An increasing number of people are living with pain and seeking relief. The majority of people in pain first seek help from the primary care provider who might not be up to date with the latest information about treating and preventing chronic pain. Here are a few pearls of information that should be passed along to all primary care providers. Your mission is the spread this knowledge because knowledge is a powerful foundation for solutions.  

Prevention

Acute Shingles:                                            

• Everyone over the age of 50 years old needs a vaccine if it is not contraindicated
• Even if the treatment is initiated over 72 hours after onset, use an anti-viral medication when the virus is active and for as long as it is active
• PLEASE prescribe Tri-Cyclic Anti-depressants (Dr. Bajwa at Harvard calls them "Tri-Cyclic Analgesics") to prevent post-herpetic neuralgia.

Diabetic Peripheral Neuropathy and Chemotherapy-Associated Neuropathy

• Natural supplement Acetyl-L-Carnitine is a neuroprotectant that has been shown to prevent painful neuropathy when one takes 1000mg TID

Complex Regional Pain Syndrome

• Vitamin C used early after a trauma or perioperatively can prevent CRPS,especially in regards to the wrist, hand, foot, and ankle.

Treatment

Painful Diabetic Peripheral Neuropathy

Based on clinical evidence the following is a list of medications worth trying:

• First line medications: Duloxetine, oxycodone CR, Pregabalin (however, doses greater than 300mg/day are not efficacious) and TCA's.
• Second line medcations: Carbamazepine, tramadol, gabapentin, lamotrigine, and venlafaxine.

Lumbar Pain

• Strongly urge the cessation of smoking because this lifestyle habit only accelerates the degenerative process.

• If imaging is required, save the patient from unnecessary radiation exposure by skipping the plain x-rays and just getting an MRI.

Fibromyalgia

• Promote aerobic exercise as an important first-tier treatment.

• Look for other causes of pain like statin medication use, hormonal imbalances, vitamin deficiencies and steroid-use myopathy before using this label.

• Encourage meditation to relieve stress because stress can play a major role in nervous system related pain like fibromyalgia.

Cancer Pain

• Prescribe NSAIDs and/or Zoledronic Acid (a bisphosphonate) to treat the pain from bone metastases, a type of pain that often does not respond to opioids.

• Strongly consider intrathecal pump to deliver opioid medications because this technology can prolong life.

Headaches

• Take actions to promote normal sleep patterns in order to treat and prevent headaches, especially in the young.

• Warn patients against the overuse of over-the-counter medications that can lead to rebound headaches.