Pain Archive

Ask the doctor

Q. My brother went to the emergency room because he thought he was having a heart attack. Instead, he was diagnosed with costochondritis. What is that?

A. Costochondritis is caused by inflammation of the cartilage between the ribs and the breastbone, called the costosternal joints (see illustration). This uncommon condition can trigger a stabbing, aching pain that's often mistaken for a heart attack.

Inside your wrist, a slick tunnel passes through the carpal bones. The nerves and tendons of the wrist pass through this space, called the carpal tunnel. One of these nerves, the median nerve, controls sensations in the palm side of the thumb, the index and middle fingers, and half of the ring finger. It also transmits the impulses to certain hand muscles that allow the fingers and thumb to move. Carpal tunnel syndrome occurs when this nerve becomes irritated or squeezed. Symptoms include numbness, tingling, pain, or weakness in the hand of the affected wrist.

Because the carpal tunnel starts out narrow, it doesn't take much to aggravate or compress the median nerve. A number of conditions can make a person more prone to carpal tunnel syndrome. These include:

Aquatic therapy can reduce pain and pressure while providing an effective workout.

When you're struggling with joint pain, gravity can make exercise an unpleasant experience. But exercising in water, also known as aquatic therapy, can change all that. "It enables you to do many of the same exercises you'd do on land without applying the same force on your joints," says Gayle Olson, a certified athletic trainer at the Sports Performance Center at Harvard-affiliated Massachusetts General Hospital.

The condition causes leg pain and fatigue that make activity difficult, but lifestyle changes can improve how you feel.

The occasional leg pain or stiffness is often not cause for concern, but if pain or fatigue develops after just a few minutes of walking or climbing stairs, it could be an early sign of peripheral artery disease (PAD).

"PAD not only interferes with an active lifestyle, but also can put you at higher risk for a heart attack and stroke," says Dr. Michael Belkin, chief of the Division of Vascular and Endovascular Surgery with Harvard-affiliated Brigham and Women's Hospital. "You can't cure PAD once it occurs, so you want to take measures to avoid it as much as possible."

Pain relief creams and ointments can get the medicine right to where it hurts, and the smell is often familiar and soothing. But do they work?

When something like a knee hurts, there's a natural tendency to rub it. And if it really hurts, most of us will think about popping a pain-relieving pill of some kind — acetaminophen (Tylenol) for starters, or perhaps one of the nonsteroidal anti-inflammatory drugs (NSAIDs) like aspirin, ibuprofen (Advil, Motrin), or naproxen (Aleve, Naprosyn).

The CDC’s Guideline on Prescribing Opioids for Chronic Pain helps doctors and patients manage treatment at safe levels and avoid dependence. Any plan to taper medication dosage should be personalized to the patient’s needs.

News briefs

Many people use psychological techniques to help them cope with chronic pain. But which approach is best? A study published Jan. 31, 2019, in the journal Evidence-Based Mental Health offers insight. Researchers analyzed 21 randomized studies focusing on the effect of either cognitive behavioral therapy (CBT), to redirect pain-related thoughts and behaviors, or mindfulness-based stress reduction (MBSR), combining yoga and meditation to build awareness and acceptance of moment-to-moment experiences (including pain). The result: There was no clear winner. Both approaches reduced pain and depression and improved physical functioning compared with usual care or no care. The authors say the findings are important, since CBT is considered the go-to psychological technique for chronic pain. But MBSR should be considered as an additional tool, they suggest. Want to try it? Many hospitals, universities, and meditation centers offer MBSR programs. You can also search for MBSR videos and classes online.

In the journals

Lack of sleep may make you more sensitive to pain, according to a study in the Jan. 28, 2019, issue of The Journal of Neuroscience.

Researchers found that poor sleep interferes with certain pain centers of the brain and can change how a person perceives and reacts to discomfort. In the study, scientists scanned the brains of 25 healthy adults in two sleep environments: first, after they slept eight hours, and again after they were kept awake for 24 to 28 hours. During both scans, they also received uncomfortable levels of heat to their legs.

Peripheral artery disease is serious but preventable.

As people get older, they sometimes shrug off painful cramping in their calves when they walk as a sign of age or overexertion. But it can be a symptom of a more serious condition known as peripheral artery disease, or PAD.

PAD is a condition in which fatty deposits collect in arteries outside the heart — most commonly in the legs — and reduce blood flow in that part of the body. Doctors used to think PAD mostly affected men, but when researchers began to include more women in their studies, they learned that the condition is just as common in women, affecting one in every 10 women over age 50 and one in every five over age 60, says Dr. Aruna Pradhan, a cardiologist and assistant professor of medicine at Harvard Medical School.