Ask the Doctors June 2004 Issue

Ask Dr. Marks: 06/04

Which is better for relieving lower back pain—a heating pad or a cold pack?

It depends on whether the pain is acute or chronic and your individual preference. There are, however, some general recommendations that you should consider. If the pain is acute, such as that experienced after lifting a heavy object, ice may be more beneficial than heat. Ice reduces the amount of inflammation that the injured muscles suffer, and it can relieve muscle spasms. On the other hand, if you suffer from chronic lower back pain, then heat can be more beneficial than cold. Heat warms the muscles and makes movement easier. It also allows you to be more effective in your exercise program.

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How long should pain medication be used? Is there any danger of becoming addicted to pain medications?

There is always a danger of becoming addicted to pain medications, and it varies depending on the type of medication used. The danger is relatively minor for an individual suffering from acute pain, such as sprains and fractures. It is greatest for individuals suffering from chronic pain that can be relieved by narcotic pain relievers. Such patients need to be monitored carefully and should be aware of the danger that they may be in.

Certain personality types are more likely to become addicted than others. These individuals also run a higher risk of addiction to such substances as alcohol.

The best course of action is to be mindful of the potential for addiction and be careful with any medications taken. There are very effective non-narcotic pain relievers that can be used over a long period of time. Nonsteroidal anti-inflammatory drugs (NSAIDs) can provide relief for mild to moderate pain. If the pain is more severe than what NSAIDS can handle, then narcotic pain relievers are indicated.

The dosage of narcotic pain medications should be the lowest possible to achieve the results desired. With severe chronic pain, a patient may be best served by consulting a pain-management physician.

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I'm interested in knowing more about cortisone injections. How long does pain relief from a cortisone injection last? How many times can a cortisone injection be repeat-ed safely? Can cortisone be harmful in any way?

Cortisone injection into an inflamed joint is very effective at relieving pain and swelling. A good cortisone injection will last two to two-and-a-half months. It has been my practice to repeat injections every three months until they no longer are effective.

Cortisone injections, like other types of treatment, are effective only for a certain severity of arthritis. When the arthritis passes beyond that zone of effectiveness, then cortisone no longer works.

Cortisone does have potential side effects. In large doses, usually taken orally, it can cause weight gain, facial fullness, and, in some patients with knee arthritis, even avascular necrosis of the femoral heads. These are extreme cases, however.

Like any injection, infection is a potential complication. The infection rate, however, is extremely low.

Cortisone can also have a deleterious effect on articular cartilage. This is why cortisone should not be given to individuals with a normal joint or minimal arthritic change.