ANSWERS TO THE 100 QUESTIONS GPs ARE MOST OFTEN ASKED
What IS the best way to treat your aching back and creaky knees?
THEY’RE some of the most common questions fielded by GPs across the country every day. And here, continuing our brilliant, week-long series, we reveal the answers given by top experts. Today, we focus on pain, sleep and mental health . . .
ACHES & PAINS 25 My lower back really aches. Can I have some painkillers?
Painkillers should generally be used only as a short-term measure for low back pain, says roger knaggs, professor of pharmacy at nottingham University and a member of the British Pain Council.
‘no painkillers are proven to work for all people in the long term, and they all have lots of side-effects — particularly opioids [such as codeine], which research suggests can make you more sensitive to pain and carry the risk of dependency and addiction,’ he says.
‘so, in the long term, the risk of taking pain-relieving medicines outweighs the benefits.’
He says nonsteroidal anti-inflammatory drugs (nsaiDs), such as ibuprofen, are among the most effective for low back pain. ‘But niCe (national institute for Health and Care excellence) says they should be prescribed at the lowest effective dose for the shortest possible time,’ he warns.
nsaiDs have gastric side-effects and very high (i.e. prescription) doses can raise the risk of a heart attack in people with heart disease and kidney problems in the elderly.
People who can’t take nsaiDs can be prescribed weak opioids in combination with paracetamol (e.g. co-codamol) for acute back pain but only as a short-term treatment. (When taken alone, paracetamol is ineffective for acute or persistent low back pain.)
‘in the long term, the best treatments for back pain are non-drug therapies such as exercise, physiotherapy, pain management and relaxation techniques and any medicines are just best used for acute flare- ups,’ says Professor knaggs.
26 Why can’t I take ibuprofen regularly for my sore hip/knee/back?
IBUPROFEN is a type of nsaiD which, although effective as painkillers, can disrupt the lining of the stomach — causing inflammation and ulcers, explains Dr rod Hughes, a consultant rheumatologist at st Peter’s Hospital, Chertsey.
‘This can sometimes happen after only a few weeks, it’s very unpredictable,’ he says. They can also cause problems for people with heart disease.
‘That’s why it’s not advisable to take them long-term for chronic problems such as hip, knee and back pain. it’s ok to take them every now and again for an acute flare-up of pain, but not week after week.
‘instead, i recommend alternatives such as losing weight and muscle strengthening and stretching exercises to support the affected joints, relaxation and natural remedies.
‘if pain is particularly troublesome, steroid injections can be used periodically. These can be given by a specialist or GPs with special interest in this area.’
Community pharmacist sid Dajani says that drugs to reduce stomach acids, such as omeprazole, can be prescribed to reduce the risk of stomach irritation with nsaid, though these also have side-effects.
27 Why does my coccyx hurt weeks after a fall?
WHILE most coccyx (tailbone) injuries will heal fully within a few weeks, sometimes it can take months, says Dr serge nikolic, a consultant in pain medicine at Barts Health NHS Trust, london.
‘Most injuries to the tailbone are just bruises — fractures are rare,’ he says. But because there are a lot of nerves in the area and ligaments connected to the coccyx, any injury can feel ‘very painful’. Damage to the bone will cause most pain, but you could also have damaged the muscles surrounding the coccyx. These can spasm — which is how the body protects itself from further injury — and this action can add to the pain.
Most people will recover quickly using ice packs, antiinflammatory gels and antiinflammatory painkillers such as ibuprofen and naproxen, says Dr nikolic.
‘We also advise avoiding sitting as much as possible and to use customised wedge-shaped cushions with a cut-out hole to take the pressure off the coccyx,’ he explains. Try the arkstore 11 Degree Dual Comfort Coccyx seat Wedge (£49, backcs.co.uk).
‘if none of these help and you’re still in pain after around four weeks, see your GP for a referral to a physiotherapist or an orthopaedic or pain consultant for a steroid injection to reduce inflammation,’ says Dr nikolic.
28 I have pains running down my legs from my lower spine. What can I do?
THIS pain is usually caused by sciatica, says Dr anupam Bhattacharjee, a consultant neurologist at the royal free Hospital in london. other symptoms can include tingling, numbness, weakness and pain in the bottom and feet.
‘sciatica is usually caused by a trapped nerve or a disc prolapse or other degenerative changes in the spine that pinch a nerve,’ says Dr Bhattacharjee.
‘in rare cases, if the back muscles go into spasm it can make it difficult to walk.’
exercise, including stretching, physiotherapy and Pilates can all help prevent painful muscle spasms that can occur, he says.
sciatica normally clears up within six weeks, although it can take longer.
‘GPs can prescribe drug treatments such as pills for neuropathic or nerve pain,’ says Dr Bhattacharjee.
severe cases can be referred for anaesthetic or steroid injections. if there is massive compression on a nerve, then nerve decompression surgery,
where a section of bone or disc removed to relieve the pressure, may be offered, but in the majority of cases we will try to avoid surgery wherever possible,’ he adds.
29 What can I do about tennis elbow?
Tennis elbow — pain around the outside of the elbow — often occurs after strenuous overuse of the muscles used to extend the elbow, says rheumatologist Dr Rod Hughes.
Typical activities that might bring the pain on include playing backhand in tennis, or spending hours hedge clipping, wallpaper stripping, weeding the garden or other repetitive movements such as typing.
‘initially, there is usually a low grade trauma — a bump or knock — and the muscles in the forearm are strained, and the sites where the tendon joins the bone become inflamed,’ says Dr Hughes. ‘This is then made worse by repetition and overuse.’
Treat it with a short course of nonsteroidal anti-inflammatory drugs (nsAiDs) or topical nsAiD gels and ice, initially.
‘Right from early on, though, it’s very important that you practise regular exercises to stretch the tendons so that they don’t become stiff and shorten as they heal,’ he adds. ‘You need to avoid the more extreme movements that might have brought on your problem, but you should not rest your arm completely nor put it in a sling.’
Typical rehabilitation exercises include twisting a towel in opposite directions with both hands, with your shoulders relaxed, and repeating the movement ten times in one direction and then the other.
‘The aim is to avoid the tendon healing so that the elbow is bent,’ says Dr Hughes. if it doesn’t heal after three months, you may need a steroid injection from your GP or a specialist in rheumatology.
30 What about golfer’s elbow?
GolfeR’s elbow affects the inside rather than outside of the elbow, as in tennis elbow. it’s caused by inflammation of the tendons around the elbow bone and is triggered by too much bent arm movement: picking things up, hammering, weightlifting, rowing — or a golf swing.
Treat it in the same way as you would tennis elbow [above].
31 Does turmeric help with arthritis?
THeRe’s good quality evidence that the spice turmeric, commonly used in curries, may help, says rheumatologist Dr Rod Hughes.
Turmeric and its active ingredient curcumin are thought to be antiinflammatory and a review of 28 studies published in the Journal of Medicinal food in 2016 showed that they can improve pain and function in patients with arthritis.
A 1,000 mg dose a day of curcumin ‘seemed to be the most effective’, says Dr Hughes. ‘Although more research is still needed, i recommend curcumin supplements to patients myself as something to try alongside other treatments such as physiotherapy, muscle-strengthening and steroid injections,’ he says.
‘supplements are more palatable than sprinkling turmeric on food — you would have to eat 17 curries to get the equivalent amount of curcumin in a 1,000mg tablet.
‘But this on its own won’t help if you’re overweight, unfit and have bad joints — you still need to lose weight and take exercise.’
Another natural remedy that may help with arthritis is rose hip, another anti-inflammatory. A review of studies published in 2008 found it helped with acute pain in patients with low back pain and hip and knee arthritis.
32 Why do my heels hurt?
THe most common cause is plantar fasciitis, a thickening of the band of tissue underneath the sole of the foot, says Kaser nazir, a consultant podiatric surgeon at Guy’s and st Thomas’ nHs foundation Trust in london. The main symptoms are pain at the bottom of the foot, especially at the front and centre of the heel.
‘There is wear and tear on the plantar fascia as we age and then often a trigger such as extra pressure from weight gain, pregnancy, a new exercise regimen or running in ‘barefoot’ trainers [which provide
minimal cause micro tears and thickening of cushioning or support] can the tendon where it attaches to the heelbone,’ says Mr Nazir.
‘This leads to swelling and scarring, which can become painful. The most common time to feel pain is first thing in the morning or rising after sitting.’
The condition is treatable, but it can take many months for symptoms to die down. self-help measures include stretching exercise, using icepacks to
massage the heel before bed, a short course of anti-inflammatory drugs and wearing shoes with cushioned heel pads.
Medical treatments — usually offered after about six weeks — include steroid injections to reduce pain and inflammation. Another option, available privately, is platelet rich plasma (PRP) therapy, where stem cells are injected in the area to speed up healing. ‘There isn’t much of an evidence base yet for PRP but anecdotally it seems to be effective,’ says Mr Nazir.
‘The latest treatment is shockwave therapy, which causes micro injury in the area and increases blood flow, encouraging healing.’
It is a weekly treatment offered at NHS physiotherapy departments, but availability is limited.
‘Around 70 per cent of people report improvement,’ says Mr Nazir.