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Managing Pain: What's Next, What Works

Stopping Pain in Its Tracks

Another way doctors may be able to reduce the pain their patients endure after surgery could be to give them pain relievers before surgery, rather than after. Mark Lema, MD, PhD, chairman of the department of anesthesiology and pain medicine at Roswell Cancer Institute in Buffalo, N.Y., talked about new research that has shown giving patients pain medication several hours before surgery can not only reduce their pain after surgery, but also reduce the amount of anesthesia needed.

Lema says the body responds to a surgical incision like any other cut or trauma, and the nerve endings swell and become more sensitive to pain as a defense mechanism. By giving pain relievers before the cut is made, doctors may be able reduce that painful response.

"It's like a tree falling in an empty forest," Lema said. "If pain signals go to an unconscious brain, they're still capable of causing damage to the nerve endings."

In the past, doctors were hesitant to give popular pain relievers known as NSAIDs (which include aspirin and acetaminophen) before surgery because they could cause excessive bleeding. But newer, safer Cox-2 pain medications don't carry that risk.

A recent study found patients who were given Cox-2 drugs one hour before minimally invasive knee surgery had an additional six hours of pain relief after surgery and needed fewer pain medications in the days after surgery.

Targeted Exercise Beats Surgery

Some people with low-back pain may be able to avoid painful surgery altogether by following a targeted exercise plan that addresses their pain individually.

"One size does not fit all and there is not one exercise for everyone with back pain," said Joel Press, MD, medical director of the Center for Sports, Spine and Occupational Rehabilitation with the Rehabilitation Institute of Chicago.

"The back is a complicated structure with a lot of potential pain generators that we can twist and turn," he said. That means doctors and physical therapists should work with their patients to determine the exact cause of the pain before developing an exercise plan. Press says many health care providers and patients fall into the trap of thinking there are only a few general exercise that everyone should do.

Instead, Press recommends "directionally preferenced" exercises that direct patients in the opposite direction of their pain.

"That means if someone hurts when they bend forward all the time, then we'll initially move them in the opposite direction away from their pain," said Press. "Progression to strengthening of the hip, back, side, abdominal, and lower-limb muscles, the so-called core muscles, is then addressed."

"Core strengthening can form a 'muscular corset' to protect the back and prevent chronic pain," said Press.

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