YouDocs, 9-24-13: Techniques for managing chronic pain

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Q: I've had shoulder pain for a couple of years, and the constant low-level agony is making me nuts. What should I do? -- Johnny M., Akron, Ohio

A: More than 100 million North Americans live with chronic pain, and, as you indicated, it does a lot more than just make you feel achy. Chronic pain is associated with a three- to fourfold increase in the rate of depression and anxiety, and most folks also have problems with sleep, memory, attention, high blood pressure and resulting cardio problems, not to mention sexual dysfunction.

The most common sources (not related to cancer) are degenerative spine disease, lower-back pain, rheumatoid arthritis, osteoarthritis (perhaps in your shoulder), fibromyalgia, HIV, migraine, nerve pain and complications of shingles.

The first step is to get the right diagnosis from a specialist (maybe a second opinion, too). If pain medications are suggested, ask about a pain-management specialist who knows how to do nerve-dampening blocks and how to safely put you on (and take you off of) potentially addictive drugs.

But we're huge fans of using wellness to control pain!

• Try mind-body therapies: guided imagery, cognitive-behavioral therapy, meditation, breath work, massage and acupuncture. They can break the cycle of pain, then stress that worsens the pain, then more stress and even worse pain.

• Get daily physical activity. You'll dispel stress and build strength. Work with a physical therapist to determine the safest, most effective exercise and to learn how to use the two best short-term pain relievers, heat and ice.

• Adopt an anti-inflammatory diet to help put out the pain fire: Eliminate added sugars and syrups, any grain that isn't 100 percent whole, and trans and saturated fats, and go for lots of omega-3 DHA from salmon and ocean trout two to three days a week, and consider a daily 900-mg supplement.

Q: I just turned 50. The kids are at college; the house is almost paid for; you'd think I'd be happy. But I'm getting hot flashes, and I'm grumpy all the time. There's no second honeymoon in our house! Do I just have to live with this? -- Nancy J., Washington D.C.

A: Many women in their 50s feel ambushed by conditions related to menopause. In addition to hot flashes, you may have brain fog, heart palpitations, mood swings, sleep problems and less interest in sex. In fact, declining hormone levels can lead to vaginal atrophy -- around half of women say intercourse becomes so painful (because of thinning, fragile tissue) that they avoid it. Plus, there are the risks to your heart health and long-term brain function.

Fortunately, menopause symptoms don't have to put you on the sidelines of your life. You can be as energetic, engaged and frisky in the bedroom as you want to be! And that's big news for the 72 percent of women (like you) who are getting no treatment at all for menopause symptoms!

First: Don't rule out hormone therapy. If you're not at increased risk for heart disease or breast cancer, before age 60, up to five years of taking micronized progesterone and bioequivalent estrogen can banish symptoms. And older women can safely use topical estrogen to restore vaginal health.

Lifestyle changes also help: Get sweaty -- on purpose. Exercise can improve your quality of life and sometimes reduces hot flashes. Dropping just 10 percent of your weight can cut hot flashes and improve sleep.

(Email your health and wellness questions to Dr. Oz and Dr. Roizen at youdocsdaily@sharecare.com.)

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