MU: What do you say to people with chronic pain who have given up hope of ever feeling better?

Dr. Giaimo: Don’t give up! Throwing in the towel limits any kind of therapeutic endeavor. First, get engaged. Talk to your healthcare provider about the pain you are having. If the provider feels uncomfortable about addressing the issue, ask for a referral to a pain management specialist. There are a number of physicians with this training, and you want to take advantage of their experience.

MU: What can people do to get the care they need?

Dr. Joseph Giaimo

Dr. Giaimo: Two things come to mind: 1) Prior to the appointment, take time to write down all the information that you want to share with the physician. 2) Complete and print out an online pain survey—there’s one at osteopathic.org. Pain is very subjective, and difficult to describe. The short survey helps people explain their symptoms in more objective terms. Patients who walk into the office with these tools in hand are more able to help the doctor help them.

MU: What’s the most common myth about managing chronic pain?

Dr. Giaimo: Probably the most important and common one that I hear is: “Well, I have pain, and it’s just a normal part of my life.” That’s just not true. It is not normal to have pain.

Many also have concerns, some based on fact and some on myth, about becoming addicted to pain medications. But pain medication is not the only treatment out there. We will consider exercise—certainly an adjunct that we all use and should use more; physical therapy, manipulative therapy, acupuncture, and holistic medicine. There’s a host of alternatives that we can attempt to coordinate.

MU: But addiction to pain pills is a real and present danger, right?

Dr. Giaimo: Certainly, there are many so-called pill-mills—providers who inappropriately prescribe pain medications—and patients who suffer the consequences. And I think that scares away patients and physicians who are trying to do the right thing. Generally, medications used under supervision by a physician are well tolerated. There’s a time, particularly after acute injuries, when people require some pain medication. But then there’s a time when patients need to transition to other, less addictive medications.

Again, patients need to be comfortable with the people who are taking care of them. A holistic approach to alleviating pain is more than reaching for prescribed pain medication. Instead, we develop a coordinated plan to rest or ice an injured area, use pain medications and anti-inflammatories as appropriate, and patiently work toward physical therapy without the drugs.

MU: When should a person get professional help for managing pain?

Dr. Giaimo: Any time the pain is unremitting. Of course, chest pain or severe abdominal pain can be life threatening and require immediate medical attention. But other types of pain in a limb or joint that don’t respond to rest, ice, heat, and over-the-counter pain medicine within two weeks should be evaluated, at least at an initial level. Pain lasting more than six weeks becomes more difficult to deal with because supporting muscles start to weaken, and a greater degree of physical therapy and rehabilitation will be required to help the person recover.

MU: What do you look for during an initial examination?

Dr. Giaimo: The initial priority is to determine whether an acute problem, such as a fracture, is causing pain and needs immediate care. In addition, I perform a physical exam to assess nerve involvement. In someone with back pain, a recent onset of urinary incontinence, bowel problems, or dragging the foot while walking could signal significant nerve entrapment problems that also require emergency attention.

MU: What therapies are utilized for chronic back pain?

Dr. Giaimo: In the absence of acute problems, the most effective therapy for chronic pain includes a systematic plan of bed rest, stretching and strengthening exercises, yoga, and dietary changes to lose weight if indicated. Improving body mechanics and sleep habits are also very helpful. If you’re frequently sitting at a desk—and so many of us do—regularly get up and stretch.

MU: Who can best assess and address a person’s body mechanics?

Dr. Giaimo: Osteopathic physicians are well suited for this type of evaluation because, again, their basic philosophy is that the structure and function of the body are integrated. Certainly, other physicians also have good experience and knowledge of musculoskeletal issues, including primary care physicians, chiropractors, and some acupuncturists.

Managing chronic pain is a team effort. There’s no one individual that can do all of this. But out of the gate, I recommend that people experiencing pain see their physician, who can then call together and coordinate an entire team of pain management specialists as appropriate.

Sometimes I refer patients to an anesthesiologist who will inject a painful area for a few weeks of relief while they start to recover from an injury. Acupuncturists can be helpful. Physical therapists can do wonders, particularly with putting together a training regimen.

MU: You are a D.O. What distinguishes you from a Medical Doctor (M.D.), specifically as it relates to chronic pain management?

Dr. Giaimo: M.D.s and D.O.s go to four years in college followed by four years in medical school. An allopathic school for M.D.s focuses on treating a disease state while the emphasis at an osteopathic school is on the form and function of the entire individual. Osteopathic physicians are uniquely positioned for managing chronic pain because it is rarely isolated. More often, something happens in one part of the body that affects other areas. Our approach to pain involves looking at the entire structure of the person rather than the physical pain and discomfort of one region.

MU: Do M.D.s and D.O.s often collaborate?

Dr. Giaimo: They’re very complementary. There was a time when there was a very distinct line drawn between those two entities. But in today’s age of the Internet and electronic medicine, we can and do cooperate. My particular specialty is pulmonary and critical care medicine and our practice has osteopathic and allopathic physicians on staff.

Managing Chronic Pain The Saturday Evening Post

Warming local anesthetics before injecting them significantly reduces the pain of the injection, according to new research published online in Annals of Emergency Medicine.

“Warming an injection is a cost-free step that emergency physicians can take to reduce pain from a shot,” said lead study author Dr. Anna Taddio of the University of Toronto in Canada.  “Patients often dread the sight of a needle, but doing something as simple as warming the injection to body temperature can make a painful part of an emergency department visit more tolerable.”

Researchers reviewed 18 studies involving 831 patients. Warming injections prior to administering them consistently produced a “clinically meaningful reduction in pain” regardless of how the shot was administered and whether a small or large amount was injected.

In the study, injections were warmed with water baths, incubators, fluid warmers, baby food warmers, a warming tray, and a syringe warmer.  Anecdotal reports suggest that some emergency physicians warm injections in their hands prior to administering them.

“Future research should examine the effects of warming local anesthetics for dental procedures and for procedures specifically involving children,” said Dr. Taddio.  “This is an area where a small change may make a big difference for a patient.”

Ouch-less Injections The Saturday Evening Post

On CR’s “Dirty Dozen” list of dangerous compounds are: aconite, bitter orange, chaparral, colloidal silver, coltsfoot, comfrey, country mallow, germanium, greater celandine, kava, lobelia, and yohimbe.

In the US, supplements are considered as foods. Current laws require the FDA to prove that a supplement is harmful, rather than charging its manufacturer to prove the supplement is safe and effective, as is required with drugs.

In 2004, the FDA banned one supplement ingredient (ephedrine alkaloids) based on data showing it posed an “unreasonable risk” for illness or injury, particularly in people with heart failure and high blood pressure.

To find supplements that are most likely to help, and not harm, your health:

Talk to your health care providers about the products you use and the ones you are considering, especially if you are pregnant or nursing, take medicines for a chronic disease, or plan to have surgery.

Look for “USP Verified” on the label. The United States Pharmacopeia sets standards for the quality, purity, and strength of dietary supplements and posts a list of verified products on its website at www.uspverified.org. USP testing is voluntary.

Report problems. Tell your health care providers if you experience any symptoms after starting a supplement. To alert the FDA about serious side effects, go to the FDA website at http://www.fda.gov/medwatch or call  800-332-1088.

Do your homework. Be wary about supplement claims in ads, on TV and by sales staff. Seek out reliable sources for assessing supplements, including www.nlm.nih.gov/medlineplus/druginfo/herb_All.html and nccam.nih.gov/

4 Steps to Safe Supplements The Saturday Evening Post

Be an active partner in your healthcare. Keep track of your medicines and conditions, advises The National Consumers League. Talk to your doctor if your insurance company contacts you about a potential switch. Find out if the new medicine has different side effects or possible interactions with other drugs, supplements, or foods, and what signs of trouble to look for. Your health is the most important factor in determining whether a switch is right for you.

Readers may send their letters to Medical Mailbox, 1100 Waterway Blvd., Indianapolis, IN 46202. Please include mailing address. Via email: medicalmailbox@satevepost.org.

Medical Mailbox supplements the advice of your healthcare provider, whom you should consult for personal medical problems.

Keep Track of Your Drugs The Saturday Evening Post