Ask the Doctor – Chronic Pain

Chronic pain is a problem for 23.5 million Americans. The most difficult part of a chronic pain diagnosis is the lack of knowledge on the issue. Doctors Bradley Galer M.D. and Charles Argoff M.D. however are trained and ready to help you deal with pain in Defeat Chronic Pain Now! Here are some common questions and their answers.


Q: What do you typically recommend for your  patients with back pain?

A: Luckily, we’ve worked in multidisciplinary pain centers with a team of experts including physical therapists, pain psychologists, and others. most often, we prescribe a topical drug or an oral NSAid or COx-2 drug. And we always have our back pain patients begin an active pT program. We also most often have each patient assessed by a pain psychologist and treated for any psychological condition he or she may have due to the back pain.

Q: How do I avoid developing neck pain associated  with my occupation?

A: Remember, you have neck muscles that need to move on a regular basis. In this day and age of computers, we all need to remember to stretch our necks every ten to twenty minutes.

Q: Motrin, advil, topical NSaIDs, and acetaminophen have all stopped working for my Oa knee pain. What’s my next step?

A: There are actually still several very good treatment choices for you. You could try lidoderm, tramadol,  duloxetine, or opioid medication to see if these can give you good pain relief without bad side effects. Also, you can try hyaluronic acid joint injections. if these fail too, and your pain and disability are severe, you may be a candidate for knee replacement surgery.

Q: My mother had RA. Will I definitely get it when I’m older?

A: No. Though the chances are better than 50/50 you will eventually have RA, some things cannot be predicted, such as at what age you may develop symptoms of RA, how severe a case of RA you may get (less or more serious than your mother), and if you develop RA what the rate of progression will be.

Q: What is a typical drug regimen for a patient with PhN pain?

A: We need to reiterate that every patient should be on the least amount of medication that provides the best balance of good pain relief and few if any side effects. However, many pHN (and other neuropathic pain) patients may need several drugs. We always try a topical drug first, usually the lidocaine patch 5% (lidoderm). if that gives some good relief but the patient is still suffering from moderate pain, we’ll add one oral medication, either gabapentin (Neurontin), pregabalin (lyrica), or duloxetine (Cymbalta).

Q: In managing any type of headache, should certain medications be avoided in women who are pregnant? If so, which ones?

A: Unfortunately, all of the prescription drugs, both acute and preventive medications, should be avoided. Pregnant women should seek out and try non-medication therapies, all of which can be very effective.

Q: My doctor has kept me on the same medications to treat my pain for three years. I am not sure if they’re helping me anymore. what should I do?

A: First, remember all medication changes must be reviewed with your doctor and she or he has to agree to such changes and monitor every change. This is a very good question that many patients have or should be asking themselves. Any medications you take (whether for pain or any other condition) should only be taken if it is helping and not hurting you. For pain, that usually means that it is providing at least 30% pain relief and has no bad side effects. However, sometimes patients after a while aren’t sure if the medication is working. The best way to tell is to see what happens as you slowly decrease the dose—does the pain get worse? Again, this must be done under your doctor’s supervision. The good news is that if your current treatment is not helping you as much as in the past, it is likely that your doctor can consider a newer regimen that may be more helpful.

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chronic-pain-coverIf you are one of the millions of people suffering from chronic pain, it can often seem as if your discomfort is running—and ruining—your life. Maybe you’ve even been told that “it’s all in your head” and you just have to endure the debilitating effects of migraines, arthritis, back and neck pain, and chronic illness. You can feel good again! Defeat Chronic Pain Now! is your survival guide to preventing, reversing, and managing chronic pain.

Referencing breakthrough medical research, two of the leading pain specialists in the field, Bradley S. Galer, M.D., and Charles E. Argoff, M.D., present hidden and little known causes of common chronic pain conditions, how to avoid misdiagnosis, and the latest treatments under development including:

—Myofascial Dysfunction: The real (undiagnosed!) culprit in 90% of Back and Neck Pain

—DMARDS and NSAIDS: Two breakthrough drugs that promise significant relief for Arthritis

—Nutraceuticals: The natural wonder treatment for Peripheral Neuropathy

—Focal heat trigger-point (FHTP) therapy: The new drug-free approach to Migraine relief

The first practical book on integrative pain management, Defeat Chronic Pain Now! gives you the latest information on surgical options, new medications, complementary therapies, and psychological interventions that can be used to rewire your body for pain relief. For each condition and procedure, you’ll learn what to expect in the hospital and the doctor’s office, and what self-therapy solutions you can do on your own. Detailed illustrations and easy-to-understand descriptions help you select the best treatment options to improve your unique type of pain and take back your life.