Q: I’m trying to curb my use of NSAIDs (nonsteroidal anti-inflammatory drugs) because they can upset my stomach. Are there any all-natural anti-inflammatories?
A: Yes, and they have few bad side effects—and lots of good ones. Note that the risks with NSAIDs such as ibuprofen do not stop with those tummies. At the heart of the matter is the effect that NSAIDs have on inhibiting the cox-2 enzyme, which helps protect the lining of your blood vessels and prevents clotting. Interfering with our body’s production of this enzyme can lead to an increased heart attack risk. Experts formerly thought the NSAID naproxen (Aleve) was exempt from this effect, but two studies, including one this year, have found that it may also increase the risk of heart attack and stroke.
One reason that NSAIDs can trigger serious complications is that they were never meant to be used for extended periods. Get your stomach, heart and overall health back on track by using NSAIDs as needed, just once in awhile. Never take an NSAID for longer than three days with a fever or longer than 10 consecutive days for pain without first consulting your doctor.
The No. 1 swap-out you can make in your regimen: Add omega fatty acid supplements and foods. We’re big believers in the power of the omega-3 fatty acids ALA and DHA, which tamp down inflammation and ease pain without negative side effects. Take a 900 mg supplement of DHA daily, along with about 12 ALA-rich walnut halves daily to hit your mark. We also recommend a 420 mg supplement of purified omega-7s (aka palmitoleic acid), a lesser-known but beneficial fatty acid that is hard to get enough of through diet alone (it’s found mostly in macadamia nuts). Also try relaxation techniques such as deep breathing and meditation to decrease inflammatory pain.
Q: My statin medication causes muscle aches. How can I reduce the pain?
A: You’re not alone. About 20 million Americans use statins such as Lipitor, Crestor or Pravachol to decrease risk of heart attacks and strokes. These successful drugs work their magic in two major ways: They either lower the bad LDL cholesterol or they decrease inflammation. Regardless, up to 20 percent of those who use a statin suffer from myopathy, the muscle aches and soreness that you’re experiencing. For some it’s a minor irritation, but for others it can interfere with functioning and, in rare cases, it may be life-threatening and cause organ damage.
Here are five main strategies for treating myopathy:
1. Change statins. Because each medication can affect your body chemistry differently, it makes sense to switch it up a few times.
2. Look at your other meds. Talk to your doctor about your other medications; they might interfere with the metabolizing of statins. One large study found that taking statins with additional drugs—most commonly antibiotics and antidepressants—doubled the risk of muscle pain compared to patients solely on statins.
3. Add coenzyme Q10. Many docs start every statin patient on a daily 200 mg supplement of coenzyme Q10. CoQ10 has gained more attention than a celebrity wedding because of its alleged ability to prevent cardiovascular aging, but it also helps stimulate energy pathways in our muscles and nerves. Our bodies produce it naturally, but statins tend to reduce the body’s production of coQ10, which may be related to statin myopathy.
4. Stop the statin. Abandon the statin altogether and try other approaches (see strategy 5) to control inflammation or LDL cholesterol levels. If you choose this route, you must be under your doctor’s direct observation. Why? Because once a statin is started, stopping it causes a rebound increase in artery-clogging plaque rupture, which could cause clots and raise your risk of stroke and heart attack during the few days and weeks after you discontinue the drug. An alternative may be on the horizon: PCSK9 inhibitors, a new drug class being developed by several drug companies for people who have significant heart disease risk from elevated LDL cholesterol. Early studies look promising, but this once- or twice-a-month injection will probably be very expensive.
5. Redo your diet; get moving; quit smoking. The most powerful defense can be found at the end of your fork, so incorporate this strategy no matter what. Better health habits may let you reduce the statin dosage, easing muscle pain. People taking statins slash their risk of a heart attack by an extra 22 percent by eating more healthfully, engaging in exercise and quitting smoking. To begin work toward a reduced dosage, eat more plant-based foods such as leafy greens, fruits, nuts, olive oil, beans and legumes as well as omega-3-rich salmon. And move every day.
Q: I think a relative may be addicted to prescription pain medication. What are the signs and how can I help her?
A: Prescription painkiller addiction and overdose are growing epidemics, particularly among women. According to the U.S. Centers for Disease Control and Prevention, prescription overdoses have increased 400 percent for women and 265 percent for men since 1999. Women are at higher risk of prescription drug addictions because they’re more likely to experience chronic pain, to be given higher doses (plus, women are smaller and are more sensitive to some drugs) and to use them for extended periods compared to men. The fallout is tragic: Approximately 18 American women die each day from painkiller overdoses. Since 2010, overdoses have killed four times as many women as homicide. The most common overdoses in women in 2010 were from narcotics or opioids (OxyContin, Percocet, Vicodin, etc.), followed by benzodiazepines (anti-anxiety or sleep drugs such as Xanax and Klonopin—what we term hypnotics), and antidepressants; all are used in people with chronic pain.
Here’s how you can determine whether your relative’s Rx use is an addiction and whether she’s in danger of overdosing: Find out whether she is bouncing from doc to doc—people with addictions often engage in doctor shopping to score different prescriptions from different physicians. Ask her which drugs she takes, how much and whether she’s using alcohol, too (addictions and overdoses are more common when patients combine medications, particularly when they mix their mental-health drugs with painkillers and/or alcohol). If you suggest she is taking too much and she denies it, or if she refuses to acknowledge that it’s affecting relationships, it’s a red flag: Denial is a hallmark of addiction. Another way to know whether she’s addicted: Does she have a compulsion to use in the face of consequences? In other words, would she rather have her pain medication and stay home instead of go to an important event (like a wedding) or a key business meeting?
If you believe your loved one is addicted, call the Substance Abuse and Mental Health Services Administration hotline (1-800-662-HELP). You and your family should express your concern to your relative as a group, not one on one; the addict can always outsmart you one on one. Experts recommend having at least five of you present for an intervention. Be clear that you are coming from a place of concern and are ready to be supportive in the journey to recovery. Encourage your relative to speak with her primary health care provider about additional resources such as a stress management program or counseling.
Q: A friend swears by chiropractic care for neck and back pain, but I’m worried to try it because of the risks. Is it safe?
A: We applaud you for trying to evaluate the risks and benefits of treatments. Every treatment has risks, and not every treatment works for every person, and that’s exactly the case when it comes to back pain. Here’s what we know about chiropractic care: It has been found to be the least expensive and fastest treatment for back pain treatment in some gold-standard studies, but it doesn’t relieve everyone’s pain and it does have risks. One recent study from the journal Stroke found that in people under 45, the risk of stroke increased with neck adjustments by chiropractors or osteopathic doctors. The rotations used in neck adjustments may cause a small tear in the artery walls in the neck, which could lead to a stroke if a blood clot forms and travels to the brain. But this is rare. For anyone thinking about chiropractic care, it’s important to discuss family or medical history of stroke with your chiropractor or osteopathic physician, who can then assess your risk factors. If you do not have special stroke risk factors then you might follow your friend’s advice. Chiropractic treatments or physical therapy treatments—or the two combined—are something we recommend for most first-time episodes of back pain.
Q: I’ve heard that phrase “mind over matter” and wonder if there’s any truth to the idea that you can control pain with your mind?
A: You betcha! Never underestimate the power of your mind. Guided imagery is one way to use the mind to control pain. Guided imagery is like purposeful daydreaming, where you envision yourself in a state of relaxation and physical and emotional wellbeing. Studies have shown that just doing guided imagery once before surgery helped patients who underwent heart surgery leave the hospital sooner and use less pain medications in the seven days following surgery.
Mindfulness meditation—learning to focus on the present, to observe thoughts and feelings without judgment, and to focus on your breath—also lowers perception of pain. A 2009 study from The Journal of Pain found that patients who practiced mindfulness meditation for 20 minutes a day over a 3-day period had a significant reduction in pain ratings and anxiety scores. The benefits associated with meditation are thought to be associated with changes of the breath, a relaxed state of mind, and a more regulated reaction to pain. The researchers note that improving mindfulness allows patients to recognize pain as a momentary sensory event that is not worthy of emotional reaction. Regardless of whether you regularly experience chronic pain or not, we recommend everyone take time each day to meditate. Becoming mindful is not something that happens overnight and instead develops in time, with practice.
Finally, there’s the placebo response, which might sound hokey, but it’s backed by science. The placebo response happens when you perceive an improvement in your condition simply from the psychological effect of getting treatment versus the actual treatment. In other words believing that a pill will work can make you feel better, even if the pill is a sugar pill. In some studies, about 30 to 60 percent of pain can be relieved by placebos. So go on, believe.