Unfortunately, a few weeks ago I worsened an old knee injury. Twisted on a planted knee and likely did some damage to the medial meniscus. It does bring a different level of understanding when it comes to pain and longer lasting pain (in no way am I comparing three weeks of knee pain to someone who has experienced months or years of pain). After a few days of somewhat significant swelling and sharper pain, my knee has turned into a sub-acute phase — dull, mild swelling, more annoyingly the unpredictability of having the meniscus ‘pop’ followed by some sharp pain and reduced mobility until it finds its way back to a less painful position.
As an active person, I can see how this would start to weigh physically and emotionally if it were to continue for months or years. But, what are the options for pain control?
Chronic pain treatment has been in the forefront of medical discussions for years now — the opioid crisis, abuse, overdose deaths and, honestly, holding prescribers responsible for overuse are all pretty normal items in our news and medical journals.
Let’s look at opioids. According to CDC guidelines, in chronic pain they are only first line therapy for active cancer treatment, palliative and end of life care. Acutely they may be used for orthopedic injuries or post-surgical pain, but in the lowest and shortest dose possible.
What does that leave us? Quite a few options, actually; both non-opioids and non-pharmacological treatments have been shown to be effective. When it comes to medications, we all know of acetaminophen and NSAIDs (ibuprofen, naproxen, etc.) and their fairly significant effects for inflammatory pain. If the pain is more neuropathic in nature, then gabapentin or pregabalin are first line. Antidepressants, both TCAs and SSRIs, also work well in chronic neuropathic pain as well as with chronic headaches or fibromyalgia. Lastly, topical agents are an alternative to the oral meds already listed. Lidocaine patches and topical NSAIDs and Capsaicin (think hot peppers!) are available.
Non-pharmacologic treatments are an integral part of treatment as well. Back pain, arthritis pain and fibromyalgia have all been shown to respond well to exercise. Additionally, if you are overweight, you are just adding pressure to those joints, so weight loss is definitely a help. Cognitive Behavioral Therapy and biofeedback have also been shown to be effective.
The most effective regimen is one that uses the correct combination of all of the options. NSAIDs, exercise and weight loss are a good place to start for my knee pain. Physical therapy may be added in the future as well.
If you have some pain issues, go see your provider, try different therapies as there may be one that works that you never have considered. Stay active, and keep an open mind to alternatives.
For more information on pain management, check out the cdc.gov website for chronic pain guidelines.
Have a great week, and be healthier today than you were yesterday!
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