Your questions on pain relief

问）我有been diagnosed with arthritis in the spine. This is as a result of muscle spasms in my upper back (which I have had on and off for the last 11 years), sometimes left side and sometimes right. It is now occurring more frequently, and has occurred six times in the last eight months, which last for four to five days, and the pain is quite excruciating. Codeine, diazepam and paracetamol do not ease the situation at all. I have about 30 seconds to do anything before I need to place my hand on my back to help relieve some of the pain. I have had two osteotemies and two total knee replacements and also have arthritis in my hands, so I am quite used to pain, but this is something else and is quite wearing me down. I am wondering if you could throw any light on the situation for me on how to manage the pain?

威尔特郡桑德拉 - 2012年

A)I wonder if the severe pain and muscle spasms are due to ‘something getting caught’ or becoming misplaced in the spine. Sometimes, malalignment can cause such severe episodes, and gentle manipulation (byphysiotherapists, chiropractors or osteopaths) can solve the problem relatively quickly. Sometimes little bits of tissue called plica can get caught up between the small facet joints of the neck. The facet joints allow your head to turn and they depend on the smooth movement of the two surfaces of the joint. If something gets in between the surfaces, then movement stops and pain starts, usually quite dramatically. Again, physical treatments such as gentle manipulation can be of help.

该答案由Philip Helliwell博士在2012年提供，在出版时是正确的。

问）我今年23岁，刚刚被诊断出因舒尔曼病而被诊断出患有脊柱的退化性关节炎。我想知道这有多普遍？我不老了，也没有超重，没有运动损伤，所以我似乎不适合任何常见的关节炎原因。我只是想知道是否可能还有很多像我这样的其他人！

莎拉通过电子邮件 - 2013年

A)Scheuermann’s disease is a benign condition of the spine occurring in adolescents. It consists of inflammation of the outer parts of the spinal bones (vertebrae). It is self-limiting but can cause pain and stiffness when it is active, and can result in the affected person becoming prematurely ‘round shouldered’ due to forward bending of the spine. It is uncommon in its most severe form but I suspect milder, less bothersome cases occur more frequently. In your case, if you had suffered pain and stiffness of the spine in your teens I suspect it would have been picked up at the time. From time to time we see traces of it when taking spinal x-rays for other reasons, and it seems to have passed un-noticed in these people. Whatever the cause of back pain it is advisable to keep the back muscles strong and the spine flexible to prevent future deterioration.

该答案由Philip Helliwell博士在2013年提供，在出版时是正确的。

问）我最近被开处方的止痛药osteoarthritis，但我真的不喜欢服药，并担心服用太多或依赖它们。我怎么知道何时服用太多止痛药？

通过电子邮件命名 - 2016年通过电子邮件

A)简而言之，您不应该在数据包上的指示或在标签上进行规定的药物的说明。

根据我的经验，许多人不使用止痛药in the most effective way to manage their pain, using them too little rather than too much. The reasons for this are often related to myths that exist around painkillers.

Painkillers don't normally mask more serious problems

人们担心止痛药会掩盖更严重的问题。如果您发现自己需要定期进行止痛药一周以上的时间，而没有很好的解释或诊断疼痛，那么值得与您的全科医生，练习护士或药剂师交谈，以适当评估您的问题。

但是通常止痛药不会掩盖更严重的损害。

在正确的时间和正确的剂量使用止痛药

人们担心他们会沉迷于止痛药。这不会在短期内发生，并且大多数按照处方或指示服用的止痛药。

有一些更强的止痛药需要仔细的监测时间长时间，因为身体习惯了将它们放入系统中。但是这些药物仅在处方中可用，应由医生监视以检查副作用，请确保它们仍然必要并评估是否有其他问题存在持续使用。

可以通过医生或药剂师的意见来管理许多强止​​痛药的常见副作用，例如便秘或恶心。

I completely understand why people worry that they'll come to rely on painkillers. But when used properly, at the right time and the right dose, they can help people to get back to normal activities, sleep well and do the things they enjoy more quickly. Unfortunately, people tend to suffer with pain and wait for it to become really bad before taking a dose of painkillers, rather than using the clock to gauge when to take the next dose.

以最低剂量定期使用止痛药

我建议有关节和背痛的人会定期使用止痛药，以控制疼痛所需的最低剂量，并让他们重新恢复正常的活动。有时，这意味着要进行计划 - 如果您的膝盖骨关节炎并且知道您的脚上忙碌了一天，那么值得提前服用止痛药以使您白天保持舒适。背痛也是如此。

In summary I prefer people to use painkillers in a way that allows them to live with less pain and keep doing the things they enjoy, rather than not using medications that can help, suffering with pain and doing less.

该答案由汤姆·马格姆（Tom Margham）博士在2016年提供，在出版时是正确的。

问）我今年55岁，膝盖和手指患有关节炎。不幸的是，当我服用阿司匹林时，我不允许服用抗炎药片。我尝试了各种自然疗法，但没有任何作用。我是一名钢琴老师，您可以想象，我手中的关节里有痛苦和僵硬并不有趣。您有什么可以为我的情况提供建议的吗？

Diana, Kent - 2010

A)没有绝对的理由不将低剂量阿司匹林和抗炎片一起使用，但是由于胃的风险，医生不喜欢这种组合。一些医生可能会说抗炎药萘普生可以用作阿司匹林的替代品。总体而言，全科医生避免了一种趋势non-steroidal anti-inflammatory drugs (NSAIDs)完全可能导致胃溃疡并增加心脏病发作的机会。与任何药物一样，优缺点必须保持平衡。

What alternative treatments could you take? Paracetamol at a decent dose (up to eight tablets daily) may also control your symptoms well. The evidence for葡萄糖胺isn't strong and the same applies to fish oil, but you could try these for a trial period. It's also important to keep the muscles around the joints strong so don’t neglect those exercises, particularly for the knees.

该答案由Philip Helliwell博士在2010年提供，在出版时是正确的。

问）我的丈夫在两个肩膀上都有关节炎，并且有很多疼痛，尤其是在晚上他无法舒适而疼痛使他保持清醒的时候。他服用正常的止痛药，每三个月左右就注射了医生的可的松。但是，尽管如此，这种情况越来越严重，疼痛正在增加。

我们想知道如果the gym and getting advice from them would help, or sauna and steam? He's tried葡萄糖胺但是说这无济于事。我请他尝试按摩，但是我还没有说服他。你会推荐什么？

通过电子邮件 - 2015年

A)Anyone who’s experienced肩部疼痛会同情你的丈夫。日常生活中有很多活动依赖我们的肩膀工作良好。不过，您对去健身房的想法在正确的轨道上。

肩膀是一个惊人的关节 - 将强度与体内任何关节的运动范围最大。然而，我们为这一运动范​​围付出的价格是，关节非常容易出现与肌肉无力或失衡有关的问题，这在痛苦的关节中很快发生。肌肉控制不佳会导致一个不稳定和痛苦的马虎关节。

理疗followed by continued work to strengthen the muscles of the shoulder and keep the flexibility and range of movement is the order of the day here. This can be combined with treatments like injections every now and then as needed to control the pain, so that the exercises are possible.

如果尽管进行了物理疗法和注射等疗法，但事情仍在恶化，那么肩部手术可能是一种选择。骨科医生可以建议关节镜检查（钥匙孔手术）是否有帮助或是否有shoulder joint replacementis required. But technology and expertise in shoulder replacements is many years behind that of knee and髋关节置换。因此，它们更多地用作帮助管理疼痛的最后手段，并且没有原始关节功能之类的东西。

So in summary – press on with exercises, physiotherapy,止痛药并在必要时注射，如果这些事情无济于事，则可以选择手术。

该答案由汤姆·马格姆（Tom Margham）博士在2015年提供，在出版时是正确的。

问）我有osteoarthritis in both knees，不是很严重，仍然可以走短距离。但是，晚上在床上，我倾向于在左膝盖上大约4点或5点醒来，左膝盖疼痛，足以使睡眠困难。您能解释一下为什么我在床上时应该更加痛苦吗？除了服用之外，我能做什么止痛药?

苏珊，赫特福德郡 - 2010年

A)这是一个普遍的问题。发生这种情况的原因可能有很多。夜间疼痛通常是严重程度的指标，用于评估进一步治疗的需求，例如手术。根据您的说法，这可能不适用于您的情况。但是，您的病情可能值得获得医疗“更新”。有时，当疼痛发生时，疼痛几乎没有发生时更明显，但是在这种情况下，人们通常会发现难以入睡。如果您因痛苦而醒来，这表明关节炎已经达到了更高级的阶段。睡前12小时，用长时间的动作持续时间服用药物可能会有所帮助。某些抗炎药是通过这种方式配制的，有些止痛药通常被标记为“修改（或缓慢）释放”。

该答案由Philip Helliwell博士在2010年提供，在出版时是正确的。