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To Your Good Health: Dealing with pain

Dear Dr. Roach: I just returned from seeing my husband鈥檚 doctor with him, and I鈥檇 gone this time to be sure the doctor knew how my husband鈥檚 use of painkillers has escalated.

Dear Dr. Roach: I just returned from seeing my husband鈥檚 doctor with him, and I鈥檇 gone this time to be sure the doctor knew how my husband鈥檚 use of painkillers has escalated. He began using painkillers a few years ago and now is using the medication daily. Often, he鈥檒l take dose after dose, saying the pain won鈥檛 go away.

He just had an MRI done, but the doctor doesn鈥檛 think there is anything abnormal, ignored my concerns and handed my husband a new prescription for a more powerful narcotic!

My husband does a lot of driving in heavy traffic. What can I do?

W.B.

The use of narcotics for treating chronic pain (apart from treating cancer pain) is a big controversy in medicine right now. Of course your husband鈥檚 doctor wants to relieve his pain, and I am sure is doing his or her best to do so. But it doesn鈥檛 seem clear why your husband is having pain, and using powerful narcotics for pain from an unclear cause is, in my opinion, not a good idea. First of all, you can be masking symptoms of a condition that requires treatment other than pain control. Second, narcotics have significant side-effects, including falls and traffic accidents. Third, long-term use of narcotics for noncancer pain in a recent study didn鈥檛 provide reduction in pain. This may be due to the fact that the body gets used to narcotics, so higher and higher doses are required for the same amount of pain relief, and eventually the level of pain is as bad as it was before starting on narcotics.

Your husband may need further evaluation, apart from the MRI, to find out where the pain is coming from. Often we can鈥檛 find a definite reason. In that case, other medications besides narcotics can be more effective and have fewer side effects. A pain- management specialist can help.

Dear Dr. Roach: I am a healthy 70-year-old female. In the past year or so, though, I have had no energy. I feel like my head is in a fog all the time. I have been to doctors with these complaints, and they ask a few questions or maybe give me a blood test, but I never get a reason or help with the way I feel. It is an effort to lift my feet or arms sometimes. Is this what 70 feels like and I just need to accept it? That鈥檚 what my doctor seems to think.

R.T.

There are many possible causes for your concerns. The lack of energy, muscle weakness and the feeling of being in a fog are very nonspecific. I can think of a dozen causes off the top of my head, starting with thyroid problems, vitamin D deficiency and polymyalgia rheumatica (although that usually is arms and shoulders, and is much worse in the mornings).

You are not getting the care you need. Be more assertive with your doctor. Yes, we all slow down as we get older, but I have seen too many people not get care for medical conditions soon enough because symptoms were attributed to getting old.