin, ibuprofen can cause bleeding problems. "However, the side effects of aspirin can last for 10 to 14 days, while the bleeding problems caused by ibuprofen are much more short-lived," says Peter Staats, M.D., assistant in the Division of Pain Medicine, Department of Anesthesiology and Critical Care Medicine at Johns Hopkins University School of Medicine in Baltimore. If you take ibuprofen regularly, it can upset your stomach as aspirin does. Take it with meals, suggests Dr. Staats. Narcotics. Also called opiates, the two common narcotics are codeine and morphine, which are strictly available as prescription drugs. They block pain signals, too, but they''''re much more powerful than acetaminophen. For severe pain, doctors may combine these with other analgesics such as acetaminophen. Narcotics can be addictive. They can also cause drowsiness, dizziness and nausea. Main Meds for Most Maladies With aspirin, acetaminophen and ibuprofen, you have three inexpensive nonprescription pain relievers for almost every occasion. Which is best for each kind of pain? Here''''s an overview. Headaches. For everyday tension-type headaches, each of the three drugstore pain relievers can do the job, says Frederick Freitag, D.O., member of the board of the National Headache Foundation. Minor aches and fever. All three relievers work, but you might want to consider acetaminophen, because it''''s easier on your stomach lining than the others. Toothaches. Ibuprofen is your best bet. It outperformed aspirin and acetaminophen in one study. Sore muscles. Ibuprofen and aspirin have the edge. They are anti-inflammatory agents that help reduce swelling of sore or bruised muscles. Ibuprofen is less irritating than aspirin to most people''''s stomachs. Sprains and tendinitis. Again, aspirin and ibuprofen get the nod, because they help reduce swelling. Menstrual cramps. Ibuprofen is the drug of choice. For best results, start taking ibuprofen three days before you start your period. Cautions Any drug that''''s used for chronic pain can have a potential "tolerance" effect, says Margaret A. Caudill, M.D., Ph.D., co-director of the Arnold Pain Center at Deaconess Hospital in Boston, assistant clinical professor of medicine at Harvard Medical School and author of Managing Pain before It Manages You. "Taking daily painkillers can really cause you problems," she says. "The body has a way of building up tolerance to any drug used to kill pain. Your body may need more and more medication to relieve pain--and it can produce side effects." To prevent a rebound problem, take pain medication no more than three days a week, suggests Alan Rapoport, M.D., co-director of the New England Center for Headache in Stamford, Connecticut, assistant clinical professor of neurology at Yale University School of Medicine and co-author of Headache Relief for Women. This is particularly important for women, who might react more strongly than men to standard doses of many medications. The standard doses are usually based on studies done on men, who are generally larger and heavier than most women. Women have drug side effects about twice as often as men do, doctors say. And women tend to absorb and use more of the medication in an average drug dose. Women also eliminate drugs from their systems more slowly than men do. |
2. Hold the position for 90 seconds. Ninety seconds is the minimum, not the maximum, Dr. Anderson says. You will probably want to continue the hold because your muscle will feel like melting butter. In the fold position, the body is treating itself.
3. Return to normal slowly. In the folded position your muscle forgets its pain, says Dr. Anderson. So awaken it very slowly and gently as you unfold it. "You don''''t want to excite that waking muscle into spasm again."
Learning to Relax
If you have chronic pain, your lifestyle may be contributing to your suffering. Relaxation and sleep could be the keys to relief.
"Many women who suffer from some kind of chronic pain just push through daily living until the pain tips them over the edge," says Dr. Caudill. "But there are basic, commonsense things to do--relaxation techniques, taking time for bubble baths, maintaining friendships and keeping up your social network." In order to find the time to do that, "it''''s very important for women to pace themselves and delegate activities to decrease stress and pain," she says.
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Sleep problems can make pain problems worse, adds Dr. Caudill. She recommends a period of unwinding before you go to bed. "Write in a diary or do breathing exercises."
One method to help release tension is the relaxation response described by Dr. Caudill''''s colleague, Herbert Benson, M.D., at Harvard Medical School in the early 1970s. Here''''s how to do it: Sit or lie down in a comfortable position, relax all your muscles and breathe slowly and deeply. Focus on a phrase or a word and repeat it in your mind each time you exhale. If your mind wanders, gently guide it back to your word.
Don''''t pay attention to thoughts that intrude; just let them passively float through your mind. Practice the relaxation response for 20 minutes once a day or for 10 minutes twice a day, advises Dr. Caudill.
If there are some days when you don''''t have ten consecutive minutes to yourself, here''''s a quick relaxer from Dr. Caudill: Take a moment to tense all your muscles at once, then take a deep breath and slowly breathe out, letting all the tension go.
Tools of the Trade
Gimmicks and gadgets galore promise to vanquish your pain. Some of them only cause more pain--in your purse. Here are two tools that really work, experts say.
Say ahhh with a Thera Cane. The Thera Cane is a hook-shaped plastic rod with small bumps at both ends. Along its length are four smooth-tipped pressure applicators, or pitons. By pressing the pitons against different areas of your body, you can deep-massage muscles that are difficult to reach, including the ones in your back. Simply press the piton into the muscle and slowly rock it back and forth across the tender spot. The tool comes
Made of hard plastic, the Thera Cane has a number of bumps, knobs and handles--so you can apply "deep pressure massage" to different areas of your body. |
with directions and a video. To find out where you can buy one, you can contact the Thera Cane Company by calling 1-800-947-1470. Get some feedback. With biofeedback techniques, you can actually learn how to control and diminish pain by altering your body''''s response to pain signals.
Here''''s how it works. A trained biofeedback therapist hooks you up to sensors connected to a biofeedback machine. The machine can measure muscle tension, temperature, breathing patterns, heart rate or blood flow. If you have back pain or a headache, the biofeedback machine registers it and immediately feeds you audible or visual signals--in the form of beeps or flashing lights.
To get pain relief in the back and shoulder, hold the Thera Cane as shown, applying pressure as shown to "deep massage" the shoulder muscle. Instructions with the Thera Cane describe other positions and pressure points for pain relief. |
Over a period of two to six months, the therapist trains you how to use your body to regulate and control the lights and sounds--and hence your pain. By achieving pain-free state feels like. Eventually, you can reproduce that state yourself and graduate from the machine.
Pain-Free Food
For people who get headaches there are specific foods that can cause pain. Migraine triggers such as red wine and chocolate are infamous. But studies show that some foods do the opposite--and actually increase your pain tolerance, says Dr. Caudill. Here''''s how to sort through the good and the bad.
Talk turkey. Foods such as turkey and milk that contain the essential amino acid tryptophan are terrific. Tryptophan is a precursor to the pain-squashing brain chemical serotonin. It has been used to treat premenstrual problems, depression and drug and alcohol cravings.
| Take Flight from Plane Pain If airplane ear pain puts you off flying, or makes every flight extremely uncomfortable, here''''s a way to tame the problem. Thirty minutes before your flight leaves, take a decongestant that contains pseudoephedrine. In a study of 190 fliers with recurrent ear pain, only 32 percent of the people who received pseudoephedrine before takeoff had ear pain, compared with 62 percent in the placebo group. This research confirms anecdotal reports of the effectiveness of this pain prevention strategy. Decongestants dilate the eustachian tubes and make it easier to clear the ears of the pressure built up inside. The medicine also helps decrease secretions that might block the tubes, says study co-author Jeffrey Jones, M.D., director of the Department of Emergency Medicine at Butterworth Hospital in Grand Rapids, Michigan. But researchers warn against this decongestant if you have thyroid disease, heart disease, high blood pressure or diabetes. In these cases Dr. Jones recommends other ear-clearing techniques, such as chewing gum or yawning. |
A diet rich in tryptophan, high in complex carbohydrates and low in proteins may increase pain tolerance, says Dr. Caudill. She recommends tryptophan titans such as turkey and other lean meats, fish and low-fat or nonfat milk. But the secret to good health and pain relief is simple, general nutrition. "You should always eat a balanced diet and never skip meals," she advises.
Abort alcohol. Many of Dr. Caudill''''s chronic pain patients have found that alcohol makes their problems worse. If you get frequent headaches or muscle pain, try eliminating alcohol and see if you feel better.
If alcohol seems to trigger headaches at some times and not at others, try limiting your cocktails to one glass of dry white wine at a time, suggests Alan Rapoport, M.D., co-director of the New England Center for Headache in Stamford, Connecticut, assistant clinical professor of neurology at Yale University School of Medicine and co-author of Headache Relief for Women.
In general, the lighter the color of alcohol, the lighter the pain reaction. Even if you just have one glass of wine, drink several glasses of water before you go to bed and more water when you get up to rehydrate, suggests Dr. Rapoport.
When the Head Aches
The ancient gods punished offenders for their sins by giving them headaches, our early sisters thought. Later on, Egyptians wrapped their aching heads in their best linen to relieve pain. On top of the wrapped heads, they placed clay crocodiles, with some wheat in the crocs'''' mouths from the gods'''' sacred storeroom.
Modern versions of the cloth and croc still exist. Some women remember their grandmothers tying a rag around a throbbing head. Folks in Latin America sometimes use a live toad on the head instead of a clay crocodile.
| Your Guide to Pain-Free Dentistry If you ever saw the dental-torture scene in the movie Marathon Man, you''''ll never forget it. Laurence Olivier bends over Dustin Hoffman with a drill--and an agenda: As soon as Hoffman spills the beans, Olivier will stop the drill. It''''s a classic fear-monger''''s moment. For most women it doesn''''t take a movie to inspire dental terror. Many of us will do almost anything to avoid going to a dentist. Chances are, no matter how minor the procedure, we''''re probably g
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