Pain Management

MY APPROACH TO PAIN MANAGEMENT since November 2004 (for acute injuries)

People think they want a life free of pain, but pain serves an important function. Pain alerts us that something is wrong and prevents us from doing further damage. The body is designed to handle pain and to repair itself. The more we take medicine to do its job, the less efficiently it works.

Medicines most frequently used for acute and chronic pain are:
1) Non-steroidal anti-inflammatory drugs [NSAIDs], like Motrin, Aleve, and aspirin.
2) Steroids, like prednisone and cortisone.
3) Narcotics--such as Lortab, Oxycontin, and Vicodin.
4) Acetaminophen (Tylenol)

Why should I consider NOT using NSAIDs? They are anti-inflammatory, therefore, anti-healing. They do help with the pain, but they impair healing.

A couple of years ago, a patient asked me, "If God designed inflammation to heal things, why do we try to stop it?" That question stopped me in my tracks, after treating people with NSAIDs for over twenty years! I had assumed that arthritis is a progressive condition; but, in retrospect, I wonder if we get worse because we interfere with God's plan for healing by slowing the inflammatory process.

God designed the body to repair itself. As soon as we are scratched, the body's defense system springs into action to repair the breach. As soon as we sprain an ankle, our body mobilizes its crew to begin to repair what is damaged. What did people do 200 or 2,000 years ago when they sprained an ankle? They walked as soon as they could, without applying ice, or an Ace bandage, or taking medicine. And I'm convinced they got better much faster than we do.

Why am I convinced? Since my patient's life-changing question, I have not taken a single NSAID. If I strain a muscle, I just let it heal, rather than reaching for the ibuprofen. I am functionally better today, in my fifties, than I was a few years ago.

My advice to my patients:  Pretend you're an old dog. They're pretty good at treating injuries. They lie around and baby the injured limb for a while, then begin to walk on it as soon as they can. Before long, they're chasing rabbits again.

Why should I consider NOT using cortisone (pills or shots)? They are powerful anti-inflammatory agents, which impair the healing process. See above info on NSAIDs.

Why should I consider NOT using narcotics? Besides their potential for being addictive, they mask pain. Pain is given to us to keep us from doing "stupid." If I allow pain to be my limiting factor, I limit my activity according to the injury. If I take a narcotic, and mask the pain, my protective reflex is not there, allowing me to do more than I should, causing further injury.

Why should I consider NOT using acetaminophen? So far, this is the one medicine I frequently suggest, IF something is really needed. But recently I read that there may be an association between frequent acetaminophen use and asthma. (Doesn't everything cause some problem?!)

So, what do I do for pain management? Usually nothing. If anything, I apply heat and use Tylenol. Sometimes the healing process seems slow; but it happens faster when I don't interfere with it.

For strains and sprains:

·                     Use the injured part as normally as possible, as soon as possible. Don't stay out of work if you can go to work.

·                     Let pain be your limiting factor, to tell you how much you can do. If it hurts to do it, but you can do it, it is okay to do it. If you can't do it, don't.

·                     Don't get in the way of the healing process. Let pain be your friend.

It is too early to say whether my NOT-using-NSAIDs approach will eventually show improvement in my joints by X-ray. I hope to see in a couple of more years whether my "degenerative joint disease" (osteoarthritis) has improved, stabilized, or deteriorated. (I know it got progressively worse over the first thirty years.) But I trust my Maker to know best how to fix me.

...For I am fearfully and wonderfully made....  Psalm 139:14

Click here for information on:

Medical Credentials:

MD degree from Medical College of Georgia in Augusta, 1982

Family Practice Residency at Medical Center of Central Georgia, Macon, GA—1982-1985

Board Certified by American Board of Family Medicine—1987-1994, 2006-2013. (Board Eligible 1994-2006)

Family Practice—Nashville, GA, 1985-1994

ADD/Stress Clinic [part-time]—Nashville, GA, 1994-2000

Emergency Medicine—part-time 1994 - present

Urgent Care, Prison Medicine—2005-2006