• Peter A Kechejian MD, CPE

Ask the Pain Expert #1

What can I do for lower back pain caused from sitting with a long drive to work, long work hours at a desk, topped off with a long drive home? - Jennifer

Well Jennifer, all that sitting is certainly putting a strain on your back muscles and putting a lot of pressure on your lumbar discs, and that’s not good. Any time you can get up and walk around a little during the day is a good break from all the sitting, but many times this just isn’t practical during a busy day, so you have to set yourself up with some preventive back pain relief tricks. The first is to make sure your work chair and car seat are ergonomically sound with a soft supportive bottom and an adjustable lumbar support feature. If you have a heated seat feature in your car, that’s a great bonus...the heat can sure take away a lot of that stiffness and soreness from a long commute…and at work, consider an 8-hour heat wrap like ThermaCare that you can pick up at CVS or Costco to put on your back. Another trick is to stretch a few minutes before and after you start your day at work and after the bell rings at the end of the work day. You can take an OTC NSAID that has helped take away pain and inflammation for you in the past, like Ibuprofen and Aleve as needed, or a prescription anti-inflammatory, like Celebrex or Mobic. You can use a TENS unit to relief your low back pain, as needed; this seem to be a popular “go to” for those pain sufferers that like that relaxing pulsating tingly sensation to relax spasm-like discomfort. If worst comes to worst, you can consider a Velcro back brace for support to give your back muscles a break from time to time.



I was recently diagnosed with a popliteal cyst on the back of my left knee. It was caused by the strenuous amount of physical activity I did the few days prior. The cyst ruptured and everything feels much better for the most part. However, some very mild pain/discomfort still remains in the area including the top of my calf as well as the bottom of my hamstring. Is this still fluid? If so, do I need to get my knee drained or will the problem clear up in time like the cyst had done in the first place? And finally, as an avid runner/athlete, is there anything I could do to prevent fluid build-up in my knee from happening again in the future? - Mitch

Well Mitch, this sounds like the classic orthopedic Baker’s cyst diagnosis, which is an out pocketing of the knee synovial fluid into the popliteal fossa behind the knee, leaving you with this popliteal cyst; and it sounds like it popped and drained into the tissue behind the knee and calf and that’s why you’re still a little sore and still feel some fluid back there. Taking a NSAID on occasion, icing behind the knee, stretching your calf a little, getting back to graded exercise with walking, then jogging, then running again would be the general plan of treatment. If the cyst reappears, you can do wrap treatment with a compression wrap, not too tight, you don’t want to cut off your circulation…if that doesn’t work, and the painful cyst persists, then your orthopedist can drain it in the OR and try to suture off the opening that arose from the knee joint; this is a safe, minimally-invasive outpatient procedure. This is your best chance of keeping the cyst from coming back in the future.



Do pain medications usually cause side effects? If so, are they really bad? - Francis

Well Francis, in general, any medication can cause side effects, but pain medications of an opioid-narcotic nature are notorious at causing dizziness, sleepiness, nausea, and constipation in up to 1/3 of patients who try them…and yes, these side effects can be quite troublesome and even dangerous if not kept in check; inadvertent respiratory depression from opioid narcotics are implicated in thousands of deaths/year in this country-bad and sad. Many patients want to stay away from opioid pain meds, and only want to take Motrin or Aleve, thinking these are safer alternatives…but, even these NSAIDs can have difficult to-deal-with side effects of gastric ulceration and bleeding, kidney, and blood pressure issues; in fact, thousands of elderly patients die every year from bleeding ulcers caused by stomach and duodenal ulceration from NSAIDs. Even muscle relaxants and nerve pain agents have side effects. So side effects can be really bad, if not fatal in some.

But not to fear, a balance of not too much and not too little universally seems to work in most pain management programs, like The Pain is the PITS Program!



What's the difference between rheumatoid arthritis and regular arthritis? - Brenda

Well Brenda, first of all there are 100 different types of arthritis, believe it or not; that’s what our rheumatology colleagues tell us. But Rheumatoid arthritis (RA) and Osteoarthritis (OA) are the two most common types, with osteoarthritis (regular arthritis) being much more common in society. The basic difference between the two stems from the source or etiology of the arthritic condition, with osteoarthritis coming from basic wear-and-tear mechanical causes, like OA of the hands, shoulders, hips and knees; and RA is an unfortunate autoimmune disease process that involves the body turning on itself and attacking the lining of joints (hands, feet, shoulders, knees) resulting in pain and inflammation-nasty. In terms of treatment, both start out with NSAIDs, but can eventually progress to needing opioid narcotics; and RA can be treated with specific immunologic medications, both orally and by way of IV infusion care, typically under the care of a rheumatologist.

If you have a slight pull in a hamstring, can you still work thru the pain in order to strengthen the muscle of should rest be the best solution to heal it? - Sammy

Well Sammy, this a great question, because you can go either way with this. If you’re a well-conditioned athlete, and you keep yourself in great shape, you probably have the muscle tone and healing potential to work thru the pain of a slight hamstring pull and it most likely won’t progress to a severe strain and sprain…. now, if you’re a weekend warrior, like most of America, and you’re a little older, heavier, not in good shape muscular-tone wise, then your certainly at more risk of making a slight pull progress to something worse. With this in mind, the best treatment to heal a hamstring pull is to rest it, ice it, compress it, and raise it up (remember the RICE tip) …for a few days; then get back to gently stretching your hammys, and getting back to your old antics…keep having fun out there, but always exercise a little judgement when you don’t feel quite right.



Is the constant cracking sound in the joints a sign of onset Arthritis? - Bill

Well Bill, it certainly could be the start of an arthritic process and it shouldn’t be considered normal and you have to live with it. The noisy cracking is also called crepitus in medical circles, and represents fascial tissues, cartilage, and bones around joints, especially the knee, all rubbing against each other and making that characteristic grating noise. And it’s this constant rubbing pathology that leads to the inflammatory pain that starts the arthritic process. So, what can we do about all this? Well, if you have unfortunately already injured a joint and suffer from a lot of crepitus as a result, it’s tougher to rehab from this. Fortunately, if you never suffered from a joint injury, then taking a proactive approach with keeping your weight down, eating right and taking lubricating supplements (like glucosamine and chondroitin), gently exercising (low impact) to keep joints strengthened and conditioned will keep you away from the horrors of facing total knee replacement at an early age. So, keep in shape and pay attention to any noisy joints that might need orthopedic consultation, if you can’t handle it on your own.



I have chronic pain in my neck. Any tips for comfortable sleep with this pain? -Antwon

Well Antwon, let’s assume your neck pain is of musculoskeletal causes, like from myofascial spasms, or from arthritic facet spine joints, or from a degenerated or herniated cervical disc; if this is the case, then your best bet is going to be a mechanical approach with propping your pillow just right so its supportive enough to keep your neck in a neutral position, especially if you are a side sleeper. Before hand, you can take an evening NSAID or muscle relaxant, or opioid narcotic pain killer. Taking sleep supplements can help, like melatonin and chamomile tea. Heat and or ice can help, using your TENS unit, and if you’re a toss-and-turner, consider wearing a soft collar brace to help support your neck. And never forget to always prepare yourself for sleep (good sleep hygiene): keep the bedroom quiet, dark, and cool; don’t drink caffeine at night, don’t exercise strenuously near your sleep time, and so forth…so Antwon, these are some tips you can literally take to bed with you, and have a good night’s rest on the Pain is the PITS Program!



If you have a slight pull in a hamstring, can you still work thru the pain in order to strengthen the muscle of should rest be the best solution to heal it? - Sammy

Well Sammy, this a great question, because you can go either way with this. If you’re a well-conditioned athlete, and you keep yourself in great shape, you probably have the muscle tone and healing potential to work thru the pain of a slight hamstring pull and it most likely won’t progress to a severe strain and sprain…. now, if you’re a weekend warrior, like most of America, and you’re a little older, heavier, not in good shape muscular-tone wise, then your certainly at more risk of making a slight pull progress to something worse. With this in mind, the best treatment to heal a hamstring pull is to rest it, ice it, compress it, and raise it up (remember the RICE tip) …for a few days; then get back to gently stretching your hammys, and getting back to your old antics…keep having fun out there, but always exercise a little judgement when you don’t feel quite right.


THE OVERALL GOAL:  ACHIEVE A LIFETIME OF IMPROVED COMFORT AND QUALITY OF LIFE

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