If you have high blood pressure, you can lower it with small lifestyle changes. Work with your doctor to develop a plan for lowering your blood pressure. Part of the plan may also include taking blood pressure-lowering medicine. However, your lifestyle changes will be just as important.

Path to improved health

How do tobacco products affect blood pressure?

The nicotine in cigarettes and other tobacco products causes your blood vessels to constrict and your heart to beat faster. This temporarily raises your blood pressure. When you quit smoking or using other tobacco products, you can lower your blood pressure. Stopping tobacco significantly lowers your risk of heart disease and stroke.

What about losing weight and exercising?

If you’re overweight, losing weight usually helps lower blood pressure. Regular exercise is a good way to lose weight. It also seems to lower high blood pressure even if you don’t lose weight. And even a 5 pound weight loss can bring down blood pressure significantly if you are overweight.

Is sodium really off limits?

Not everyone is affected by sodium. However, sodium can increase blood pressure in some people. Most Americans who have a healthy blood pressure should limit the sodium in their diet to 2,300 mg per day. African Americans, older adults, and people who have high blood pressure should limit the sodium in their diet to 1,500 mg per day. Your doctor may tell you to limit your sodium even more.

To lower your sodium intake, don’t add salt to your food. Check food labels for sodium. Some foods, such as potato chips, obviously have a lot of sodium. But you may not realize how much sodium is in food like bread, canned vegetables, soups, and cheese. Also be aware that some medicines contain sodium.

Do I need to quit drinking alcohol?

In some people, alcohol causes blood pressure to rise quite a bit. In other people, it doesn’t. If you drink alcohol, limit it to no more than 1 drink per day for women or 2 drinks per day for men. One drink is a can of beer, a glass of wine (4-5 oz.), or 1 shot (jigger) of liquor. If your blood pressure increases when you drink alcohol, it’s best to not drink any alcohol.

Does stress affect my blood pressure?

Stress may affect blood pressure. To combat the effects of stress, try relaxation techniques or biofeedback. These things work best when used at least once a day. Ask your family doctor for advice.

Do other health conditions cause high blood pressure?

A little more than half of people who have diabetes have high blood pressure too. Talk to your doctor about other health conditions that could be causing your high blood pressure.

How can I know if changing my lifestyle is helping?

One of the best ways to know if what you are doing is working is to see for yourself. Consider buying a home blood pressure monitor. Use it to see whether what you are doing is lowering your blood pressure numbers. Ask your doctor to recommend a monitor.

Even if doing the things mentioned in this article don’t decrease your blood pressure, they still will promote your overall health and are worth continuing.

Things to consider

Not lowering your blood pressure puts you at higher risk for certain diseases. These can include:

• Stroke
• Heart attack
• Heart failure
• Kidney disease
• Early death

Questions to ask your doctor

• What are the symptoms of high blood pressure?
• What is considered normal blood pressure?
• Can I lower my blood pressure through lifestyle changes alone?
• What are the side effects of blood pressure medicine?
• Could any medications I am taking raise my blood pressure?

Resources

Centers for Disease Control and Prevention: Manage High Blood Pressure

National Institutes of Health, MedlinePlus: Controlling Your High Blood Pressure

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Kegel exercises strengthen the muscles under the uterus, bladder, and bowel (large intestine). At the bottom of your pelvis are layers of muscles known as your pelvic floor. They are shaped like a hammock and connect to the front, back, and sides of your pelvic bone. Your pelvic muscles support the bladder, rectum, and sexual organs. They hold them in place and help control the flow of urine.

For women, pregnancy and childbirth can weaken the pelvic muscles. For men, prostate surgery can weaken the pelvic muscles. Your risk also increases as you age and if you are overweight. Brain and nerve disorders can also lead to problems with urine leakage or bowel control.

Weak pelvic muscles can cause you to leak urine. Luckily, Kegel exercises can strengthen your pelvic muscles and help you regain bladder control.

Path to improved health

You can do Kegel exercises almost anywhere, at any time. People can’t see you do them. That’s because it involves tightening and releasing the muscles in your pelvis. It is easiest to start off doing them as you are lying down. As they become easier, you can do them while driving, working, or watching TV.

Before you start the exercises, you’ll need to locate your pelvic muscles. They are the same muscles you use to stop urine flow or hold in gas. To exercise, pull in (contract) or squeeze your pelvic muscles. Hold this for 3 to 5 seconds, then release and rest for 3 to 5 seconds. As you continue, you can increase the amount of time you hold and rest up to 10 seconds. Do 10 to 20 exercises 3 times per day. If you are doing the exercises correctly, the muscles in your thighs, bottom and stomach should remain relaxed.

You may not notice change in your muscles right away. As with other muscles in your body, it can take 4 to 8 weeks of daily exercise. Keep a log of your exercises to track your progress.

Things to consider

If you struggle with incontinence, try contracting your muscles after going to the bathroom. This can help ensure you have gotten all the urine out. Be careful though. Doing Kegel exercises mid-urination can cause a bladder infection.

You also should tighten your muscles before certain movements. This includes sneezing, coughing, laughing, jumping, or lifting a heavy object. The contraction can prevent pelvic muscle damage and urine leakage.

Talk to your doctor about Kegel exercises. They can help make sure you are doing them correctly. Keep them informed of your progress or if your problem isn’t improving. You may need another form of treatment, such as pelvic floor physical therapy or surgery.

Questions to ask your doctor

• Is a weak pelvic floor associated with other health issues?
• What does it mean to contract or tighten my pelvic floor muscles?
• Should Kegel exercises be painful?
• Will I always have to do Kegel exercises?

Resources

National Institutes of Health, MedlinePlus: Kegel exercises – self care

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Prostate cancer is one of the most common types of cancer in men. Fast-growing tumors can spread to other parts of your body. This form of cancer can be hard to treat if it is not caught early. Slow-growing tumors may not require treatment at first, or at all.

Path to improved health

Below are the most common prostate cancer treatments. Each treatment type has different benefits, risks, and outlooks. Talk to your doctor about what option is best for you.

Watchful waiting

If you have slow-growing cancer, your doctor may recommend observation as the first phase of treatment. This also might apply to men who are older or have severe health issues. Watchful waiting involves monitoring changes in your symptoms and tumors. It can consist of regular rectal exams, blood or imaging tests, and/or biopsies. If your doctor detects changes, they likely will suggest a type of active treatment.

Surgery

Radical prostatectomy is a surgery to remove your entire prostate. This includes lymph nodes and seminal vesicles. Surgery typically is an option if your cancer is contained to your prostate and has not spread. The surgeon can remove your prostate through one large incision or laparoscopically. Laparoscopic surgeries are also known as minimally invasive surgeries. They are performed using a laparoscope (a small, thin tube with a camera on the tip that is used to see the inside of your body) through a small number of incisions. These types of surgeries lead to less pain and a quicker recovery time than more invasive surgeries.

Surgery does require a stay in the hospital. Recovery time varies from several weeks to months. Usually, you can return to work in about 1 month. During recovery, you will have a catheter to help you urinate until the cut heals. Most men regain bladder control within a few weeks after surgery.

The success rate for surgery is very high if all the cancer gets removed. Surgery also provides your doctor with information. They will know the exact size and state of your tumor. However, as with all surgeries, there can be complications. These include blood clots, internal damage, or a reaction to the medicine. After surgery, you could have bleeding or an infection. There is a chance of erectile dysfunction (impotence) or loss of bladder control.

Men who have surgery to treat prostate cancer are no longer able to have children naturally. Your body still creates sperm but does not release it. If you want to have a baby, talk to your doctor about storing sperm before surgery. Treatment also can alter your orgasms and increase your risk of getting a hernia in your groin.

Radiation therapy

Radiation kills cancer cells using high-energy rays. This treatment is an option for both low- and high-grade forms of prostate cancer. It can be done on its own or with surgery. It also is an option if not all cancer gets removed or if your cancer comes back.

There are two types of radiation therapy. External radiation is known as beam therapy. It uses a machine that is similar to an X-ray. You get it 5 days a week for 6 to 8 weeks. Each radiation session lasts about 10 minutes. Internal radiation is known as seed therapy, or brachytherapy. It is more intense and only is given 1 time. Seed therapy requires a hospital stay since it involves anesthesia (medicine that puts you to sleep). The increased dose of radiation can cause discomfort.

The success rate for radiation therapy is about the same as surgery. Since the prostate gland and lymph nodes are not removed, your doctor won’t know the exact size and state of the tumor. Beam therapy has milder side effects than seed therapy. These can include frequent urination or urinary burning or bleeding. Rectal pain, rectal bleeding, and diarrhea are possible during or following treatment. Over time, you might become infertile or have erectile dysfunction.

Chemotherapy

Chemotherapy kills cancer cells using powerful drugs. It is given through an IV (intravenous) drip. A course of treatment lasts several weeks or months. Chemotherapy often has intense side effects. Most common are nausea, fatigue, and hair loss. It mostly is used by men who have fast-growing or advanced prostate cancer. It can help prolong your life.

Cryotherapy

Cryotherapy kills cancer cells using cold gases to freeze them. It is an option for men who have early or recurring cancer. It can be used in combination with other treatment types. The goal of cryotherapy is to eliminate your prostate gland. This is like surgery but is less invasive. It destroys your prostate with cold temperatures instead of an incision and removal.

Your doctor will perform a transrectal ultrasound (TRUS) to monitor the process. It does require a stay in the hospital because anesthesia is used. Cryotherapy often is less painful than surgery and has a shorter recovery time. You will have a catheter to help you urinate while you heal. Most men regain control of their bladder and bowels within a few weeks.

The long-term success rate of this treatment is unknown. A wide range of side effects is possible. Mild ones include urinary or rectal bleeding or burning. A swollen scrotum or penis and erectile dysfunction is common.

Hormone therapy

Your doctor might prescribe medicine to lower your level of male hormones, or androgens. Your hormones, including testosterone, can cause prostate tumors to grow or spread. Hormone therapy often is used in combination with other treatments. It can be done for several months in the form of pills or injections.

Hormone therapy does not cure prostate cancer. It can help shrink your tumor or prevent future growth. It also can control symptoms of prostate cancer. Side effects include fatigue, decreased sex drive, and erectile dysfunction. Osteoporosis (weakened bones) can be a more severe side effect.

Things to consider

It is up to you and your doctor to decide what treatment options are best. It may be good to get a second opinion. You should take several factors into consideration, including:

• Grade and stage of cancer
• Age and lifespan
• Overall state of health
• Any medicines you take or other conditions you have
• Size of your prostate gland (enlarged glands are more sensitive to treatment)
• Lifestyle changes
• Recovery time

Your outlook for prostate cancer depends on these factors, as well. Ask your doctor what you can do to prolong and improve your quality of life.

Questions to ask your doctor

• Is my grade and stage of cancer treatable or curable?
• How do I know if I need treatment?
• How do I decide what treatment is best for me, or what treatment to start with?
• Are there any clinical trials available to me?
• How long does treatment last?
• How will treatment affect my daily life? Will I still be able to do my normal activities?
• Can treatment affect my sex life or ability to have children?
• What are the long-term effects of prostate cancer treatment?
• What is my chance of cancer returning after treatment?
• What happens if I choose not to get treatment?

Resources

American Family Physician: Prostate Cancer: Making Decisions About Treatment

American Society of Clinical Oncology: Prostate Cancer: Treatment Options

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Prostate cancer, the growth of abnormal cells in a man’s prostate gland, is a leading cause of death in men. Your doctor can perform a screening. The screening includes a prostate-specific antigen (PSA) test (blood test) to check the PSA level in your blood. PSA is a substance produced by the prostate gland. A high PSA level may indicate a prostate problem. A digital rectal exam (DRE) is still widely used by many physicians. This is a physical screening in which your doctor inserts their gloved finger into your rectum to feel the size of your prostate. If you doctor needs more information, they may use imaging tools, such as ultrasound or MRI to get a more detailed look of your prostate.

Path to improved health

The goal of prostate screenings is to find cancer early. Cancer is easier to treat and more likely to be cured if it is caught early.

However, most cases of prostate cancer are not aggressive. More men have a slow-growing form of prostate cancer. This means they may not have symptoms or even require treatment. This approach is called “watchful waiting” or “active surveillance.” Prostate cancer treatment can have long-term side effects. These include loss of bladder control and erectile dysfunction. There is a rare chance of problems occurring in surgery to get a biopsy. This is the only way to confirm a prostate cancer diagnosis.

PSA test results aren’t always accurate or are “false positives.” This means that the PSA test result suggests that you might have cancer when you do not. A false-positive test result can lead to unneeded tests, such as a biopsy, and side effects from testing. It also causes worry for you and your family.

For these reasons, the American Academy of Family Physicians and U.S. Preventive Services Task Force have issued clinical recommendations. For men 55 through 69 years of age, they do not recommend routine PSA screening. Instead, they recommend having a conversation with your doctor about the risks and benefits of periodic screening. They do not recommend PSA screening for prostate cancer in men 70 years of age and older.

Other organizations have different screening recommendations. These include the American Cancer Society and the American Urological Association. Their guidelines depend on your age and state of health.

Things to consider

Ultimately, the decision to be screened for prostate cancer is between you and your doctor. Talk to them about your specific concerns. They can weigh the pros and cons with your personal health and risk factors.

Doctors and scientists perform ongoing and new research. These studies, or clinical trials, help to learn more about the benefits and risks of prostate cancer screening. Ask your doctor about the most recent study results. Try to stay up to date on new progress in prostate cancer screening and treatment.

Questions to ask your doctor

• How do I know if prostate screening is right for me?
• What are the symptoms of prostate cancer?
• If I have a high level of PSA, what problems could I have?

Resources

American Academy of Family Physicians: Clinical Preventive Service Recommendation: Prostate Cancer

American Cancer Society: Recommendations for Prostate Cancer Early Detection

American Urological Association: Prostate Cancer Guidelines

National Cancer Institute: Prostate Cancer—Patient Version

National Institutes of Health, MedlinePlus: Prostate Cancer

U.S. Preventive Services Task Force: Prostate Cancer: Screening

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Your cognitive health is determined by how well your brain can perform mental processes. These include remembering things, learning things, and using language. A healthy brain is just as important as a healthy body. Many of the things you do to keep your body healthy can also keep your brain healthy. It is also important to stay socially and mentally active.

What is cognitive decline?

Cognitive decline is when your brain doesn’t work as well as it used to. For example, a person who is experiencing cognitive decline may have trouble learning, using language, or remembering things.

Some cognitive decline is a normal part of growing older. Cognitive decline that happens quickly or that affects day-to-day activities is called dementia. A head injury, a stroke, or disease (for example, Alzheimer’s disease) can damage brain cells and lead to dementia.

As your body gets older, so does your brain. You can’t stop normal cognitive decline, just as you can’t stop other parts of normal aging. However, you do things to reduce your risk of decline. You can maintain your body and brain health by making healthy choices about your lifestyle, diet, and exercise. Healthy choices can also help prevent disease.

Path to improved health

There isn’t one specific diet that is best for brain health, but eating healthy is important for your overall health. Choosing foods that nourish your body and brain can help prevent or delay health problems, including conditions that increase your risks for dementia. There are many things you can do to nourish your body and brain.

Manage your weight. Studies show that obesity, diabetes, high blood pressure, and high cholesterol can all increase your risk for dementia. To lose weight and keep it off, avoid short-term or “fad” diets. Instead, adopt a healthy way of thinking about and eating food.

Eat fruits, vegetables, and whole grains. A diet that includes lots of fruits, vegetables, and whole grains can reduce your risk for chronic diseases, including heart disease, diabetes, and cancer. These same foods may also help protect brain function. The antioxidants in leafy greens, dark-skinned vegetables, and cruciferous vegetables (broccoli, cabbage, and turnips) may be especially protective. Vegetables including beets, broccoli, Brussels sprouts, cauliflower, eggplant, kale, red bell peppers, romaine lettuce, and spinach are good choices.

Avoid unhealthy fats. Try not to eat any trans fats. These are man-made fats that are bad for you. Trans fats are often used in processed foods and store-bought baked goods. Read food labels carefully to check for trans fats. They will appear in the ingredient list as “hydrogenated vegetable oil” or “partially hydrogenated vegetable oil.”

Foods that are high in saturated fats (for example, red meat) can contribute to high cholesterol levels. Over time, high cholesterol can increase your risk for heart attack and stroke. When you do eat red meat, reduce your portion size. Choose poultry and fish more often.

You can also avoid unhealthy fats by using olive oil or canola oil when you are sautéing foods. Bake, broil, or roast your food instead of frying it.

Get your omega-3 fatty acids. The most common source of omega-3 fatty acids is fatty fish (sardines, tuna, salmon, mackerel, and herring). Try to eat this type of fish once or twice a week.

Talk to your doctor about the risks and benefits of taking vitamins or supplements. Your doctor might suggest a dietary supplement based on your overall health and the vitamins or minerals your diet lacks. If you are interested in taking another type of supplement, talk to your doctor about why you want to take it and what you hope it will do for you. He or she can help you figure out if a dietary supplement will interact with any medical conditions you have or any prescription or over-the-counter (OTC) medicine you are taking.

Stay active physically, socially, and mentally. Physical activity helps prevent disease and maintain blood flow to the brain. If you don’t already exercise, try to work up to 30 minutes of moderate activity into your schedule 5 times a week. Moderate activities include anything that gets your heart rate up. Walking, hiking, bicycling, and swimming are all good options. Choose something you enjoy doing.

Any activity you do with other people helps to stimulate your brain. A social activity can be as simple as having lunch with a friend or walking around the block with a neighbor. Volunteer opportunities in your community or church are good ways to be social. Another option is finding a club or social group that focuses on a sport, hobby, or topic you enjoy.

To keep your brain cells strong and active, it’s important to stay mentally active. Challenge yourself to learn something new. Read to stay informed and for fun. Enroll in a class at a local community college or adult education center. Or, challenge yourself in a different way by playing games, completing puzzles, or trying memory exercises.

Things to consider

It is normal for your memory to lag as you get older. Forgetting where you put your keys, for example, is not a sign of Alzheimer’s disease. Being unable to retrace your steps to find the keys could be a sign. Other signs include losing track of the date or the season, or difficulty completing familiar tasks.

There is currently no known cure for Alzheimer’s disease. Researchers are working to find a way to delay or prevent Alzheimer’s disease. Until then, taking care of your body and brain are the best ways to prolong cognitive health.

Questions for your doctor

• What could be causing my memory loss?
• Is it possible that my medications could be making my memory worse?
• Are there any medications that can help with memory loss?
• Is it safe for someone with cognitive decline to drive?
• My parent could have dementia. How can I talk to them about it?

Resources

Centers for Disease Control and Prevention: Healthy Aging

National Institute on Aging: Assessing Risk for Alzheimer’s Disease

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Genes are found in chromosomes and are made up of DNA. We inherit genes from our parents. Our gene structure dictates how our body grows and regulates. When genes are normal, they work properly. When genes are abnormal or damaged, they can lead to disease. These are called gene mutations, or changes. Some changes run in families. These happen by chance and are called hereditary or inherited diseases and conditions. A gene mutation can be the sole cause of disease. However, most diseases occur from a mix of genetic and environmental factors.

Genetic testing looks at your genes to check for any mutations. The test is done with a blood, saliva, or tissue sample. There are several reasons why you might do genetic testing.

• To diagnose a disease or a type of disease
• To determine the cause of a disease
• To determine treatment options for a disease
• To find your risk of getting a certain disease that possibly can be prevented
• To find your risk of passing a disease to your children
• To screen your embryo, fetus, or baby

Path to well being

Talk to your doctor if you think you are at risk for an inherited disease. They may refer you to a genetic counselor, who can review your family history and provide advice. They will ask you questions about your health and the health of your blood relatives. This information can calculate what your risk may be. It can help you decide whether you want to get testing. It also may determine if your insurance will pay for the testing.

If one of your family members already has the disease, they should get genetic testing first. This will show if their disease was passed down or occurred by chance. People from different ethnic groups are often more at risk of certain diseases.

A positive test result means that you have the gene mutation. This increases your risk of the disease. However, it does not guarantee you will get the disease. It does mean you could pass the mutation to your children.

A negative test result means that you don’t have the gene change. This may mean the disease doesn’t run in your family or wasn’t passed down to you. A negative result does not guarantee you won’t get the disease. It means that your risk of the disease is the same as it is for other people.

Common conditions and diseases that benefit from genetic testing include:

• Colon cancer (Lynch syndrome)
• Breast cancer (BRCA gene)
• Down syndrome
• Cystic fibrosis
• Tay-Sachs disease
• Sickle cell disease
• Spina bifida
• Turner syndrome
• Von Willebrand Disease
• Albinism
• Duchenne muscular dystrophy

There are others and more are becoming available as research advances.

Things to consider

Genetic testing has pros and cons. These can change depending on your situation. Keep in mind that genetic testing is a voluntary choice. You should not feel forced to do it.

Some benefits of genetic testing include:

• You might be less worried about getting a certain disease.
• You might be able to change your lifestyle to reduce your risk.
• You might know how to move forward with family planning.
• You might be able to get treatment to prevent the disease. This could include medicine or surgery.
• Your doctor will know how often to screen for the disease.

There also are reasons you might not want genetic testing done. These are mainly emotional or financial.

• You might be more worried about getting a certain disease.
• You might feel angry, guilty, or depressed.
• It could lead to problems with your employer or insurance company.

Questions to ask your doctor

• How do I know if I should see a genetic counselor?
• If my genetic testing result is positive, what is my risk of getting the disease? What can I do to prevent or treat it?
• Should my genetic testing be done in a clinical setting or can I do it from home?

Resources

Centers for Disease Control and Prevention: Genetic Testing
National Cancer Institute: Genetic Testing for Inherited Cancer Susceptibility Syndromes
National Human Genome Research Institute: Genetic Testing FAQ

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Testosterone is a sex hormone that your body makes. Normally, men produce more of it than women do. Some men may have low amounts of testosterone. This is known as hypogonadism. Your hormone level decreases as you get older. Certain medicines and health conditions may affect it as well, including:

• Cancer treatment, such as chemotherapy
• Testicular cancer
• Injury to your testicles
• Hypothyroidism (low thyroid levels)
• Problems with your nervous system
• Obesity
• Diabetes

Path to improved health

Low testosterone can affect your physical and mental behavior. Talk to your doctor if you have symptoms, such as:

• Low sex drive
• Low sperm count
• Infertility
• Erectile dysfunction
• Changes in mood
• Depression
• Muscle or bone loss
• Decreased strength
• Weight gain
• Hair loss
• Trouble sleeping
• Trouble focusing

These can also be caused by other health issues. Your doctor will likely perform a physical exam and review your lifestyle to determine the problem. In addition, they may run a blood test to check your levels. Men usually have between 300 and 1,000 nanograms (ng) of testosterone per deciliter (dL). If your test results show a low level, you may need to increase the hormone. This can be done naturally.

Testosterone replacement therapy (TRT) is most common. This involves using man-made hormones. There are several forms that your doctor can prescribe. They include gel, a patch, or an injection. TRT is not an option for men who have certain health issues, including prostate or breast cancer. TRT also may not help men who have low testosterone due to advanced age.

TRT often is done in combination with other lifestyle changes. These changes promote overall good health. If you are obese, you should lose weight. You can do this by eating better and getting more exercise. Aim to get 7 to 8 hours of sleep each night. Try to control your stress levels. This allows your body to focus its energy on testosterone production.

Men low in testosterone should eat foods with zinc and vitamin D. These can help balance your hormones and produce more testosterone. Adult men should get about 11 milligrams of zinc per day. Zinc is in meat, poultry, seafood, and shellfish. Beans, nuts, and whole grains are also good sources. These foods, plus dairy, also contain vitamin D. Adult men should get about 600 international units (IUs) of vitamin D per day. You also should eat less sugar and saturated fat.

Things to consider

Your doctor may want to perform other tests to find the cause of low testosterone. This will help them decide if you need other treatment, as well.

There are benefits and risks to TRT. The goal of therapy is to get rid of symptoms of low testosterone. The treatment has been known to improve men’s sexual drive and mood. However, studies show that it may increase your risk of plaque buildup and heart disease. Talk to your doctor more about specific concerns. Make sure they know if you are at risk of any other health conditions.

Questions to ask your doctor

• Will I always have low testosterone?
• How long does TRT last?
• Should I take a supplement to increase my testosterone?

Resources

Endocrine Society: Hypogonadism in Men

National Institutes of Health, MedlinePlus: Could You Have Low Testosterone?

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Chronic pain is a type of pain that continues over time. It can last anywhere from 3 months or more to several years. Chronic pain may be caused by certain health conditions. It is more common in people who are older.

Treatment of chronic pain usually involves medicines and therapy. Medicines used for chronic pain include pain relievers, antidepressants, and anticonvulsants. Different types of medicines help people who have different types of pain. You usually use long-acting medicines for constant pain. Short-acting medicines treat short-term, or acute, pain.

Path to improved health

The goal of chronic pain treatment is to increase function and quality of life. Different types of medicines help people who have different types of pain. For instance, short-acting medicines treat pain that comes and goes. Long-acting medicines treat constant pain.

The most common medicines are listed below. Each one has side effects. These can range from mild to severe. It’s important to follow your doctor’s orders on how to use your pain medicine. If you have questions about side effects or about how much medicine to take, ask your doctor or pharmacist.

Acetaminophen

Acetaminophen helps many kinds of chronic pain. One brand name is Tylenol. It is also found in many and prescription and over-the-counter pain medicines. If you’re not careful, you could take more acetaminophen than is good for you. Too much acetaminophen can cause liver damage, especially if you drink alcohol. Tell your doctor if you take more than 2 acetaminophen pills a day.

Nonsteroidal Anti-Inflammatory Drugs (NSAIDs)

Other drugs that help with pain are nonsteroidal anti-inflammatory drugs (NSAIDs). Examples include aspirin, ibuprofen (two brand names: Motrin, Advil), and naproxen (one brand name: Aleve). NSAIDs come in both prescription and over-the-counter forms. These medicines can be taken sometimes or every day. When taken regularly, they build up in the blood to fight inflammation (swelling) and give general pain relief.

Always take NSAIDs with food or milk because the most common side effects are related to the stomach. Other side effects include:

• Increased bruising
• Risk of bleeding in the stomach
• Kidney damage (when taken for long periods of time)
• High blood pressure
• Interference with blood pressure medicines

If you take other pain medicines, do not take NSAIDs without talking to your doctor first.

Antidepressants

Many drugs that treat other illnesses can also treat chronic pain. For example, antidepressants can improve function and provide pain relief. Antidepressants may be used to treat nerve damage, arthritis, and fibromyalgia. They also may help with headaches, facial pain, low back pain, and pelvic pain. It can take several weeks for the medicines to start working.

Types of antidepressants your doctor may prescribe include:

• Tricyclic antidepressants (TCAs), such as amitriptyline (Elavil), imipramine (Tofranil), nortriptyline (Pamelor), and doxepin.
• Selective serotonin/norepinephrine reuptake inhibitors (SNRIs), such as duloxetine (Cymbalta).
• Selective serotonin reuptake inhibitors (SSRIs), such as fluoxetine (Prozac), paroxetine (Paxil), and sertraline (Zoloft).

Possible side effects of antidepressants include:

• Nausea
• Drowsiness
• Insomnia (trouble sleeping)
• Dry mouth
• Dizziness
• Constipation
• Weight gain
• Heart problems

TCAs tend to have more side effects than SNRIs or SSRIs, but they usually are mild. Your doctor may start you on a low dose of medicine. This helps prevent side effects and allows your body to adjust. The doctor may increase the amount over time. If at any point while taking medicine you become depressed or have suicidal thoughts, call your doctor right away.

Anticonvulsants

Your doctor may want you to try an anticonvulsant medicine. It may help reduce some types of chronic pain, such as low back pain or nerve damage. Examples of anticonvulsants are:

• Gabapentin (Neurontin)
• Carbamazepine (Tegretol)
• Phenytoin (Dilantin)
• Pregabalin (Lyrica)
• Topiramate (Topamax)

Like antidepressants, your doctor may start you on a low dose of anticonvulsants. This helps prevent or reduce side effects. The doctor may increase the amount over time. Contact your doctor right away if you have suicidal thoughts. Minor side effects may include:

• Drowsiness
• Nausea or vomiting
• Restlessness
• Dizziness
• Loss of appetite
• Weight gain
• Itching or swelling

Narcotics

Doctors rarely prescribe narcotics or opioids to treat chronic pain. This is because they are highly addictive. Currently, there is an opioid crisis in the United States. People who become addicted can develop severe symptoms, such as increased pain, depression, or suicidal thoughts. They may begin to abuse other substances, or their behaviors could become harmful or violent. Addicts are at risk of misusing or overdosing on narcotics, which can cause death. Talk to your doctor about all risks of narcotics before starting a new medicine.

If your doctor does prescribe a narcotic, be sure to follow their directions. Do not drive or operate heavy machinery when taking narcotics. Do not use alcohol. Tell your doctor if you have side effects from narcotics. These may include nausea, constipation, and trouble focusing or thinking clearly. Your doctor can prescribe an anti-nausea drug or laxative to help with side effects.

When you’re taking narcotics, it’s important to remember the difference between physical dependence and psychological addiction. Physical dependence means that your body adjusts to a medicine and needs it to function. When you function has improved, your doctor will help you slowly and safely decrease the amount of medicine. Doing this helps prevent or reduce symptoms of withdrawal. It is critical to tell your doctor about these symptoms and work through the process together.

Psychological addiction is the desire to use a drug whether or not it’s needed to improve function and relieve pain. Using a narcotic this way is harmful to your health. Talk to your doctor if you think you are addicted to narcotics. They may give you other medicines to help your addiction. They could lower the dose, change to another drug, or stop the medicine. They may recommend counseling or rehab as well.

Things to consider

Always tell your doctor what other drugs you take. This includes medicines, vitamins, and supplements. The doctor also should know about all ongoing health conditions. Some medicines may not be safe to take. Do not start a new drug without your doctor’s approval.

It is important to follow instructions when taking chronic pain medicines. Some side effects can be harmful and cause other health concerns. They can also be harmful to your lifestyle if you develop a problem. Do not stop taking a drug without your doctor’s approval.

People who take medicine for chronic pain should have regular check-ups with their doctor. Contact your doctor right away if you have severe or abnormal side effects. This includes if you have an unplanned reaction. The doctor will tell you what you should do. Seek help if you think you are dependent on or addicted to a drug.

Questions for your doctor

• What are my options to treat chronic pain?
• What medicine(s) do I need to take?
• How long do I need to take them?
• How much and how often do I take the medicine?
• Do I need to take the medicine with anything or avoid things when I take the medicine?
• What are the possible side effects? What should I do if I have them?
• How do I safely start and stop chronic pain medicines?
• Are there alternative forms of treatment, besides medicine, that can treat chronic pain?

Resources

American Academy of Family Physicians: Chronic Pain

American Academy of Family Physicians: Opioid Addiction

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