The best new pain cures, with a focus on women

[Guest guest]

The best new pain cures, with a focus on women

By Haiken

http://www.cnn.com/2007/HEALTH/06/21/pain.remedies/index.html

You've got achy shoulders from carrying the kids, the groceries, or

your incredibly heavy handbag. You look for the right pill to pop,

but what should you take? Aspirin? Ibuprofen? Or, you're about to

get your period. You know you'll get killer cramps or that nasty

headache any minute now, but nothing you take seems to help once the

pain hits.

You're not alone: Many women have a tough time finding the right

kind of relief for their pain --and for good reason: Until recently,

experts hadn't actually studied women's pain specifically, and most

research wasn't conducted with a woman's hormones and physique in

mind. All that's changing, though.

Docs now know that to banish our aches, they must develop treatments

formulated for women's bodies. What's more, researchers are also

looking for -- and finding -- ways to head pain off at the pass, so

those of us with chronic troubles such as migraine, fibromyalgia, or

backache don't have to be hobbled by pain on a daily basis. Here,

how the new research will help you live an (almost) pain-free life.

(Health.com: Smart ways to banish pain )

The prevention revolution

" The old way of dealing with pain was to 'wait until it hurts enough

to treat it,' " says Carol A. , M.D., director of Valley

Neurological Headache and Research Center in Phoenix, Arizona, and

author of " Migraine: Your Questions Answered. " " But in the last few

years, there has been a complete turnaround. Now we know that

prevention and early intervention are absolutely critical. "

The new thinking has made all the difference for Carolyn Robbins of

Petaluma, California, who suffers from chronic back and neck pain,

the result of a spinal-disk injury combined with nerve damage from

Guillain-Barre syndrome. " If you've ever had an exposed nerve in

your tooth, you know what it feels like, " says Robbins, who

describes her pain as " electrical shocks " in her upper and lower

back.

The 45-year-old mother of two doesn't wait until pain hits her full

force before treating it. She now relies on a daily prevention

regimen, starting with a hot shower and a double dose of ibuprofen.

She swims two to three times a week for strength and mobility, and

gets weekly massage and chiropractic treatments. And during those

times when things get really bad, she pulls out the stronger

painkillers prescribed by her doctor. " I've found that it's not a

good idea to try to power through the pain, because other things

start to go wrong, " Robbins says. " Pain depletes your system as much

as exposure to germs. "

Just five years ago, a " kitchen sink " approach like Robbins' might

have been pooh-poohed by pain-management types, who would have been

quick to prescribe hard-core, addictive drugs such as oxycontin for

such a serious condition. But now the focus has switched. " It used

to be, people treated the pain and didn't always treat the

underlying disease, " says.

The problem with such an approach, though, is that it sets up a

vicious cycle of dependence. " Giving narcotic pain pills to headache

patients is like giving cookies to diabetics, " she adds.

So how do you break the habit of heading straight for the medicine

cabinet? No matter what your source of pain, the first step is to

get an accurate diagnosis and then set up an early intervention

strategy with your doctor, says Neil Kirschen, M.D., president of

the American Association of Orthopedic Medicine and chief of pain

management at South Nassau Community Hospital in New York. " The

whole goal of pain management today is to keep pain from becoming

chronic, " he says.

The reason? Pain actually causes the brain to fire off a stress

response that, over time, makes nerves more and more sensitive --

and thus better able to telegraph intense pain to you. In other

words, pain actually begets pain.

Nan Weiner, executive editor at San Francisco magazine, is a case in

point. When she broke her ankle eight years ago, it never completely

healed, and the pain became chronic. What should have been a

relatively simple injury became an odyssey that had Weiner visiting

specialists all over San Francisco. She finally found a podiatrist

who " took a detective-like approach to the problem, " Weiner says, by

exploring and treating each joint and tendon in a methodical search

for the pain's source. Thanks to this care, which includes regular

pain-preventing cortisone shots, the 55-year-old mother of one has

been able to resume her hobby of salsa dancing.

Zooming in on female pain

We know that men don't suffer menstrual pain, but that's not the

only fun they're missing. " Research is uncovering very dramatic

differences in how the genders experience pain, " says Mark

Young, a professor at New York College of Podiatric Medicine and

author of " Women and Pain: Why It Hurts and What You Can Do. "

It all starts with hormones. There is no getting around how

profoundly hormones such as estrogen and testosterone affect the

central nervous system, which is responsible for perceiving and

transmitting the sensation of pain. According to experts, this is

one reason why conditions such as osteoarthritis, headaches, and

irritable bowel syndrome strike women at much higher rates than men.

Our physical differences really matter, too. " We've only recently

begun to grasp that women's body architecture is completely

different from men's, " Young says. Because women walk differently,

for instance, they put pressure on joints, muscles, and bones in

very different ways than men do. " Starting with the knees and hips

and working up to the shoulders, spine, and neck, how a person walks

can have a huge impact on how pain develops later in life, " Young

says. Just last year, one medical-implant maker finally recognized

this fact by creating a knee implant just for women.

Women are also more prone to conditions involving the immune system,

says Deborah Metzger, M.D., an OB-GYN and specialist in integrative

pain management in Los Altos, California. Scientists have long known

that women have stronger immune systems than men, she says. That

strength can backfire, though, leading women to suffer from far more

autoimmune disorders -- in which the immune system attacks itself --

and the host of mysterious diseases thought to sometimes result from

an overreactive immune system, such as celiac disease, irritable

bowel syndrome, fibromyalgia, chronic fatigue syndrome, and many

types of pelvic pain.

" Women tend to have hyperalert immune systems, which is good, "

Metzger says. " But once the immune system gets stirred up, it can

turn into a feeding frenzy. " The fired-up immune activity produces

inflammatory chem­icals that fuel all types of muscle and joint pain;

it can also activate nerves in vulnerable spots like the lower back

(sciatica), the head (migraines), and the pelvis (endometriosis and

pelvic pain).

New relief for headaches

There's good news for women who suffer migraines -- and most other

types of headaches -- which they do at twice the rate of men.

Headaches are one area where the new focus on prevention can be seen

in a host of treatment options, including Botox. Considered

experimental just a few years ago, Botox injections (in which the

botulinum toxin type A is used to paralyze specific muscles in the

forehead, brow, temples, and neck) is now offered by many hospital

pain clinics. Botox is also extremely effective for certain types of

neck pain, such as cervical dystonia.

Another treatment that's crossing over from fringy " alternative "

practitioners to mainstream pain clinics is neuromodulation, a.k.a.

transcutaneous electrical nerve stimulation, or TENS. " Think of TENS

as acupuncture without needles that you can wear at home, " says

ph Shurman, M.D., pioneer of a new pain-management model at

Scripps Memorial Hospital in La Jolla, California, and chairman of

pain management. (Take that! (for pain) )

Extremely effective for neck pain, back pain, and some kinds of

headaches, the treatment involves applying electrodes to the skin to

stimulate particular nerves. " Neuromodulation works by trying to

change the pain message into something else, " Kirschen says.

Acupuncture is also a routine part of treatment in many headache

clinics; it's used in conjunction with pain medication and other

treatments. Women seem to respond particularly well to this therapy,

Young says. " There are certain acupuncture points that are better

for women than for men, " he adds.

Fighting the fatigue

In the past year, some of the biggest headlines in pain management

have been about fibromyalgia (chronic bodywide pain in joints,

muscles, and tendons) and CFS, two conditions that strike women at

as much as six times the rate of men. After years of failing to take

these conditions seriously, the Centers for Disease Control and

Prevention and other groups have recently mounted aggressive public-

information campaigns alerting women to the prevalence of these

conditions and the importance of accurate diagnosis and treatment.

Experts have also made dramatic gains in finding treatments that

work by focusing on the sleep problems and physical weakness that

seem to fuel these diseases. (Could painkillers be hurting your

heart? )

Marly Silverman of Pompano Beach, Florida, learned she had

fibromyalgia and CFS more than 10 years ago. " It felt like acid

chemicals going through my veins, " she says, describing the

excruciating pain that forced her to quit her job as vice president

of a bank after fruitlessly seeking treatment from a variety of

specialists. Today, Silverman manages her pain with a plethora of

remedies, including painkillers, anti­spasmodics (muscle relaxants),

and lidocaine patches for localized pain. To speed research into

these complex and mysterious illnesses, Silverman founded PANDORA, a

patient advocacy and research organization that cosponsors a

national conference on the latest research into these and related

neuro-endocrine immune conditions.

In studying other immune-triggered conditions such as Crohn's

disease -- which also affects women at two to six times the rate of

men -- experts have made a similar breakthrough. Instead of treating

digestive symptoms such as gas, diarrhea, and constipation (common

in Crohn's and IBS), experts realized the culprit might be an

underlying food sensitivity, most likely to wheat gluten, milk

protein, or one of several other common allergens. What happens,

integrative pain specialist Deborah Metzger says, is that an

overreactive immune system protests against the irritating foods,

causing systemic inflammation throughout the body. She says that in

recent years she's had great success by putting patients on the

Sugar Busters diet, which eliminates sugar, white flour, and other

suspect foods. Metzger's advice: Find a doctor who will analyze all

aspects of your lifestyle rather than just medicate pain symptoms.

How to be a good pain patient

There's no question that women aren't always taken seriously when

they ask for help with a condition that doesn't have a clear-cut

explanation. Just ask those with pelvic pain. Chronic pain is bad

enough, but pain down there can be very difficult to describe. " I

see so many patients who come in with pelvic, vulvar, ovarian,

and/or lower-back pain that they've been dealing with for years, but

they can't even tell exactly where the pain is coming from, " Metzger

says. " There are certain nerves on the abdominal wall that tend to

be vulnerable spots. It takes time and patience to pinpoint what's

really going on. "

That's what happened to Jo Ziegler, 39, of Katonah, New York. She

struggled for more than a year with lower- abdominal pain. And it

wasn't until after trying a wheat- and sugar-free diet and having a

colonoscopy that she visited a surgeon who made a correct hernia

diagnosis. One simple outpatient procedure, and Ziegler was rid of

the pain.

Often, the biggest treatment barriers women encounter are plain old

stereotypes: Women are perceived as " emotional " when they try to

talk about what's bothering them, says ph Shurman, M.D., whose

wife, Gloria Shurman, Ph.D., suffers from chronic pain. " But how can

you not get emotional if it hurts, and it seems like nobody will

listen? " Gloria says.

The solution is to take a proactive approach, the Shurmans say, even

if you need to look in the mirror and give yourself a pep talk and

write down a list of symptoms or questions before you head for the

doctor's office. " The most important thing is to be persistent, "

Gloria Shurman says. " If you're in pain, don't ever take no for an

answer. "