There are many different types of pain medication, each with their own indications and mechanisms. It can be said that the more severe the pain, the more side effects and the higher the likelihood of addictive properties of a medication. This does not mean one has to put up with the pain and take it on the chin just because stronger medication may not be appropriate. One must always consider the cost-benefit ratio of the medication.
Pain from inflammation can be treated with NSAIDs, which are supposed to relieve pain by reducing the inflammation at the source. However, NSAIDs are reputed to be hard on the stomach and kidney, and some podiatric physicians believe that the known risks associated with NSAIDs are not worth potential benefits. A corticosteroid injection can be very effective for specific inflammation, but researchers have warned that long-term use can cause weakening of tendons and ligaments. Pain at the nerve root can be treated with oral steroids.
It is suggested that a group of people have come out to say Paracetamol is not useful for arthritic pain, and that they have also come out to say simple painkillers for lower limb arthritic pain do not work well either. It is interesting how they say all types of pain medication do not work well, yet they have not said why and what will work better. This essay is intended for those who do not understand the underlying concepts of different pain medications and want to know what else is available other than simple painkillers. It is important to fully understand the purpose of each pain medication because there are potential side effects and consequences from long-term use of the wrong types of medication. Failure to relieve pain can cause mild inconvenience through to disability and restriction of mobility with a resultant major effect on the mental health of the patient.
Non-Medication Pain Management Options
Physical therapy is often an essential aspect of treatment to manage foot pain. Stretching tight muscles and tendons is a very important aspect of any treatment. For many patients, it is often the underlying tightness in the calf muscles that is putting increased pressure on the plantar fascia or a similar condition causing pain under the sole of the foot. A specialized program focusing on manual therapy and flexibility exercises, usually conducted by a physiotherapist, will be successful in treating this. Manual therapy, such as myofascial release to reduce tightness of the connective tissue, and ultrasound therapy, can be beneficial in the management of various foot pains. Other simple recommendations would be to use supportive footwear and possibly even orthotics, and being lighter or losing weight to decrease pressure on the feet.
The best management, like the foot massager for pain in the feet, is the defeat of the underlying cause. There are many causes for foot pain. It is very important for the physician to diagnose the problem correctly so that a good treatment plan can be established. If the pain is due to improper footwear, overuse, or trauma, often just changing footwear, decreasing activity, or rest will relieve the pain. Many other conditions such as diabetes, peripheral vascular disease, and rheumatoid arthritis require a more meticulous long-term treatment plan to ensure management of the cause in conjunction with the symptoms.
Physical Therapy
In terms of acute injuries or surgeries, the beginning phases of physical therapy involve only rest and the use of ice to decrease swelling and pain. Treatment will then progress as stated above. The use of physical therapy has been shown to significantly improve the function of an affected limb and decrease pain. This is the goal of physical therapy whether it is for a minor sprain, or following a major surgery.
There are multiple types of physical therapy exercises. Often, a combination of stretching, range of motion, strengthening, and functional exercises are prescribed based specifically on the type of pain and the underlying cause. Stretching is used to increase flexibility of tight soft tissue and joints. Range of motion is also used to increase flexibility; it is a gradual process of manipulating a joint into a position that would cause mild discomfort. Strengthening exercises are used to increase strength of muscles and tendons, in order to better support the joints and decrease the stress on them. Functional exercises are added once adequate progress is made with the other types of exercises. These are exercises that the patient may perform during their work or daily activities, to ensure that they will cause no further harm to the affected areas.
Orthotics
There are also custom and off-the-shelf orthotics. Customized orthotics are more expensive, but they offer the best fit and support because they are made to match the specifics of your foot. Good materials for custom orthotics are crucial; they should be light, resilient, supportive, and provide cushioning. Custom orthotics also have a lifetime generally matching your old age because your foot’s and body’s needs do not change. High-quality materials are also resistant and do not change shape, ensuring the orthotics are durable. Off-the-shelf orthotics are not too expensive and can still be effective depending on what you buy and what your individual needs are. Choose materials depending on the activities the orthotics will be used for.
Orthotics can be made from many materials. Rigid orthotics are constructed from a firm material such as plastic and are best for walking shoes with laces or work boots. They are designed to control function, and while they may be uncomfortable at first, the more you wear them, the more your feet will become accustomed to the new support. Soft orthotics are best for athletes, made from soft compression materials, and are usually bulkier to provide added support and cushioning.
Orthotics are shoe inserts, leg braces, neck collars, etc. that are intended to correct an abnormal walking pattern and provide cushioning and support for painful areas of the body. They are typically recommended for patients with abnormal alignment or foot function. This can lead to pain in the lower extremities all the way up to the lower back. Having the right custom orthotic can be very effective in alleviating this pain. Typically, a foot or cast impression is obtained from the patient, and a specially designed orthotic for that individual’s foot type and problem is constructed. This will vary based on the materials and the process used by different healthcare specialists.
Rest and Ice
Following a particularly intense activity that places our weight on our back feet, the area below the medial malleolus, which connects the tibia and fibula, becomes sore and remains so for a couple of days. By now you may have noticed that your athletic performance has been hampered by an ankle injury. Whether the primary symptoms are pain and soreness resulting from tendonitis, or a more traumatic injury, acute phase management using R.I.C.E. therapy is universal. Ankle injuries are so common within the athletic community that an abbreviated form of R.I.C.E. first aid has come to mean rest and protection, and little education is necessary for its implementation. It is upon discussing rest that the complexity of compliance and the true effectiveness of this treatment can become appreciated. The demands of a working individual to continue ambulation may tax the simple instruction of staying off one’s feet. However, the nature of acute injury demands short-term compensation for a long-term gain. Depending on the severity of the injury, weight of the individual, and the desired lifestyle, offloading of the injured ankle can take many forms. For some, it may be crutch-assisted ambulation, for others with easy access to elevatory leg rest at work, a few days out of the office may be all that is necessary. With each step taken, there must be constant reevaluation of the effort versus the benefit, and increased stress is cause to return to the prior treatments of R.I.C.E. and decrease the activity.
Medication-Based Pain Management Options
There are several pain management options in the treatment of pain caused by foot and ankle injuries. Oral nonsteroidal anti-inflammatory drugs (NSAIDs) are the most commonly used medication type for such injuries. They decrease pain, limit further inflammation, and improve function. This is important because inflammation is a major cause of pain and can prevent further injury healing. This is particularly true of tendon problems and arthritis. It is essential to understand the various medication options and should be done so under the direction of a health professional. High doses or inappropriate medication usage can cause severe side effects. Always read the labels and adhere to the instructions on taking the medication. If it does not appear to work effectively, contact your doctor before increasing the dose or trying a different type of medication. This can also prevent an increase in severity of drug side effects.
Over-the-Counter Medications
Aspirin, which is chemically similar to NSAIDs, is now mainly used as a preventive medication for heart conditions and heart attack. It can, however, still be used for quick relief of minor aches and pains.
Acetaminophen is used to treat musculoskeletal and joint pain. It does not reduce swelling caused by arthritis but is effective for mild symptoms. While it is considered safer for long-term use compared to NSAIDs, acetaminophen overdose is the most frequent cause of liver failure in the United States. Patients need to be careful not to exceed the maximum dose.
There are three major classes of OTC medications for pain and each affects the body differently. These include Non-Steroidal Anti-Inflammatory Drugs (NSAIDs), Acetaminophen, and Aspirin. NSAIDs are commonly used to treat both acute and chronic conditions such as headaches, muscle pain, and arthritis. They are effective in reducing inflammation and were developed as a treatment with fewer gastrointestinal side effects than previous forms of medication for arthritis. Nevertheless, with long-term administration of OTC NSAIDs, studies have shown complications such as gastric ulcers, bleeding, and perforation of the stomach or intestines can occur. Known NSAID brands include Ibuprofen and Naproxen.
Over-the-counter (OTC) medications are often the first line of medication therapy in managing acute or chronic pain. They are readily available and can be effective if used correctly. However, patients need to be cautious of potential side effects with any medications, even those sold without a prescription. Furthermore, OTC medications only treat the symptoms; if they persist, a physician should be consulted.
Prescription Medications
Several types of prescription medications are available to reduce the pain and inflammation resulting from foot and ankle conditions. Nonsteroidal anti-inflammatory drugs (NSAIDs) are frequently used to control pain and inflammation. Prescribed NSAIDs are stronger than those that can be purchased over the counter. In some cases, prescription medication is the first step in controlling the pain and inflammation associated with a foot or an ankle condition. When oral NSAIDs are not enough, another option is the use of corticosteroid injections. These anti-inflammatory medications are many times more powerful than oral steroids and have a more focused effect on the affected area. Due to the potential side effects from corticosteroids and oral anti-inflammatory medications, such as gastrointestinal irritation, ulceration and effects on the kidney, liver, and platelet function, it is recommended that these medications should be used only under the direct supervision of a physician. Another option for pain and inflammation control is the use of pain medication that has no anti-inflammatory properties. This includes prescription strength Tylenol and various narcotics. Tylenol is the safest form of pain relief medication, but has no effect on inflammation. Narcotics are considered a last resort in pain control and are generally not recommended for long term use. Due to their potential for addiction and other side effects, the use of narcotics should only be done under the close supervision of a physician. Lastly, prescription medication might also include various vitamins and minerals. Sometimes anemia or a deficiency in certain vitamins or minerals can be an underlying cause of chronic pain. Diagnosis through blood test can lead to supplementation of the deficient nutrient and resolution of the pain.
Topical Pain Relievers
Topical pain relievers are applied directly to the area of the painful foot and/or ankle. The advantages of topical medications include the targeted application to the painful area while minimizing systemic distribution. The reduced systemic distribution decreases the risk of adverse systemic side effects. The various forms of topical medications for foot and/or ankle pain include gels, creams, ice spray, and patches. Counterirritants are a type of topical medication which creates a sensation of cold or heat which distracts the body from the pain in the foot or ankle. Common counterirritants include preparations with menthol, camphor, eucalyptus oil, and oil of wintergreen. Evidence on the effectiveness of counterirritants is mixed, but they are especially worth a try given the low likelihood of significant side effects. Another type of topical medication with both anti-inflammatory and pain relieving properties rubs containing Non Steroidal Anti-Inflammatory Drugs (NSAIDs). Available evidence for these products varies but those with prescription strength have stronger evidence for pain relief and potential effect on tissue damage. Other topical NSAID preparations with a stronger safety margin may also have beneficial effects but evidence for them is based on less rigorous research. Topical salicylates are another alternative with both their own anti-inflammatory and pain relieving properties. The conventional wisdom is that both topical NSAIDs and salicylates are most effective for conditions such as osteoarthritis but it is entirely possible that they may work for other conditions with a different underlying mechanism of inflammation or pain. There are other newer topical preparations available by prescription so it is important to discuss this option with a primary care physician or foot/ankle specialist in choosing the most appropriate medication.
Complementary and Alternative Medicine for Pain Management
Patients may want to explore the option of herbs as a form of pain relief. Though it is difficult to promote its use due to lack of regulation in herbal products and the potential for herb-drug interactions, there has been an increased use of herbal remedies by patients. It is important to know what herbs your patient is using and the type of effects it may have on their pain condition and concurrent medications. A brief listing of some common herbal remedies and their use for pain follows:
Massage therapy, such as shiatsu or reflexology, has been used as an alternative treatment to manage pain. Though there is conflicting evidence on its efficacy for pain relief, it is considered safe and has little side effects. The mechanism as to how it possibly reduces pain is by improving circulation, reducing muscle pain and inducing relaxation. This may be an option worth trying as a combination to other therapy.
Acupuncture
The information was taken from the book edited by Christopher A. Harner et al, “Managing Medication for Foot and Ankle Pain: Understanding Pain Management Options”. What is Acupuncture? Although it had been practiced for thousand years, it is most established in Traditional Chinese Medicine (TCM). According to TCM, the body contains several energy meridians and health is resulted balance of Yin and Yang throughout the body. When yin and yang is imbalance, qi blood and fluids movement will be compromised causing pain and illness. The pain and illness sometimes can be located at certain part of body such as knee pain or headache. Traditional Chinese Medicine believes that pain and illness is basically located at certain meridian point of body and the main goal of acupuncture is to rectify the body’s energy imbalance by focusing on these certain point. In modern medicine, scientists believe that acupuncture may stimulate the release of natural opiates in the body. It can also affect an area of the brain known to reduce sensitivity to pain and stress, as well as promoting relaxation and deactivating the ‘analytical’ brain, which is responsible for anxiety and worry. Acupuncture leads to regulate the disturbed neuromuscular system thus relieving pain and discomfort. The procedure involves insertion of thin needle at certain depth and duration. This may be accompanied with electrical stimulation to enhance the efficacy. After a recommended number of sessions, patients often experience significant pain relief and intense feeling of relaxation. Acupuncture has shown to be low risk and cost-effective treatment for variety of pain and illness. People often choose acupuncture as adjunct to any other treatment including pain medication and injections. Requirements for needle access may vary by country. In some countries, you can only see qualified medical doctors doing acupuncture.
Massage Therapy
Massage therapy is a treatment option which can reduce muscle pain and spasm, increase circulation, and help individuals relax. There are many different types and styles of massage, and it may take some time to find the best method for you. A masseuse needs to be adept in palpation and able to find muscle knots and tightness which could be contributing to your pain. Active Release Techniques (ART) is an example of a deep tissue massage which concentrates on finding the exact location of the problem and working to increase circulation and reduce pain in this area. ART has been shown to be effective in treating overuse injuries and could be beneficial for individuals with tendonitis and tight ankle muscles. A traditional Swedish massage is a less intense method which promotes relaxation and increased circulation. This type of massage may have psychological benefits for individuals with chronic pain and has also been proven to aid in the function of damaged muscles. Due to the potential benefits and relatively low risk of side effects, massage is a viable option for foot and ankle pain. However, it may not provide adequate pain relief on its own and is more effective when used in combination with other treatments such as chiropractic care or acupuncture.
Herbal Remedies
Herbal remedies have been used as a treatment for pain for many years, often seen as a more natural way to relieve pain. They are used in many forms such as tablets, capsules, and creams. Although there is no scientific data supporting their use, it is believed that herbal remedies may help control symptoms of foot and ankle pain without the side effects of prescription drugs. There are many different herbal remedies available, and it can be confusing to decide which may be the right treatment for specific foot and ankle pain. It’s important to check with your doctor and ask them which remedies would be the best for your specific condition. They can give you a better understanding of different remedies along with their side effects, possible interactions with medications you are already taking, and other treatment options.