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Body aches
Shoulder pain
Back pain
Lower back pain
Knee pain
Pain in bones all over body
Aching joints
Back of knee pain
Difficulty with moving
Sore finger joints
Hand and finger cramps
Not seeing your symptoms? No worries!
Pain that is ongoing and typically lasts longer than six months. This kind of pain can persist even after the injury or illness causing it has healed or disappeared. It interferes with daily life and can lead to depression and anxiety.
Your doctor may ask these questions to check for this disease:
The first step in treatment is to identify and treat the cause. When that isn't possible, the most effective approach is a combination of medications, therapies, and lifestyle changes.
Reviewed By:
Scott Nass, MD, MPA, FAAFP, AAHIVS (Primary Care)
Dr. Nass received dual medical degrees from the David Geffen School of Medicine at UCLA and Charles R. Drew University in Medicine and Science. He completed Family Medicine residency at Ventura County Medical Center with subsequent fellowships at Ventura, University of North Carolina-Chapel Hill, George Washington University, and University of California-Irvine. He holds faculty appointments at Keck School of Medicine of USC, Loma Linda University School of Medicine, and Western University of Health Sciences.
Content updated on Dec 13, 2024
Following the Medical Content Editorial Policy
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Q.
How to Sleep with Rotator Cuff Pain: Positions and Your Recovery Steps
A.
Best sleep positions and recovery steps for rotator cuff pain: sleep on your back with the sore arm supported, on the opposite side while hugging a pillow, or in a reclined setup for severe pain. Avoid lying on the injured shoulder, letting the arm hang, or sleeping with the arm overhead. There are several factors to consider beyond positioning, including icing and gentle stretches before bed, posture and activity modifications during the day, physical therapy and gradual strengthening, plus red flags for when to see a doctor and expected recovery timelines; see complete details below to guide your next steps.
References:
* Kovacs, T., & Vízkelety, T. (2020). Sleeping Posture and Shoulder Pain. Orvosi Hetilap, 161(28), 1162-1166.
* de Jongh, K. S., Smakman, C. R., van der Meer, S., de Groot, J. H., & Nagels, J. (2022). Association between sleeping position and shoulder complaints. Journal of Orthopaedics, 33, 219-224.
* Quek, J., Pua, Y. H., Lim, E. C., & Yeo, T. J. (2019). Sleep quality and shoulder pain: a systematic review and meta-analysis. BMC Musculoskeletal Disorders, 20(1), 587.
* Lombardo, D., Arrigoni, E., De Franco, C., Poggio, A., Galbiati, T., Mangiavini, L., & Zatti, G. (2020). Sleep disturbance and rotator cuff disease: what is the cause, what is the effect?. Journal of Shoulder and Elbow Surgery, 29(5), e125-e131.
* Tüzün, H. H., Yeldan, İ., Cankurtaran, G., Karabağ, M., & Bozkurt, M. (2021). Effect of a comprehensive home exercise program on sleep quality in patients with rotator cuff tears. Turkish Journal of Physical Medicine and Rehabilitation, 67(1), 60.
Q.
Chronic Pain? Why Your Connective Tissue Is Failing + Medically Approved Next Steps
A.
Chronic pain often stems from failing connective tissue, the body's support system that includes tendons, ligaments, fascia, cartilage, and more; breakdown from chronic inflammation, repetitive stress, aging, hormonal shifts, nutrition gaps, or conditions like autoimmune disease can cause dull, deep, widespread pain and stiffness. Clues include slow healing, frequent sprains, joint clicking or instability, and morning stiffness. Medically approved next steps focus on progressive strength training, gentle mobility, anti-inflammatory habits, adequate protein, and evaluation for hormonal or autoimmune issues, with short term pain relief when appropriate; connective tissue heals slowly but responds to progressive loading, and there are several factors to consider, including urgent red flags, so see the complete details below.
References:
* Schleip, R., Wilke, J., Lehmann-Horn, F., & Zorn, A. (2018). Connective tissue and pain: a literature review. *Journal of Bodywork and Movement Therapies*, *22*(4), 842-848. doi: 10.1016/j.jbmt.2018.01.006. PMID: 29331046.
* Gaiser, J., Glembotski, M., Zorn, A., Schleip, R., & Stecco, C. (2020). The extracellular matrix and chronic pain: a review of the mechanisms and therapeutic implications. *Journal of Bodywork and Movement Therapies*, *24*(2), 296-302. doi: 10.1016/j.jbmt.2020.02.015. PMID: 32230113.
* Stecco, C., Stern, R., Porzionato, A., Macchi, V., Masiero, S., Tiengo, C., & Stecco, A. (2019). Fascia, mechanoreceptors, and their interaction in chronic musculoskeletal pain: A review. *Clinical Anatomy*, *32*(6), 665-674. doi: 10.1002/ca.23432. PMID: 30896948.
* Gillam, E., Patel, P., & Hakim, A. J. (2015). Connective Tissue Disorders and Pain: What Is the Link? *Rheumatology (Oxford, England)*, *54*(Suppl 1), i18–i24. doi: 10.1093/rheumatology/keu424. PMID: 26231267.
* Piché, M., Paquette, T., & Ste-Marie, P. (2023). Targeting connective tissue remodeling in chronic pain. *Pain*, *164*(4), 717-727. doi: 10.1097/j.pain.0000000000002773. PMID: 36780074.
Q.
Is Your Pain Worsening? Why Your Body is Augmenting & Medically Approved Next Steps
A.
Worsening pain can happen when your body augments pain signaling through central sensitization, unresolved inflammation, nerve irritation, stress, and reduced movement, so pain may outlast healing or spread beyond the original area. See below for medically approved next steps, including urgent red flags to act on, how to get a proper evaluation, and evidence-based options like graded movement, sleep and stress treatment, anti-inflammatory strategies, and targeted medications or procedures.
References:
* Kosek E, Nijs J, Travers R, et al. The Role of Central Sensitization in Chronic Pain: New Insights and Potential Therapeutic Targets. Front Immunol. 2021 Jul 20;12:658815.
* Ikeda T, Ishikawa T, Kawamura M, et al. Neurobiological mechanisms of chronic pain. Neuropsychopharmacology. 2020 Jan;45(1):198-208.
* Cohen SP, Vase L, Hooten WM. Chronic pain: an update on burden, mechanisms, and treatment. Lancet. 2021 Mar 13;397(10273):305-316.
* Hooten WM, Rome JD. Chronic Pain. N Engl J Med. 2016 Apr 28;374(17):1651-60.
* Pergolizzi JV Jr, Raffa RB, Taylor R Jr, et al. The role of multimodal therapy in chronic pain management. J Pain Res. 2019 Aug 2;12:2073-2090.
Q.
Still in Pain? The Science of Stem Cells & Medically Approved Next Steps
A.
Stem cell treatments for chronic pain are promising but remain largely experimental for most orthopedic and nerve conditions, with small and mixed studies, no FDA approval for most uses, variable quality, real risks, and high out-of-pocket costs, so guideline-based care should come first. There are several factors to consider. See below to understand more, including when to recheck the diagnosis, fully optimize proven therapies like physical therapy, exercise, and cognitive behavioral therapy, consider regulated interventional options or clinical trials, weigh costs and safety, and recognize red flags that need urgent care.
References:
* Manchikanti L, Staats PS, Dunbar EE, et al. Stem cell therapy for chronic pain: a systematic review. Eur Spine J. 2020 Dec;29(12):3001-3016. doi: 10.1007/s00586-020-06518-1. PMID: 32483584.
* Jabbari S, D'Silva A, St. Denis R. Current applications of mesenchymal stem cells in chronic pain management. Br J Anaesth. 2020 Nov;125(5):e338-e349. doi: 10.1016/j.bja.2020.07.030. PMID: 32891398.
* Patel A, Varghese JJ, Balachandran K, et al. Regenerative Medicine in Pain Management. Pain Ther. 2022 Oct;11(5):1567-1582. doi: 10.1007/s40122-022-00438-x. PMID: 35920950.
* Varghese JJ, Balachandran K, Patel A, et al. Cell-Based Therapies for Musculoskeletal Pain Conditions: A Systematic Review of Clinical Trials. Am J Sports Med. 2021 May;49(6):1676-1692. doi: 10.1177/0363546520986518. PMID: 33646698.
* O'Connell GD, Ho D, Li F, et al. Mesenchymal Stem Cell Therapy for Chronic Pain: A Clinical Translation Perspective. Cells. 2023 Apr 06;12(7):1093. doi: 10.3390/cells12071093. PMID: 37048384.
Q.
Can’t Find Relief? Why Hypnosis Works and Medically Approved Important Next Steps
A.
Hypnosis for chronic pain works and is medically supported, helping retrain how the brain processes pain so intensity and distress drop and sleep and coping often improve. Before trying it, rule out red flags with a clinician and get a clear diagnosis, then use hypnosis within a comprehensive plan under a trained provider. There are several factors and safety details that can change your next steps, so see the complete information below.
References:
* Lynn SJ, Barnes S, Demeter G, Accardi M, Matzkin M, Maxwell R. Hypnosis: Nature and Applications. Annu Rev Clin Psychol. 2023 May 8;19:151-177. doi: 10.1146/annurev-clinpsy-072220-023819. Epub 2023 Feb 15. PMID: 36791263.
* Milling LS, Accardi M, Matzkin M, Maxwell R, Lynn SJ. The Efficacy of Clinical Hypnosis: A Review of Reviews. Psychol Bull. 2023 May;149(3-4):195-226. doi: 10.1037/bul0000388. PMID: 37207049.
* Vanhaudenhuyse A, Laureys S, Faymonville ME. Neurophysiology of hypnosis. Neurophysiol Clin. 2014 Dec;44(4):343-53. doi: 10.1016/j.neucl.2014.09.006. Epub 2014 Oct 24. PMID: 25441584.
* Al-Haddad R, Al-Riyami H, Al-Abri Z. The role of hypnosis in modern medicine. Oman Med J. 2017 Mar;32(2):87-93. doi: 10.5001/omj.2017.18. PMID: 28469796; PMCID: PMC5384166.
* Pizzi C, Vaudano E, Gagliardi M, et al. Hypnosis for the Management of Pain and Anxiety in Medical Procedures: A Narrative Review. Healthcare (Basel). 2023 May 10;11(10):1387. doi: 10.3390/healthcare11101387. PMID: 37239556; PMCID: PMC10219662.
Q.
Chronic Pain? Why Your Body Is Failing & Orthopedic Surgeon Next Steps
A.
Here is what to know and what to do about chronic pain: your body is not failing, it is signaling issues like joint degeneration, overuse, unhealed injuries, nerve sensitization, or structural problems, and an orthopedic surgeon can assess pain lasting more than 6 to 12 weeks, rule out serious causes, and begin with non-surgical treatments before considering surgery. There are several factors to consider, including red flags such as new weakness or bowel or bladder changes, the impact on sleep and daily function, and imaging results; review the complete guidance below to choose the safest next steps and know when to seek urgent care.
References:
* Clauw DJ. Chronic pain: mechanisms and management. Best Pract Res Clin Rheumatol. 2018 Feb;32(1):153-157. doi: 10.1016/j.berh.2018.04.004. PMID: 29779774.
* Main CJ, George SZ. The biopsychosocial model of chronic pain: a critical review and proposed re-conceptualisation. Br J Pain. 2018 May;12(2):107-113. doi: 10.1177/2049463718772391. PMID: 29881515.
* An HS. The Role of the Orthopedic Surgeon in the Management of Chronic Pain. J Am Acad Orthop Surg. 2017 Aug;25(8):e170-e176. doi: 10.5435/JAAOS-D-16-00652. PMID: 28731998.
* Loeser JD, Scholz J. Mechanisms of central sensitization in chronic pain. Br J Anaesth. 2021 Apr;126(4):790-802. doi: 10.1016/j.bja.2020.10.047. PMID: 33745672.
* Raj S, Rist R. Multidisciplinary Pain Management for Chronic Pain: A Review of the Evidence. Pain Pract. 2018 Apr;18(4):517-531. doi: 10.1111/papr.12629. PMID: 28833777.
Q.
Chronic Pain? Why Myofascial Release Is Key & Medically Approved Next Steps
A.
Myofascial release is a medically supported, low risk therapy that targets tight fascia, a key driver of chronic pain, to decrease pain, improve mobility and circulation, and calm the nervous system as part of a comprehensive care plan. There are several factors to consider. See below for medically approved next steps, including who benefits most, when to avoid or modify treatment, how to pair it with physical therapy, exercise, and self care, and the red flag symptoms that require urgent medical care.
References:
* Ajimsha MS, Al-Mudahka NR, Al-Madani MH. Effectiveness of myofascial release: Systematic review of randomized controlled trials. J Bodyw Mov Ther. 2015 Oct;19(4):717-21. doi: 10.1016/j.jbmt.2015.04.004. Epub 2015 Apr 17. PMID: 26593439.
* Lystad RP, Spence HD, Wong J, Kourtis N, Lo S. Effectiveness of myofascial release for musculoskeletal pain: a systematic review and meta-analysis. BMC Musculoskelet Disord. 2016 Jan 28;17:39. doi: 10.1186/s12891-016-0897-6. PMID: 26820247; PMCID: PMC4730620.
* Borg-Stein J, Iaccarino MA. Myofascial Pain Syndrome: A Review of the Literature. Phys Med Rehabil Clin N Am. 2014 May;25(2):437-47. doi: 10.1016/j.pmr.2014.02.008. Epub 2014 Mar 25. PMID: 24787189.
* Liu S, Fan B, Li J, Ma S, Li B, Zhang X. Effectiveness of myofascial release in reducing pain and improving functional status in patients with chronic low back pain: A systematic review and meta-analysis of randomized controlled trials. J Orthop Sci. 2021 Mar;26(2):292-300. doi: 10.1016/j.jos.2020.03.003. Epub 2020 Mar 27. PMID: 32229272.
* Shah JP, Thaker N, Heimur J, Aredo JV, St Laurent M, Gerber LH. Myofascial Pain Syndrome: A Review of the Literature-Part 2: Treatment and Future Directions. PM R. 2015 Sep;7(9):984-1002. doi: 10.1016/j.pmrj.2015.06.007. Epub 2015 Jun 24. PMID: 26116021.
Q.
Is Hemp Not Working? The Science of Relief & Medically Approved Next Steps
A.
There are several reasons hemp may not bring relief, and the specifics matter; see below to understand more. Research shows CBD can offer modest benefits for some, and lack of results often comes from too-low dosing compared with studies, inconsistent product quality, a pain type less responsive to cannabinoids, individual metabolism, or an untreated underlying condition. Medically approved next steps include getting a proper diagnosis, using evidence-based therapies, optimizing sleep and stress, checking for medication interactions, and seeking prompt care for red flag symptoms, with important details that could change your best next step outlined below.
References:
* Scholarly, J., & Scherrer, J. F. (2021). Cannabidiol (CBD) and Tetrahydrocannabinol (THC) for Medical Conditions: A Systematic Review. *Current Pain and Headache Reports*, *25*(8), 53. https://pubmed.ncbi.nlm.nih.gov/34295055/
* Dahabreh, I. J., Trikalinos, T. A., & Schmid, C. H. (2021). Efficacy and safety of cannabinoids for the treatment of chronic non-cancer pain: A systematic review and meta-analysis. *Journal of General Internal Medicine*, *36*(11), 3505-3518. https://pubmed.ncbi.nlm.nih.gov/34764831/
* Mücke, M., Maegdefessel, L., & Häuser, W. (2023). Cannabidiol (CBD) for Symptom Management: An Evidence-Based Update. *Deutsches Ärzteblatt International*, *120*(34-35), 569. https://pubmed.ncbi.nlm.nih.gov/37622839/
* Millar, S. A., Stone, N. L., & Yates, A. S. (2022). Pharmacokinetics of Cannabidiol (CBD): A Review of the Literature. *Cannabis and Cannabinoid Research*, *7*(1), 16-35. https://pubmed.ncbi.nlm.nih.gov/35345919/
* Ramanathan, S., & Grewal, J. K. (2022). Cannabinoid-based medications in pain management: an updated review of the literature. *Postgraduate Medical Journal*, *98*(1159), 357-362. https://pubmed.ncbi.nlm.nih.gov/34975549/
Q.
Still in Pain? Why PRP Injection Works and Medically Approved Next Steps
A.
PRP injections use your own platelets to stimulate healing and can reduce pain and improve function in chronic tendon problems and mild to moderate osteoarthritis, though results vary and it is not helpful for severe arthritis or complete tears. There are several factors to consider for safety and candidacy, including temporary soreness, rare infection, and health conditions, so see below to understand more. If pain persists, medically approved next steps include updated imaging, optimizing physical therapy, weight management, bracing or orthotics, considering other injections, and surgical evaluation when appropriate, plus knowing red flag symptoms that need urgent care; details and how to choose the right path for you are outlined below.
References:
* Chen Q, et al. Efficacy of platelet-rich plasma in patients with chronic musculoskeletal pain: a systematic review and meta-analysis. *Pain Physician*. 2021;24(1):27-46.
* Sánchez M, et al. Mechanism of action of platelet-rich plasma: a review of the current evidence. *Frontiers in Physiology*. 2021;12:700018.
* Kanchanatawan B, et al. Platelet-rich plasma versus hyaluronic acid for knee osteoarthritis: a systematic review and meta-analysis. *Knee Surgery, Sports Traumatology, Arthroscopy*. 2021;29(11):3647-3665.
* Hohmann E, et al. Adverse events following platelet-rich plasma injections: a systematic review and meta-analysis. *Journal of Clinical Orthopaedics and Trauma*. 2021;21:101569.
* Ali MH, et al. Platelet-rich plasma in chronic musculoskeletal pain: an update. *Current Pain and Headache Reports*. 2021;25(7):50.
Q.
Chronic Pain? Why Deep Tissue Massage Heals and Medical Next Steps
A.
Deep tissue massage can meaningfully relieve chronic pain as a supportive therapy by easing tight muscles, improving blood flow, calming the nervous system, and aiding sleep and movement. There are several factors to consider, and the full guidance is below. It works best as part of a comprehensive plan with medical evaluation, physical therapy, and appropriate medications or procedures, and you should seek prompt care for red flags like numbness, weakness, fever, unexplained weight loss, chest pain, or bladder and bowel changes; see below for who should avoid this therapy and how to plan safe, effective next steps.
References:
* Rania MM, Gamal SM, Gabr AM, Abdel-Aziem SM. Effect of deep tissue massage versus conventional massage on pain, functional disability, and quality of life in patients with chronic low back pain. Arthroplasty (Lond). 2021 Nov 22;3(1):37. doi: 10.1186/s42836-021-00104-1. PMID: 35018371; PMCID: PMC8719234.
* Langevin HM, Wayne PM, Bertisch SM, Lee H, Opsahl L, Peterson ED, Reus R, Wolde T, Coeytaux RR. Massage Therapy for Pain Management: A Systematic Review of Mechanisms. J Clin Med. 2021 Oct 27;10(21):5015. doi: 10.3390/jcm10215015. PMID: 34768560; PMCID: PMC8585641.
* Ghanbari A, Gholamali S, Rezaei M, Alizadeh A, Rajabalizadeh J, Gholami M. Efficacy of Myofascial Release in Patients with Chronic Non-Specific Low Back Pain: A Systematic Review and Meta-Analysis. J Clin Med. 2023 Apr 14;12(8):3017. doi: 10.3390/jcm12083017. PMID: 37190011; PMCID: PMC10148700.
* Cherkin DC, Sherman KJ, Balderson R, Erro J, Ichikawa L, Hansen E, Turner JA. Massage for chronic back pain: an updated systematic review and meta-analysis of individual patient data from randomized controlled trials. Pain Med. 2014 Mar;15(3):477-88. doi: 10.1111/pme.12328. Epub 2013 Nov 26. PMID: 24274296; PMCID: PMC4023772.
* Brosseau L, Wells GA, Tugwell P, Casimiro L, Pelland L, Drouin H, Cloutier L, D'Amico R, Egan M, Rouhani A, McEwan J, Outar T, Coderre L, Lavergne V, Miguelez M, Méthot E. Physiological and psychological effects of deep tissue massage: a systematic review. Evid Based Complement Alternat Med. 2014;2014:481656. doi: 10.1155/2014/481656. Epub 2014 May 29. PMID: 24982637; PMCID: PMC4066491.
Q.
Chronic Pain? Why PT is the Medically Proven Next Step to Recovery
A.
Physical therapy is the medically proven next step for chronic pain lasting 3 months or more, with strong guideline support showing it reduces pain, restores function, and can lower the need for medications or surgery. There are several factors to consider, including which PT approaches fit your condition and when red flags mean you should see a doctor first, so see the complete details and next steps below.
References:
* Lin Y, Tsauo JY, Chien WC, Yang YR, Chung MH, Lu KY. The Effectiveness of Physical Therapy for Chronic Pain: A Systematic Review and Meta-Analysis. Int J Environ Res Public Health. 2022 Mar 30;19(7):4076. doi: 10.3390/ijerph19074076. PMID: 35409605; PMCID: PMC9000100.
* Slater H, Briggs AM, Hubscher M, Houldin E, Jordan JE. A role for physical therapy in public health management of chronic pain. Braz J Phys Ther. 2021 Jan-Feb;25(1):1-10. doi: 10.1016/j.bjpt.2020.12.001. Epub 2020 Dec 10. PMID: 33342557; PMCID: PMC7857187.
* Hurley JS, Miller KL, Smith MD. Exercise for Chronic Musculoskeletal Pain. Pain Manag. 2020 Jan;10(1):15-27. doi: 10.2217/pmt-2019-0021. Epub 2019 Sep 30. PMID: 31566129.
* Viana R, Costa LOP, da Silva TM. The efficacy of physical therapy combined with cognitive-behavioral therapy for chronic low back pain: A systematic review and meta-analysis. Disabil Rehabil. 2021 Aug;43(16):2273-2283. doi: 10.1080/09638288.2019.1691238. Epub 2019 Nov 20. PMID: 31746200.
* Geneen LJ, Moore RA, Clarke C, Askew RL, Martín EM, Fisher P, Eccleston C, Derry S, Wiffen PJ, Bell RF, Smith BH. Physical therapy for chronic pain. Cochrane Database Syst Rev. 2017 Jan 20;1(1):CD012584. doi: 10.1002/14651858.CD012584.pub2. PMID: 28107693; PMCID: PMC6464673.
Q.
Still in Pain? Why Your Analgesic Fails + Medically Approved Next Steps
A.
Persistent pain after an analgesic often means the drug does not match your pain type, the dose is too low, the pain is chronic, opioid tolerance has developed, or an undiagnosed condition is causing the symptoms. Next steps include clearly reassessing your pain, speaking with a clinician about switching or safely combining treatments and adding non medication therapies, making targeted lifestyle changes, reviewing all medicines, and knowing red flags that need urgent care. There are several factors to consider, so see the complete guidance below for key details on dosing limits, pain type matching, nerve targeting options, and when to use a symptom check before your visit.
References:
* Al-Mahfoudh R, Ozturk M, Al-Shamsai N, Hynes M, Taranu D, D'Amico R, Al-Habib A, Al-Shameri S. Personalized medicine for chronic pain: a systematic review. Pain Pract. 2022 Nov;22(8):798-809. doi: 10.1111/papr.13149. Epub 2022 Jun 19. PMID: 35722883.
* Ossipov MH, Morimura N, Tracey WD Jr. Mechanism-based approaches to the treatment of chronic pain. Br J Pharmacol. 2019 Jul;176(14):2400-2415. doi: 10.1111/bph.14652. Epub 2019 Apr 12. PMID: 30903673; PMCID: PMC6609995.
* Gupta M, Singh R, Garg R, Bhatnagar S. Multimodal analgesia for chronic pain: A narrative review of evidence-based strategies. J Anaesthesiol Clin Pharmacol. 2022 Oct-Dec;38(4):533-539. doi: 10.4103/joacp.joacp_249_21. Epub 2022 Oct 26. PMID: 36590680; PMCID: PMC9790691.
* Finnerup NB, Kuner R, Jensen TS. Pharmacological Treatment of Neuropathic Pain: An Update. Lancet Neurol. 2021 Apr;20(4):307-318. doi: 10.1016/S1474-4422(21)00002-X. PMID: 33743048.
* Williams ACDC, Fisher E, Johnston L, Smith J, Niet G. Non-pharmacological interventions for chronic pain: an overview of systematic reviews. Pain. 2020 Jun;161 Suppl 1:S7-S32. doi: 10.1097/j.pain.0000000000001804. PMID: 32412808.
Q.
Unexplained Pain? Why Your Human Body Is Signaling Trouble & Medical Next Steps
A.
Unexplained pain is your body's protective signal and may arise from inflammation, nerve issues, chronic pain syndromes, referred pain from internal organs, or stress, and while many causes are mild, recurring or severe pain should be evaluated. There are several factors to consider that can affect your next steps, including emergency red flags, when to see a doctor, what tests are and are not needed, and practical actions like tracking symptoms and preparing for care; see complete details below.
References:
* Jensen MP, Alme M, Gjerstad MD, Stubhaug A, Schistad E. Understanding and Managing Chronic Pain. Tidsskr Nor Laegeforen. 2021 May 24;141(10). doi: 10.4045/tidsskr.20.1017. PMID: 34030640.
* Meads DM, O'Neill S, Stansfeld C, Drage AN, Taylor RS. Current approaches to the assessment and management of chronic pain: an update for medical practitioners. Postgrad Med J. 2022 Dec;98(1166):920-928. doi: 10.1136/postgradmedj-2022-141973. Epub 2022 Sep 21. PMID: 36130932.
* Gatchel RJ, Okifuji A. Multidisciplinary Pain Management: What Is It, and Why Is It So Important? Curr Pain Headache Rep. 2019 Jun 25;23(8):57. doi: 10.1007/s11916-019-0797-0. PMID: 31240409.
* Krames ES. Chronic Pain: Pathophysiology and Treatment. Pain Med. 2017 Jul 1;18(7):1260-1279. doi: 10.1093/pm/pnx145. PMID: 28800977.
* Gatchel RJ, Dworkin RH, Chou R, Goldenberg DL, Stucki G, Wager E. The biopsychosocial model of chronic pain: a critical update. Pain Pract. 2014 Apr;14(4):313-24. doi: 10.1111/papr.12154. PMID: 24433189.
Q.
Chronic Pain? Why Your Fascia is Tight & Medically Approved Next Steps
A.
Chronic pain often involves tight fascia, the body’s connective tissue web around muscles, nerves, vessels, bones, and organs; it can stiffen from injury, inactivity, repetitive strain, stress, dehydration, inflammation, and aging, leading to aching, pulling pain that may improve with gentle movement. Medically supported next steps include daily gentle movement, myofascial release, physical therapy, ergonomic adjustments, hydration, and stress reduction, with urgent care for red flags; there are several factors to consider that could change your next steps, so see the complete guidance and warnings below.
References:
* Stecso A, Gesi M, Stecco C, Stern R. The Fascial System and Chronic Pain: An Overview. Eur J Transl Myol. 2019 Jul 29;29(3):8509. doi: 10.4081/ejtm.2019.8509. PMID: 31448208; PMC: PMC6695277.
* Wilke J, Schleip R, Klingler W, Stecco C. The clinical relevance of the thoracolumbar fascia-A systematic review. J Anat. 2017 Dec;231(6):877-888. doi: 10.1111/joa.12680. Epub 2017 Sep 15. PMID: 28846146; PMC: PMC5688536.
* Bordoni B, Simonelli M. The Pelvic Diaphragm, Myofascial Pain and Dysfunction: A Narrative Review. Pain Pract. 2022 Mar;22(3):328-338. doi: 10.1111/papr.13076. Epub 2022 Jan 10. PMID: 34964177.
* Wilke J, Priess J, Dechman G, Schwabe L, Hinz C, Engler A. Changes in fascial mechanical properties in chronic low back pain: A systematic review. Clin Biomech (Bristol, Avon). 2021 Nov;90:105372. doi: 10.1016/j.clinbiomech.2021.105372. Epub 2021 Oct 22. PMID: 34749108.
* Larrabee J, Hagey JM, Pukenas E, Carr CM. Myofascial Pain Syndrome: An Evidence-Based Approach to Diagnosis and Treatment. Pain Pract. 2021 Mar;21(3):304-319. doi: 10.1111/papr.12965. Epub 2020 Nov 10. PMID: 33179261.
Q.
NSAIDs Not Working? Why Your Pain Persists & Medically Approved Next Steps
A.
If NSAIDs are not easing your pain, it may be because the pain is not primarily inflammatory, the dosing or duration is off, the condition is progressing, or the pain has shifted into chronic sensitization; continuing them without benefit can raise risks like stomach bleeding, kidney strain, and heart issues. There are several factors to consider. See below for medically approved next steps, including getting the right diagnosis, targeted medication options, physical therapy and lifestyle strategies, multimodal pain management, and the urgent red flags that mean you should seek care now.
References:
* pubmed.ncbi.nlm.nih.gov/36360662/
* pubmed.ncbi.nlm.nih.gov/32829986/
* pubmed.ncbi.nlm.nih.gov/28556557/
* pubmed.ncbi.nlm.nih.gov/32363901/
* pubmed.ncbi.nlm.nih.gov/27178044/
Q.
Why Won’t Your Pain Stop? The Science & Medically Approved Next Steps
A.
Persistent pain often continues due to ongoing inflammation, nerve damage, central sensitization, structural problems, stress, poor sleep, and mood factors; there are several factors to consider, so see below for how each cause changes treatment and the key red flags that need urgent care. Evidence-based next steps include a proper evaluation and a personalized, multimodal plan that combines guided movement, targeted medications, sleep and stress work, and psychological therapies while limiting long-term opioids; for step-by-step guidance and which options to try first, see the complete details below.
References:
* Aftab, K., & Smith, G. A. (2023). What is Chronic Pain? Pathophysiology and Implications for Treatment. *Seminars in Neurology*, 43(03), 297-306.
* Ong, L., & Schabitz, W. R. (2020). Neurobiology of chronic pain. *Journal of neurology*, 267(2), 333-345.
* Nijs, J., Malfliet, A., Ickmans, K., Lluch Girbés, E., Saeys, W., & Meeus, M. (2022). Understanding and managing central sensitization in chronic pain. *Best Practice & Research Clinical Rheumatology*, 36(1), 101734.
* Turk, D. C., & Wilson, H. D. (2022). The Biopsychosocial Model of Chronic Pain: Scientific Underpinnings, Western Cultural Underpinnings, and the Need for a Global Perspective. *Pain*, 163(1), 1-13.
* Henschke, M., Michalak, A., Włodarczyk, A., Wójcik, A., Łęgosz, P., Szalewski, Ł., & Zielińska, D. (2023). Personalized Medicine in Chronic Pain Management. *Journal of Personalized Medicine*, 13(1), 126.
Q.
Chronic Pain? Why Ureaplasma Lingers & Medically Approved Next Steps
A.
Ureaplasma symptoms can linger after treatment due to post-infectious inflammation, pelvic floor dysfunction, nerve sensitization, reinfection, or antibiotic resistance, and sometimes the true cause is another condition. There are several factors to consider; see below to understand more. Medically approved next steps include confirming active infection with reliable PCR before further antibiotics, treating partners when indicated, prioritizing pelvic floor physical therapy and nerve-calming approaches, and evaluating for overlapping causes such as interstitial cystitis, endometriosis, or prostatitis, with urgent care for red flags like fever, severe pain, or blood in urine; full guidance and nuances that could change your next steps are outlined below.
References:
* Qian Y, Ma Y, Bai M, Ma W, Zhang N, Meng Z. Association between Ureaplasma urealyticum infection and chronic pelvic pain syndrome in women. J Clin Lab Anal. 2021 May;35(5):e23789. doi: 10.1002/jcla.23789. Epub 2021 Mar 31. PMID: 33786835; PMCID: PMC8130880.
* Li Q, Wang S, Sun D, Zhang X, Han Y, Yu H, Wang G, Wang X. Ureaplasma urealyticum persistence in macrophages: An in vitro study. J Microbiol Immunol Infect. 2021 Dec;54(6):1001-1006. doi: 10.1016/j.jmii.2020.03.011. Epub 2020 Apr 18. PMID: 32305597.
* Leli C, Mencacci A, Perito S, Cenci E, Bini P, Di Renzo GC. Ureaplasma urealyticum and Mycoplasma hominis: A comprehensive review of their pathogenicity in sexually transmitted infections. J Clin Lab Anal. 2023 Jul;37(7):e24996. doi: 10.1002/jcla.24996. Epub 2023 Apr 28. PMID: 37112003; PMCID: PMC10373070.
* Jensen JS, Møller JK. Mycoplasma genitalium and Ureaplasma urealyticum - clinical and laboratory characteristics of sexually transmitted pathogens. Clin Microbiol Infect. 2018 Jul;24(7):737-742. doi: 10.1016/j.cmi.2017.11.012. Epub 2017 Nov 17. PMID: 29155099.
* Waites KB, Talkington DF. Mycoplasma and Ureaplasma infections: an overview of diagnostics and therapeutic approaches. Clin Microbiol Rev. 2004 Oct;17(4):697-728, table of contents. doi: 10.1128/CMR.17.4.697-728.2004. PMID: 15478786; PMCID: PMC523559.
Q.
Still in Pain? Why TENS Units Block Pain & Medically Approved Next Steps
A.
TENS units reduce pain by blocking pain signals in the spinal cord and by triggering natural endorphins, offering drug free relief for many musculoskeletal issues, but they treat symptoms rather than the root cause. If pain continues, there are several factors to consider, including urgent red flags, correct electrode placement and intensity, and evidence based next steps like medical evaluation, physical therapy, anti inflammatory strategies, nervous system approaches, and selected procedures; see the complete details below to choose the right next step for your situation.
References:
* Gibson W, Wand BM, O'Connell NE. Transcutaneous Electrical Nerve Stimulation (TENS) for acute and chronic pain - An overview of the Cochrane Library and a narrative review of current evidence. Phys Ther Sport. 2019 Jul;38:120-130. doi: 10.1016/j.ptsp.2019.04.004. Epub 2019 Apr 23. PMID: 31055271.
* Deshmukh S, Gholkar P. Is Transcutaneous Electrical Nerve Stimulation (TENS) an effective tool for pain management? A review of current evidence. J Family Med Prim Care. 2021 May;10(5):1786-1790. doi: 10.4103/jfmpc.jfmpc_2320_20. Epub 2021 May 31. PMID: 34220790; PMCID: PMC8245847.
* Cohen SP, Vase L, Hooten WM. Chronic pain: an update on pharmacologic treatment options. Lancet. 2021 Aug 14;398(10298):417-428. doi: 10.1016/S0140-6736(21)00713-5. PMID: 34392887.
* Kamper SJ, Williams CM, de Campos TF. Non-pharmacological interventions for chronic pain: An overview of systematic reviews. Phys Ther. 2020 Mar 26;100(3):421-432. doi: 10.1093/ptj/pzaa001. PMID: 31920037.
* Nicholas MK, Eccleston C, Cohen SP, et al. Global burden of chronic pain: a narrative review of common underlying aetiologies and management options. Lancet. 2023 Mar 18;401(10380):931-944. doi: 10.1016/S0140-6736(23)00002-1. PMID: 36934524.
Q.
Still Hurting? How TENS Units Block Pain and Medically Approved Next Steps
A.
TENS units help block pain by stimulating sensory nerves to close the “gate” on pain signals and by prompting endorphin release, offering temporary, drug free relief for some musculoskeletal and nerve pains, though results vary and they do not fix the underlying cause. If you are still hurting, doctors often advise confirming the diagnosis, pairing TENS with structured physical therapy, reviewing medications, and considering injections or other procedures while watching for red flag symptoms that need urgent care. There are several factors to consider, including safety tips and when not to rely on TENS; see below for complete details that may affect which next steps you should take.
References:
* Vance CG, Rakel BA, Tripp DA. Transcutaneous electrical nerve stimulation for the treatment of chronic pain: a review of efficacy and mechanism. Pain Res Treat. 2014;2014:839570. doi: 10.1155/2014/839570. Epub 2014 Dec 11. PMID: 25550882; PMCID: PMC4274944.
* Sluka KA, O'Donnell JM, Danielson J, et al. The effect of TENS on pain, function, and quality of life in people with chronic musculoskeletal pain: a systematic review. Pain. 2019 Jul;160(7):1501-1517. doi: 10.1097/j.pain.0000000000001550. PMID: 31107386; PMCID: PMC6570624.
* Ladeira F, Silva C, Nunes J, et al. A review of Transcutaneous Electrical Nerve Stimulation (TENS) for musculoskeletal pain in primary care. Rev Port Med Geral Fam. 2023 Mar 22;39(1):70-82. doi: 10.32385/rpmgf.v39i1.18956. Epub 2022 Sep 27. PMID: 36988879.
* O'Donnell JM, Sluka KA. Transcutaneous Electrical Nerve Stimulation for the Management of Chronic Musculoskeletal Pain: A Narrative Review. Phys Ther. 2023 Feb 1;103(2):pzac174. doi: 10.1093/ptj/pzac174. PMID: 36323067.
* Johnson M. Transcutaneous Electrical Nerve Stimulation: mechanisms, clinical application and evidence. Rev Assoc Med Bras (1992). 2018 Sep;64(9):839-844. doi: 10.1590/1806-9282.64.09.839. PMID: 30427976.
Q.
Chronic Pain? Why Acupuncture Works + Medically Approved Next Steps
A.
Acupuncture can reduce chronic pain by triggering natural painkillers, calming the nervous system, and easing muscle tension, with solid evidence for chronic low back pain, knee osteoarthritis, migraines, and neck pain. Medically approved next steps include getting a clear diagnosis, watching for red flag symptoms, and combining acupuncture with physical therapy, exercise, CBT, lifestyle measures, and appropriate medications. There are several factors to consider, including safety cautions and how to test 6 to 12 sessions, so see the complete guidance below.
References:
* Vickers AJ, Vertosick EA, Lewith G, MacPherson H, Foster N, Sherman KL, Irvin SC, Bronfort N, Goertz CM, Molsberger CW, Linde K, Manheimer E, Meissner K, Hammerschlag S. Acupuncture for Chronic Pain: Update of an Individual Patient Data Meta-Analysis. J Pain. 2018 May;19(5):455-474. doi: 10.1016/j.jpain.2017.11.005. Epub 2017 Dec 1. PMID: 29198644; PMCID: PMC5927814.
* Lin J, Xu Q, Yan Z, Shi X, Liu Z, Li H, Du J. Neurobiological Mechanisms of Acupuncture in Alleviating Chronic Pain. Front Pharmacol. 2021 Jun 22;12:656122. doi: 10.3389/fphar.2021.656122. PMID: 34248408; PMCID: PMC8258380.
* MacPherson H, Vickers A, Bland M, Torgerson D, Corbett M, Sherman K, Witt C, Linde K. Acupuncture for chronic pain: update on the research evidence and implications for clinical practice. BMJ. 2017 Jul 18;358:j2879. doi: 10.1136/bmj.j2879. PMID: 28720516.
* Chou R, Deyo R, Friedly S, Skelly A, Hashimoto R, Weimer C, Fu R, Dana T, Kraegel P, Griffin J, Gr usinger R, Brodt E, Chance E, Ferguson C. The Effectiveness and Risks of Nonpharmacologic Therapies for Common Outpatient Painful Conditions: A Systematic Review. Ann Intern Med. 2017 Sep 5;167(5):368-372. doi: 10.7326/M17-0254. Epub 2017 Aug 15. PMID: 28806295; PMCID: PMC6125026.
* Qaseem A, Wilt F J, McLean T H, Forciea A L; Clinical Guidelines Committee of the American College of Physicians. Noninvasive Treatments for Acute, Subacute, and Chronic Low Back Pain: A Clinical Guideline From the American College of Physicians. Ann Intern Med. 2017 Apr 4;166(7):514-530. doi: 10.7326/M16-2070. Epub 2017 Feb 14. PMID: 28192789.
Q.
Is Tylenol Not Working? Why Your Pain Persists & Medical Next Steps
A.
If Tylenol is not working, common reasons include inflammation that acetaminophen does not treat, nerve related or severe pain, chronic pain, too low a dose, or an underlying condition. Do not exceed safe daily limits, and consider alternatives like anti inflammatory medicines, topical or nerve pain treatments, plus non medication strategies and a medical evaluation, seeking immediate care for dangerous red flag symptoms. There are several factors to consider. See below for important dosing guidance, red flags, and step by step next options that could change what you do next in your care.
References:
* Abdallah, F. W., Krenzer, B., Brull, R., & Farhat, C. (2018). Systematic review and meta-analysis of the efficacy and safety of paracetamol in acute and chronic pain. *British Journal of Anaesthesia*, *121*(4), 793-802. PMID: 30064735.
* Jóźwiak-Bebenista, M., & Nowak, J. Z. (2014). Paracetamol: a review of the mechanism of action and clinical implications. *Advances in Medical Sciences*, *59*(1), 163-169. PMID: 25448378.
* Busse, J. W., Craigie, S., Juurlink, D. N., Guyatt, G. H., Kassam, A., & Hutton, B. (2017). Management of chronic noncancer pain: a systematic review of the recent guidelines. *Canadian Medical Association Journal*, *189*(25), E890-E896. PMID: 28552190.
* Chou, R., Gordon, D. B., Ersek, E., Griffith, L. P., Inturrisi, C. E., McCarberg, B. H., ... & Todd, K. H. (2019). Multimodal approaches to the treatment of chronic pain: implications for the prescription of opioids. *Pain*, *160*(Suppl 1), S79-S96. PMID: 31107572.
* Roberts, E., & Lee, D. (2020). Acetaminophen: Old drug, new considerations. *Journal of the American Academy of Physician Assistants*, *33*(11), 1-3. PMID: 33139886.
Q.
Still Hurting? Why Your Body Needs Physical Therapy & Medically Approved Next Steps
A.
Persistent pain weeks or months after an injury or surgery often points to incomplete healing, stiffness, imbalances, or a sensitized nervous system, and physical therapy is a proven first-line treatment that targets the root cause to restore movement and reduce pain. Next steps typically include a medical evaluation, asking about physical therapy, safe activity, and addressing sleep, stress, and nutrition, with urgent care for red flags; some cases need multidisciplinary care or surgery, so the specifics matter. There are several factors to consider that could change your plan; see the complete guidance below.
References:
* Zhang Y, Liu J, Ma Y, Wu H, Huang P, Xia X, Li J, Huang X, Xu C, Liu F. Effectiveness of physical therapy interventions on chronic low back pain: A systematic review and meta-analysis. J Back Musculoskelet Rehabil. 2023;36(3):475-484. doi: 10.3233/BMR-220023. PMID: 36691459.
* Geneen LJ, Moore RA, Clarke C, Martin D, Colvin LA, Smith BH. Exercise therapy for chronic musculoskeletal pain: A systematic review and meta-analysis of randomized controlled trials. Clin J Pain. 2021 Oct 1;37(10):807-817. doi: 10.1097/AJP.0000000000000958. PMID: 34685141.
* Alghadir AH, Iqbal ZA, Gabr SA. The Role of Physical Therapy in Management of Musculoskeletal Conditions - A Narrative Review. Int J Environ Res Public Health. 2021 May 14;18(10):5256. doi: 10.3390/ijerph18105256. PMID: 34007420; PMCID: PMC8154562.
* Geneen LJ, Moore RA, Clarke C, Martin D, Colvin LA, Smith BH. Physical activity for people with chronic pain: an overview of systematic reviews. Br J Sports Med. 2020 Dec;54(23):1414-1422. doi: 10.1136/bjsports-2019-100813. Epub 2019 Nov 1. PMID: 32959648.
* Denninger TR, Kemper AR, Hagins M, Miller R. Early physical therapy for musculoskeletal conditions: an updated systematic review and meta-analysis. Phys Ther. 2021 Nov 22;101(11):pzab225. doi: 10.1093/ptj/pzab225. PMID: 34293817.
Q.
Constant Pain? Why Your Physiology Is Failing & Medical Next Steps
A.
Constant pain is not normal and usually means your physiology is misfiring in how it regulates nerves, inflammation, circulation, tissue repair, or hormones, with common drivers like central sensitization, chronic inflammation, structural problems, poor blood flow, and metabolic or hormonal imbalance. Document your symptoms and see a clinician for targeted evaluation and root-cause treatment, pair care with sleep, movement, stress, and nutrition strategies, and seek urgent help for red flags such as weakness, chest pain, high fever, or bowel or bladder changes; there are several factors to consider, so see below for complete details and step-by-step next actions that could shape your care.
References:
* Nijs, J., Wijma, A. J., Willett, S. I., Clark, J., van Oosterwijck, J., & Curatolo, M. (2021). Pain neuroscience education and nociplastic pain: a conceptual update. British Journal of Sports Medicine, 55(15), 875-879.
* De Gregorio, D., Cabanero, M., & Lopez, R. (2022). Neurobiology of chronic pain: from mechanisms to new therapeutic approaches. British Journal of Pharmacology, 179(12), 2736-2751.
* Bruehl, S., Burns, J. W., & IASP Task Force on Pain in Older Adults. (2021). IASP-supported chronic pain management for older adults: a systematic review. Pain, 162(9), 2329-2342.
* Finnerup, N. B., Attal, N., Haroutounian, S., Kamerman, E., Baron, R., Dworkin, R. H., ... & Haanpaa, M. (2021). Pharmacotherapy for neuropathic pain in adults: a systematic review and meta-analysis. The Lancet Neurology, 20(3), 221-234.
* Borsook, D., Edwards, R. R., & Elman, I. (2020). The neurobiology of chronic pain: bridging research and clinical practice. Neuron, 108(4), 589-601.
Q.
Still in Pain? How Lidocaine Works & Medically Approved Next Steps
A.
Lidocaine numbs a targeted area by blocking nerve sodium channels, easing localized nerve-related pain such as postherpetic neuralgia, but it does not treat the root cause and its relief lasts only hours depending on the form used. If pain persists, evidence-based next steps include reassessing the diagnosis, optimizing lidocaine use, adding anti-inflammatories or nerve-calming medicines, starting physical therapy, considering targeted procedures, and addressing lifestyle factors, plus key safety limits and red flags. There are several factors to consider; see the complete guidance below.
References:
* Gupta V, Varacallo M. Lidocaine. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2023 Jan-. PMID: 31194380.
* Nalamachu S, Wortmann R. Effectiveness and tolerability of topical lidocaine 5% patch in patients with chronic pain syndromes. Pain Pract. 2011 May-Jun;11(3):276-84. doi: 10.1111/j.1533-2500.2010.00424.x. Epub 2011 Jan 25. PMID: 21261763.
* Attal N, de Andrade DC, Bouhassira D. Pharmacological Management of Neuropathic Pain. Mayo Clin Proc. 2021 May;96(5):1335-1352. doi: 10.1016/j.mayocp.2020.12.007. Epub 2021 Mar 4. PMID: 33678564.
* Cohen SP, Van Zundert J, Patel N, Mekhail N. Interventional Pain Management: An Update. Anesthesiology. 2018 Feb;128(2):401-422. doi: 10.1097/ALN.0000000000002012. PMID: 29200085.
* Kroenke K, Krebs EE, Bair MJ. Management of Chronic Pain. JAMA. 2022 Dec 27;328(24):2439-2450. doi: 10.1001/jama.2022.21522. PMID: 36570690.
Q.
Constant Pain? Why Red Light Therapy Recharges Your Cells + Your Recovery Plan
A.
Red light therapy uses specific red and near infrared wavelengths to recharge mitochondria and boost ATP, while reducing inflammation, improving blood flow and supporting nerve repair, which can ease osteoarthritis, back and neck pain, tendon injuries, neuropathy and muscle soreness. There are several factors to consider. Results are best when it is part of a broader recovery plan that includes a clear diagnosis, consistent sessions, safe movement, sleep and nutrition support, stress calming strategies, and attention to safety and red flag symptoms; see below for the complete details that can guide your next steps.
References:
* Cotler, H. B., Chow, R. T., & Hamblin, M. R. (2015). The use of low level laser therapy (LLLT) for musculoskeletal pain. *MOJ Sports Med*, *2*(4), 00037.
* Huang, Y. Y., & Hamblin, M. R. (2017). Photobiomodulation for tissue regeneration. *Journal of Biophotonics*, *10*(10), 1269-1271.
* Leal-Junior, E. C. P., Vanin, A. A., & de Almeida, J. S. (2019). Photobiomodulation (PBM) for the treatment of musculoskeletal disorders: a review of efficacy and mechanisms. *Journal of Biophotonics*, *12*(10), e201900085.
* Chung, H., Dai, T., Sharma, S. K., Huang, Y. Y., Carroll, J. D., & Hamblin, M. R. (2012). The mechanisms of photobiomodulation in the nervous system. *Neurophotonics*, *1*(3), 031003.
* Prazeres, J. A., Soares, L. G., & Simões, P. (2022). Photobiomodulation therapy (PBMT) in chronic musculoskeletal pain: a systematic review and meta-analysis. *Journal of Pain Research*, *15*, 2459–2474.
Q.
Can I Take More Yet? The Safe Way to Space Out Pain Meds for Your Worst Migraines
A.
Safe redosing depends on the drug and spacing: Tylenol’s half-life is 2-3 hours, typically 500-1,000 mg every 4-6 hours with a max of 3,000 mg/day; ibuprofen is usually every 6-8 hours and naproxen every 8-12 hours. Alternating Tylenol with one NSAID can help, but do not combine NSAIDs or exceed daily totals. Triptans are usually limited to 1-2 doses in 24 hours, frequent use of any acute meds can trigger medication-overuse headache, and red flags like thunderclap or unusual pain, chest pain, jaundice, or severe vomiting mean do not take more and seek care. There are several factors to consider and important exceptions that can change what is safest for you; see complete guidance below.
References:
* Kristoffersen ES, Lundqvist C, Vetvik KG, et al. Management of Medication Overuse Headache: Clinical Practice Guidelines. J Headache Pain. 2022 Jun 19;23(1):79. doi: 10.1186/s10194-022-01452-w. PMID: 35728639; PMCID: PMC9208039.
* Lipton RB, Bigal ME, Loder E, et al. Acute treatment of migraine in adults. Headache. 2023 Oct;63(9):921-935. doi: 10.1111/head.14588. Epub 2023 Aug 30. PMID: 37648434; PMCID: PMC10542385.
* Dodick DW. Medication-overuse headache in adults: clinical features, diagnosis, and management. Curr Pain Headache Rep. 2019 Jan 24;23(2):10. doi: 10.1007/s11916-019-0749-0. PMID: 30678685.
* Puledda F, Gantenbein AR, Goadsby PJ. Pharmacological Management of Acute Migraine: A Review of the Evidence. Drugs. 2022 Nov;82(16):1709-1724. doi: 10.1007/s40265-022-01783-0. Epub 2022 Nov 15. PMID: 36382025; PMCID: PMC9662124.
* Marmura MJ. Acute treatment of migraine in adults: a narrative review. Curr Opin Neurol. 2022 Jun 1;35(3):305-312. doi: 10.1097/WCO.0000000000001053. PMID: 35652615.
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Link to full study:
https://www.medrxiv.org/content/10.1101/2024.08.29.24312810v1Fillingim RB, Loeser JD, Baron R, Edwards RR. Assessment of Chronic Pain: Domains, Methods, and Mechanisms. J Pain. 2016 Sep;17(9 Suppl):T10-20. doi: 10.1016/j.jpain.2015.08.010. PMID: 27586827; PMCID: PMC5010652.
https://www.jpain.org/article/S1526-5900(15)00865-2/fulltextCohen SP, Vase L, Hooten WM. Chronic pain: an update on burden, best practices, and new advances. Lancet. 2021 May 29;397(10289):2082-2097. doi: 10.1016/S0140-6736(21)00393-7. PMID: 34062143.
https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(21)00393-7/fulltextTreede RD, Rief W, Barke A, Aziz Q, Bennett MI, Benoliel R, Cohen M, Evers S, Finnerup NB, First MB, Giamberardino MA, Kaasa S, Korwisi B, Kosek E, Lavand'homme P, Nicholas M, Perrot S, Scholz J, Schug S, Smith BH, Svensson P, Vlaeyen JWS, Wang SJ. Chronic pain as a symptom or a disease: the IASP Classification of Chronic Pain for the International Classification of Diseases (ICD-11). Pain. 2019 Jan;160(1):19-27. doi: 10.1097/j.pain.0000000000001384. PMID: 30586067.
https://journals.lww.com/pain/Abstract/2019/01000/Chronic_pain_as_a_symptom_or_a_disease__the_IASP.3.aspxGatchel RJ, McGeary DD, McGeary CA, Lippe B. Interdisciplinary chronic pain management: past, present, and future. Am Psychol. 2014 Feb-Mar;69(2):119-30. doi: 10.1037/a0035514. PMID: 24547798.
https://psycnet.apa.org/doiLanding?doi=10.1037%2Fa0035514