Chronic Pain: Causes, Treatments, and When to Seek Help

Q: Chronic Pain: Causes, Treatments, and When to Seek Help

Hello, thank you for your questions. <br>Here are my responses：<br>1. <br>Is the lack of improvement due to me taking the medication too late? After all, I have had this symptom for 1 to 2 months, so the effect is not significant. <br>--> This is likely unrelated to the timing of

Body pain

Hello Doctor, I am the one who asked you last time about taking Aceclofenac 100mg (I wonder if you remember me).
For the past 1 to 2 months, I have been experiencing pain in my upper back, finger joints, fingertips, soles of my feet, toes, knees, elbows, arms, lower back, palms, and occasionally on the back of my hands.
I followed your advice and have been taking Aceclofenac 100mg; today is the fourth day of taking it.
I feel that the effect has not been very good and there hasn't been much improvement.
Additionally, I feel that the areas where I experience symptoms have increased (of course, this should not be due to taking the pain medication).

1.
Is the lack of improvement because I started taking it too late? After all, I have had these symptoms for 1 to 2 months, so the effect might not be significant.

2.
If I have been tested and it is not rheumatoid arthritis, gout, lupus, or ankylosing spondylitis, what do you think is the most likely issue? Is it simply a case of bodily inflammation?
3.
Do my symptoms have a direct relationship with joint inflammation?
4.
I read online that it is recommended not to take pain medication for more than 8 days in a month, as it can be harmful to the liver and kidneys (is this true?).
I have currently taken it for four days; if I take it for 8 days without much effect, what do you think I should do? Should I wait until next month to take it for another 8 days, or should I do something else?

Ken, 20~29 year old female. Ask Date: 2023/01/02

Dr. Gao Jiankai reply Internal Medicine

Hello, thank you for your questions.
Here are my responses:
1.
Is the lack of improvement due to me taking the medication too late? After all, I have had this symptom for 1 to 2 months, so the effect is not significant.
--> This is likely unrelated to the timing of taking the medication, but rather to the underlying cause of the pain.
Some causes of pain do not respond well to anti-inflammatory and analgesic medications.
2.
If I have been tested and ruled out rheumatoid arthritis, gout, lupus, and ankylosing spondylitis, what does the doctor think is the most likely issue? Is it simply a case of systemic inflammation? --> It could possibly be fibromyalgia, but a thorough evaluation by a physician would provide a more accurate diagnosis.
3.
Do my symptoms have a direct relationship with joint inflammation? --> This would need to be assessed by a physician for a more accurate determination.
Observing the joints in person is essential for diagnosing arthritis.
4.
I read online that it is recommended not to take pain medication for more than 8 days in a month, as it could harm the liver and kidneys (is this true?).
I have taken it for four days; if I take it for 8 days with no effect, what does the doctor suggest I do? Should I wait until next month to take it for another 8 days, or do something else? --> This is misinformation.
If anti-inflammatory and analgesic medications are taken for more than two weeks, it is generally advisable to reassess their effectiveness after one month.
If you have concerns, it is best to consult with your physician for a proper evaluation.

Best regards from the Allergy, Immunology, and Rheumatology Department of Changhua Hospital, Ministry of Health and Welfare.
We care about your health.

Reply Date: 2023/01/02

More Info

Chronic pain can be a complex and multifaceted issue, often requiring a comprehensive approach to understand its causes, treatments, and when to seek further medical help. Based on your description of symptoms, it appears that you are experiencing widespread pain in various areas, including your upper back, joints, and extremities. This can be indicative of several underlying conditions, and it’s important to consider both physical and psychological factors that may contribute to your pain.

Understanding Chronic Pain
Chronic pain is defined as pain that persists for longer than three months and can arise from a variety of causes. Common causes include:
1. Inflammatory Conditions: Conditions such as arthritis, fibromyalgia, or other autoimmune diseases can lead to chronic pain. Even if you have ruled out rheumatoid arthritis, gout, lupus, and ankylosing spondylitis, there are other inflammatory conditions that might not have been considered.

2. Musculoskeletal Issues: Chronic pain can also stem from musculoskeletal problems, such as muscle strain, ligament injuries, or degenerative disc disease. Poor posture, repetitive strain from activities, or even stress can contribute to musculoskeletal pain.

3. Nerve Damage: Conditions like neuropathy or other nerve-related issues can cause pain in the extremities. This may be due to diabetes, vitamin deficiencies, or other underlying health issues.

4. Psychological Factors: Chronic pain is often exacerbated by psychological factors such as stress, anxiety, and depression. These can create a cycle where pain leads to stress, which in turn can increase the perception of pain.

Treatment Options
You mentioned taking Aceclofenac, a non-steroidal anti-inflammatory drug (NSAID), for pain relief. While NSAIDs can be effective for managing inflammation and pain, they may not always provide complete relief, especially if the underlying cause is not purely inflammatory. Here are some considerations regarding your treatment:
1. Timing of Medication: If your symptoms have persisted for 1-2 months, it is possible that starting medication later in the course of your symptoms may have contributed to a slower response. Chronic pain often requires a multifaceted treatment approach, including medication, physical therapy, and lifestyle modifications.

2. Alternative Treatments: If NSAIDs are not providing sufficient relief, you might consider discussing other treatment options with your healthcare provider. These could include physical therapy, acupuncture, or even cognitive-behavioral therapy to address the psychological aspects of chronic pain.

3. Monitoring Symptoms: Keep a detailed diary of your symptoms, including when they occur, their intensity, and any factors that seem to exacerbate or alleviate them. This information can be invaluable for your healthcare provider in determining the best course of action.

4. Limitations on NSAID Use: It is true that prolonged use of NSAIDs can have adverse effects on the liver and kidneys. The general recommendation is to limit the use of NSAIDs to no more than 8 days in a month unless directed otherwise by a physician. If you find that you need to take them frequently for pain relief, it may be a sign that you need a reevaluation of your treatment plan.

When to Seek Further Help
If your symptoms do not improve with the current treatment or if they worsen, it is important to follow up with your healthcare provider. They may consider further diagnostic testing, such as imaging studies or blood tests, to explore other potential causes of your pain. Additionally, referral to a specialist, such as a rheumatologist or pain management specialist, may be warranted to provide a more targeted approach to your symptoms.

In summary, chronic pain can be a challenging condition to manage, and it often requires a comprehensive approach that includes medication, lifestyle changes, and possibly psychological support. If you continue to experience widespread pain without improvement, it is crucial to seek further evaluation to identify any underlying issues that may need to be addressed.

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