Thanks everybody. I really enjoyed this hour. I wish for all of you that you find some creative ways to relieve your pain very soon! Good evening to you all.

Rebecca S, It sounds like your chronic back pain has been a terrible problem. You have been seen by some of the specialists that can be most helpful. Not knowing your problem in person, I can't offer specific advice. But I can recommend a good book for people who have difficult pain problems--"Managing Your Pain Before It Manages You," by Margaret A. Caudill.

Also, make sure you have been getting a pain medicine that treats nerve pain ("neuropathic pain medicine"--your doctor will know several to choose from) in addition to any narcotic or other pain medicine you are taking.

Keep asking, and keep trying.

Incidentally getting a good night's sleep on most nights can make an immense difference in pain anywhere.

A couple of you are wondering about pain related to "restless legs" at night--this is such an interesting problem. Restless legs can be the result of low iron--I recommend having your "ferritin" (stored iron) tested by a blood test and if your level is lower than about 50 mcg/dL, take some iron supplements to bring up your level. Restless legs can also be a side effect of medicines that are used to treat some psychiatric symptoms (mostly, antipsychotic medicines, known by some people as "tranquilzers") and sometimes stomach medicines (nausea medicines especially) can have this as a side effect, too.
Restless legs can be treated with medicines--good choices are carbidopa/levodopa (Sinemet) or pramipexole (Mirapex)--ask your doctor.

I do think acupuncture is helpful for many people. Worth a try.

I also think chiropractic treatment can be helpful for back pain. I don't recommend chiropractic treatment for the neck, since that is a delicate area and I hate to see it heavily manipulated.

Ultrasound for bursitis--not so helpful long term, I think. However some people benefit from ultrasound treatments for certain shoulder problems--"calcific tendonitis." And some people swear by it (in their physical therapist's office) for improvement of their pain in the short term.

The TENS unit is a popular part of this conversation--let me weigh in. These devices (you are correct, whoever posted this--TENS is short for transcutaneous electrical nerve stimulation) are sometimes useful and never harmful. A TENS is essentially a pager sized device with a wire, that creates a subtle vibration at the skin surface that is detected by nerves beneath the skin. Usually, the stimulator is placed near to the spine in the back, to try to treat pain that comes from a nerve in the spine area.

The idea behind a TENS unit is that your spinal cord is only capable of sending one kind of "sensing" signal at a time. If you are feeling vibrating, your spinal cord has to take a break from sending your brain its "pain" signal, in order to send a "vibrating" signal instead. You must all know that this works--you can believe it--just think about what you do when you burn your hand on the stove. You shake your hand like crazy, right? And while you are shaking your hand, your pain temporarily goes away? This is based on true knowledge of how the nerve and brain anatomy works.

I have had some people very happy with the benefit of a TENS unit. Unfortunately you should not get your hopes up too high--in the largest studies we have, there is not a dramatic difference from TENS for most people. Usually TENS units are placed by a physical therapist--obviously, having your TENS unit in the right location makes a large difference in how well it works.

Jennifer F, for severe knee arthritis a knee replacement surgery is a good option--most people who have surgery are really glad they had it done. If you want to avoid or put off surgery, ask your doctor to check your x-rays to see if you have arthritis that is mostly in the "medial" compartment. If your arthritis is mostly on one side (in this case, the part of the joint on the inner side of your leg) then an "unloader knee brace" (hinged knee brace) can be very helpful for reducing pain. These braces are less helpful for people who have evenly distributed arthritis ("tricompartment") because they work by shifting your weight from one part of the joint to another.

Have you tried some of the over-the-counter cream/rubs that are available for knee arthritis, such as "icy hot" or "ben gay" or other menthol rubs? These can help. Some people like using capsaicin cream (sold as brand name zostrix) which can reduce your knee pain if you use it 3 or 4 "rubs" per day. This type of cream takes a little getting used to--it can burn the first few times you use it, and it can burn if you take a long break from applying it and start over newly.

Debby C, your foot pain at the base of your heel might be a common problem called "plantar fasciitis." I am glad you tried heel inserts-presumably, these were heel cushions or heel pads. These can be very helpful. Another very important way to help plantar fasciitis pain is to stretch the muscles way up in your calf-it turns out, tight calf muscles pull against the calcaneus (bone in the heel) and rotate it in such a way that a sensitive area of the bone is more exposed at the base of your foot. This means that with every heel strike (every step) you can "slap" this sensitive area. The bony place I am talking about is where a large group of fibers (the "plantar fascia") attach to the calcaneus, and they often come together onto a small bone spur. You don't need to have this "spur" removed-it is normal. But you do need to stretch your calf muscles (at least nightly, preferably twice a day) in order to "bury" it out of harm's way.

For some people arch supports can help plantar fasciitis. Rarely, an injection is called for.

Plantar fasciitis can be provoked by wearing high heeled shoes or boots too much of the time, since this allows your calf muscles to shrink up or tighten up-they are not stretched all day long with regular use if you are in a high heel.

Sensational Sadie Sexy Senior Sitizen, it is not strange at all that your spinal stenosis pain (usually back pain and leg or buttock pain) is better with your treadmill on an incline. When you bend forward (as anyone does when you walk up hill, lean over a shopping cart, or sit down) the small "wings" off the back side of your spinal column are more widely spaced, and nerves that are pinched from spinal stenosis (bone growth, which creates narrowing of the space for the spinal cord and exiting nerves) have less pressure upon them. More people should try out your strategy!

Wow, several people seem to have shoulder pain issues, including bursitis. This is one that can be genuinely helped by physical therapy exercises, as well as by injection. Physical therapy to strengthen the rotator cuff muscles actually results in a widening of the space between your shoulder bones, as the muscles become stronger (they "pull" the shoulder into a more widely spaced anatomy.) People who have shoulder bursitis (or any problem with the rotator cuff, such as tendonitis, "impingement syndrome," or a tear) should also be very careful about the way you get out of a chair. If you "push off" with your arms and "rock" forward out of a chair with straight arms, you will re-injure your shoulder very reliably. The humerus (arm bone) in this case works like an upside down "pestle", grinding into the capsule area of the shoulder as if it is an upside down "mortar." Our shoulders were never meant to take this kind of punishment.
If you want to make it easier to get out of a chair (many people with shoulder issues start with bad knees!) I suggest one of these strategies:

•·         Use physical therapy to strengthen your quadriceps muscles, so you have more power to stand without help

•·         Put a thick blanket on your favorite chair, to raise the level of its seat

•·         Change your "usual" or favorite chairs to a stool or higher chair, so it is easier to get up each time.

Cynthia J, your question about non-drug treatments is a great jump off point for us.  

You should always use non-drug treatments to improve your pain, even if you need to take a medicine every day. Physical therapy, hot packs, relaxation exercises, supportive footwear, a cane or a brace are good examples.

One non-drug treatment I hear great feedback about from patients is use of the "Thermacare HeatWraps" that you can buy at most pharmacies now, with no prescription. These are large adhesive pads that you can position where your pain is worst, shaped differently for back, shoulder, neck, knee, etcetera, and the pack releases heat for about 8 hours. These are a huge improvement over our old strategies for applying heat, like warming up a bag of dry rice in the microwave-our old strategies could never last so long.

Has anyone tried these newer heat packs?

I see some of you have already posted that you have carpal tunnel syndrome, which is a problem of pressure causing "suffocation" (reduced blood supply) to a nerve in the wrist (the median nerve). This is a perfect example of a soft tissue pain problem that can be helped by local strategies. Here are some of my favorite suggestions for carpal tunnel:

•·         Use a wrist splint: To reduce pressure in the carpal tunnel, avoid flexing or extending the wrist repeatedly, or holding the wrist in a sharply angled position for a long uninterrupted time. Positioning the wrist at a sharp angle is something many people do during sleep, to "prop" their head on their wrist. Did you know wrist splints can help daytime symptoms, even when they are only worn during the night? This is true, because they allow for recovery of the nerve in the time you are wearing them, and this benefit can last into the next day.

•·         Wear driving gloves: Gripping (for example, gripping a steering wheel) can increase pressure at the wrist. Gloves prevent you from gripping

•·         Use utensils with an enlarged grip: This can also reduce your need to "grip" and can alleviate the carpal tunnel pressure. Try putting pipe insulation-those soft foam tubes-over the handles of your most often used tools.

•·         Surgery of the carpal tunnel is useful for some people.

Welcome, everyone! I can see it will be a full conversation tonight, and I hope a useful one. One thing that is important for doctors and patients who are managing pain is to avoid lumping all pains together. It will help me to hear about your specific problems. Some musculoskeletal pain problems can be treated with very specific adjustments in the way you work or exercise, or they can be treated with splinting or a corticosteroid injection. I love best to identify tendonitis or bursitis problems when these are contributing to pain-specific treatment for these problems can give you dramatic relief.

We will get underway in just a few minutes--I am glad to see so much interest in this topic! I am also not surprised. Pain--particularly chronic pain-has an incredible impact on a person's outlook and ability to function. I take care of many people with chronic pain and it is an area of special interest to me.