Managing Pain - Doctor Q&A

Posted by seantan

Dear Dr. Lee, I have a friend who is suffering from Parkinson's disease and she often feels pain, after her medication has worn off. She feels muscle pain every three to four hours. This is despite the fact that her doctor had doubled her dosage. I believe her body is getting used to the medication and hence it does not work as well for her any more. My question is this: is there anything she can do to manage this pain on top of taking her medication?

Answered by Dr. Bernard Lee, KK Women's and Children's Hospital

Muscle aches and pains are commonly associated with Parkinson’s disease. The treatment would involve finding out the cause of the pain and appropriate medications. The common causes of pain would include end of dose failure that is likely and would need dose adjustment by the neurologist. Other causes would include nerve related pain and pain related to wear and tear such as osteoarthritis. Medications can also be prescribed to assist with pain relief and treat depressive symptoms that might be present.

Posted by junhao97

Dear Sir, I am married middle age man. I would like to know to cure my both palm dumbness upon waking up. Getting more serious as affected my sleep. Tested no Cholerestal or high blood pressure /glucose normal. is there any blood circulationpoblem n how cure it.

Answered by Dr. Bernard Lee, KK Women's and Children's Hospital

The symptoms of palm numbness on both hands can be due to many reasons. It would be advisable to consult your doctor to further evaluate this. The relevant history that may assist your doctor may include symptoms of previous trauma or accident, neck pain, numbness and weakness in the hands and feet.

Posted by teresagay

dear doctor, i am suffering fm arthristis and i have pain all over my body most of the time. recently i hve intense pain on my left tigh and it travels down to my knee and shin. i limp when i get up to walk bec of the pain. pls advise why is this happening to me.

Answered by Dr. Bernard Lee, KK Women's and Children's Hospital

Arthritis is commonly due to degenerative or wear and tear changes in the joints. This commonly happens in the spine, hips and knees. The description that you have described seems to suggest what commonly is called sciatica. This is a sharp electrical pain down the thigh, knee and foot. This is commonly due to degenerative changes in the spine or slipped disc with irritation of the nerves that go down to the legs. If you also have weakness of your legs, loss of urinary or bowel control, please consult a doctor immediately.

However, to be sure, it would be advisable to seek medical consultation and further investigations can be done to find out the cause of your symptoms. Treatment may include medications, physiotherapy and if need be, injections to help to relieve the pain.

Posted by rachel

Dear doc, I feel a pain my knees on and off when I am walking up and/or down the stairs; but not normal walking. I seem to hear this slight 'creaking' sound. Is this arthritis? What can I do about it? I also feel a pain in one of my knees when I am swimming. Why would this be so, when the weight is off my body then? Should I be taking glucosamine supplements? Are they an effective preventive supplement, or a curative measure? thanks

Answered by Dr. Bernard Lee, KK Women's and Children's Hospital

Osteoarthritis is a possibility especially if the pain symptoms are worse on climbing up and down stairs. There is wear and tear of the cartilage in the knee joints. Other symptoms may include knee swelling and morning stiffness. It would be advisable to consult your doctor for evaluation that might include knee X rays. The treatment can include pain medications, physiotherapy and injections. Generally, knee surgery for osteoarthritis is reserved for severe cases. Glucosamine is essential for cartilage health and function and it is one of the treatments available and you can discuss this with your doctor. There are several formulations of glucosamine including tablets and sachets.

Posted by quekjl86

Dear doctor I have persistent lower back pain whenever i walk or stand too long or too much... even sometimes when i sit too long, my lower back sure hurts. What is the possible reason for it? recently i went to see chinese tcm, the doc told me my lower spine is slightly crooked and I almost had a slipped disc. Is wearing a back support a good way of supporting my back now?

Answered by Dr. Bernard Lee, KK Women's and Children's Hospital

I have persistent lower back pain whenever i walk or stand too long or too much... even sometimes when i sit too long, my lower back sure hurts. What is the possible reason for it?
It will be difficult to pinpoint to one condition which might be giving you these symptoms. It could be purely musculoskeletal problem such as deconditioning of your muscles, ligaments in the lower back, degenerative changes in the lower back bones, or it could be deep seated problem in your lumbar spine. I would have suggested to you to see a pain specialist, who might want to get a MRI scan done after examining you. You may wish to seek some advice regarding your posture if you feel that it is incorrect. Please remember the old dictum:- sit smart, sleep smart, stand smart, walk smart, lift smart.

Recently i went to see chinese tcm, the doc told me my lower spine is slightly crooked and I almost had a slipped disc. Is wearing a back support a good way of supporting my back now?
It will be unprofessional on my part to comment upon someone else at this moment without examining you.

Posted by janey

I sometimes have a recurrent very bad pain on my back and shoulder, usually only on one side, to the point of hardly being able to move. Someone told me it could be my sleeping position. What is the best sleeping position, and type of pillow? I find those contoured ones not much use and uncomfortable. Are using patch pain killers and creams (eg. salon pas, bengay, etc) for such aches and sore muscles okay? Are there long term bad effects to these? How do I tell its really time to seek a doctor's attention? What's the difference in treatment given between a GP and a Pain Specialist? Would seeing a doctor for medication result in long term dependence/addiction?

Answered by Dr. Bernard Lee, KK Women's and Children's Hospital

I sometimes have a recurrent very bad pain on my back and shoulder, usually only on one side, to the point of hardly being able to move. Someone told me it could be my sleeping position. What is the best sleeping position, and type of pillow? I find those contoured ones not much use and uncomfortable.
Every individual is different, hence the advice would vary according to every individual’s need. In general, not too hard or not too soft pillow or bed is recommended.

Are using patch pain killers and creams (eg. salon pas, bengay, etc) for such aches and sore muscles okay?
One can use such treatment for the problems you have described, but this is generalized advice. There are some contraindications to their use. Without seeing you or knowing your medical condition in detail, it will be wrong for me to say whether it is good for you in either short term or long term.

Are there long term bad effects to these?
I would suggest to you to look into the literature which comes with the medicinal package when you buy one. It will enlist all the side effects which will answer your question.

How do I tell its really time to seek a doctor's attention? What's the difference in treatment given between a GP and a Pain Specialist? Would seeing a doctor for medication result in long term dependence/addiction?
If your pain is bothering you that it has started affecting you daily, if you have lost weight in last 6 months, if you have osteroporosis, if you feel numbness in any part of your body, mainly in the upper or lower extremities, if you are passing motion and urine without you knowing about it, if you have developed weakness in your upper or lower extremities, if the pain is like an electric shock, you may wish to see a doctor on urgent basis. Pain specialists are the doctors trained specially in pain management. They usually would have better understanding of the pain problem and will examine you thoroughly, they may advice you to do some more tests (investigations) and propose best suitable plan for your pain management. Any medication can have a side effect of dependence, but in general this issue is not a major one with the medications which are normally used in pain management centers by pain specialists. Answered by Dr Bernard Lee

Posted by Jass

Hi Doctor, Recently I had experience sharp cramps on left abdominal- the cramp was like an intense pinch on stomach. There were twice when I feel pain on below breast bone to my abdominal area which get intense while I move my body. How should I respond should the symptoms recur? Could I had an appendicitis? Thanks

Answered by Dr. Bernard Lee, KK Women's and Children's Hospital

I am sorry but it is impossible for me to pinpoint to one condition without examining you and without getting any more detailed history. I would suggest that you should see a doctor (not necessarily a pain specialist) in the first instance who might be in a position to advice you after examining you.