Sample. Do not reproduce. › documents › pain_management.pdf · The pain comes and goes _____...

The HealthyLife® Manage Your Pain Self-Care Guide helps you identify and describe different types of pain. It presents twenty-five methods to treat pain. It also helps you decide when to manage pain on your own and when to seek medical care.

Topics Include:• Abdominal Pain• Arm Pain & Hand Pain• Back Pain• Chest Pain• Fibromyalgia Pain• Headaches• Foot Pain• Leg Pain• Shingles Pain• Sprains, Strains & Sports Injuries• Pain Management ResourcesAmong Others

Learn More: Go to www.HealthyLife.com to get reliable health information on thousands of topics in English and Spanish for:• Health News • Drugs & Supplements • Dictionary• Health & Wellness • Medical Encyclopedia • Directories

Sample. Do not reproduce.

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Manage Your Pain

by Don R. Powell, Ph.D.and the American Institute for Preventive Medicine

Note: This guide can help you make informed choices about your health. It does not replace medical advice or treatment. Follow your doctor’s or health care provider’s advice.

Contributors and ReviewersSusan Schooley, M.D., Medical Director, Detroit Region and Chair,

Department of Family Medicine, Henry Ford Medical Group, Detroit, MI and Medical Director, American Institute for Preventive Medicine, Farmington Hills, MI

James Kohlenberg, M.D., Internal Medicine, John R Medical Clinic, Madison Heights, MI and William Beaumont Hospital, Royal Oak, MI

Jeanette Karwan, R.D., Director, Product Development, American Institute for Preventive Medicine, Farmington Hills, MI

Dan Mayer, M.D., Professor, Emergency Medicine, Albany Medical College and Attending Physician, Emergency Department, Albany Medical Center, NY

Andria Watha, Manager, Graphic Designer, American Institute for Preventive Medicine, Farmington Hills, MI

This guide is one of many self-care books and programs offered by the American Institute for Preventive Medicine. The goal of all of these is to help individuals reduce health care costs and improve the quality of their lives.

For more information, contact:American Institute for Preventive Medicine30445 Northwestern Hwy., Suite 350 | Farmington Hills, MI 48334248.539.1800 | Fax: 248.539.1808Email: [email protected] | Web site: www.HealthyLife.com

For free health information, go to:www.HealthyLearn.com

© 2014, 1st ed., American Institute for Preventive Medicine. All rights reserved.

HealthyLife®

Self-Care Guide


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Table of ContentsWhat Is Pain? ........................................................ 4Pain Facts .............................................................. 4Types of Pain ......................................................... 5Identify and Be Able to Explain Your Pain ........... 625 Methods to Manage Pain .................................11When is Medical Care Needed for Pain? ............ 14Abdominal Pain ................................................... 15Arm Pain & Hand Pain ........................................ 19Back Pain ............................................................. 23Chest Pain ............................................................ 28Ear Pain ............................................................... 31Fibromyalgia Pain ............................................... 34Foot Pain ............................................................. 35Headaches ............................................................ 40Leg Pain & Ankle Pain ........................................ 45Neck Pain & Shoulder Pain ................................. 50Shingles Pain ....................................................... 54Skin Injuries & Wound Pain ................................ 56Sprains, Strains & Sports Injuries ....................... 59Toothaches ........................................................... 62Pain Management Resources .............................. 64

Introduction

People experience pain in different ways. What matters is how pain affects you. Managing pain makes it easier to do your day-to-day activities and better cope with illness and injury.

Use this guide to:n Learn about pain and how much it affects your life.n Identify and be able to explain your pain.n Identify causes of pain that could threaten life or result in the loss of a

limb.n Find out ways to treat and manage your pain.n Find out about pain management resources.

Telephone Numbers & Information

Emergency Medical Service (EMS): _______________________________Police: _______________________________________________________Suicide Prevention Lifeline: 800.273.TALK (8255)Poison Control Center: 800.222.1222Local Poison Control: ___________________________________________

Doctors / Health Care Providers Name Specialty Phone Number____________________ ____________________ _____________________________________ ____________________ _____________________________________ ____________________ _________________

Hospital: ____________________ Pharmacy: _______________________Employee Assistance Program (EAP): ______________________________

Health Insurance InformationCompany: ___________________ Phone Number: ___________________Address: _____________________________________________________Policyholder’s Name: ___________________________________________Policy Number: ________________________________________________

What to Tell Your Doctor / ProviderUse this summary when you call or visit a provider. Also see pages 6 to 11.

Where it hurts: _________________________________________________How much it hurts (0 = no pain →10 = hurts the worst): ________________When it started: ________________________________________________The pain comes and goes _________ The pain lasts all the time _________Other symptoms with the pain: ____________________________________What helps the pain: ____________________________________________What makes it worse: ___________________________________________Medicines I take: _______________________________________________Treatments other than medicine I used: _____________________________Medication allergies: ____________________________________________


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What Is Pain?

Pain is your awareness of hurt or discomfort and how you perceive it. This applies when you feel physical or emotional pain.

The feeling of physical pain starts in nerve receptor cells that are below your skin and in organs inside your body. These nerve cells send a signal to nerves in your spinal cord and from there to your brain.

Pain can be a sign that something is wrong, such as a skin injury, an infection, or an illness. It can range from a mild discomfort to pain that is extreme and severe.

Emotional pain is often described as distress, mental anguish, or a “broken heart.”

Physical pain and your emotions interact with each other. Your emotions have a direct impact on how you feel pain. You can use your emotions and your mind to help you manage pain.

Pain Factsn About 75 million persons living in the U.S. have chronic or recurrent

pain.n Pain affects more persons in the U.S. than diabetes, heart disease, and

cancer combined.n Pain is one of the most common reasons people seek medical care.n Chronic pain costs over $100 billion dollars a year in medical costs,

disability payments, lost productivity, and retraining workers.

Types of PainAcute PainThis type of pain usually starts suddenly. It can range from mild to severe and is caused by another problem or event. Examples are: n Atemporaryillness,suchasanearache,theflu,orasorethroatn An injury, such as a broken bone, or a burn, a sprain or strainn Surgery or other medical proceduren Labor and deliveryWhen the cause of the pain is treated with success, the pain goes away.

Chronic Pain Withthistype,painsignalskeepfiringinthenervoussystem for weeks, months, or years. The pain can come and go or persist. It can range from mild to severe. The cause of chronic pain is not always known, but it may be due to or related to a number of reasons. These include:n Arthritisn Back problemsn Cancer or chemotherapy for cancern Headaches that persistn Medical conditions that cause problems with nerve

signals, such as diabetes and multiple sclerosisn Otherchronichealthconditions,suchasfibromyalgiaandsicklecell

anemian A past injury or illness

Chronic pain can interfere with your daily activities and affect the way you eat, sleep, work, relate to others, and enjoy life in general. When you have chronic pain, it is common to be irritable, worried, angry, and depressed. Having chronic pain and depression increases the risk of suicide. The need to stop the pain can lead to:n Unproven treatments that could be harmfuln Overuse and/or addiction to pain relieving medicines. Drug use.n Repeated surgeries

Pain can affect many aspects of your daily life.

Back pain is a common medical

problem.


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Identify and Be Able toExplain Your Pain

Answering the questions below will help you identify your pain and be able to explain it to your doctor or health care provider. Pages 7 to 10 in this guide allow you to answer these questions one at a time. Your answers also help you identify things that trigger your pain and how it affects your daily life. Make a copy of this chart. Take your answers with you to show your doctor or health care provider.

Questions to Answer Your Answer1. Where does it hurt?

2. How much does it hurt?

3. Whendidthepainfirststart?

4. How long have you had it?

5. Does it last all the time or does it come and go?

6. Does it occur with any other problems or symptoms?

7. What makes the pain worse?

8. What medicines have you taken to relieve the pain?

9. What treatments other than medicines have you used?

10. How has the pain affected your life?

1. Where does it hurt?Circle areas of the body and/or place a check mark (3) in the boxes showing where you have pain.

q Headq Neckq Shoulder(s)q Arm(s)q Elbow(s)

q Wrist(s)q Hand(s)q Finger(s)q Backq Chest

q Abdomenq Groinq Hip(s)q Leg(s)q Knee(s)

q Ankle(s)q Footq Toe(s)q ____________q ____________

2. Does it last all the time or does it come and go?__________________________________________________________________________________________________________________________


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4. How much does it hurt?Pain scales are used to help you rate your pain. The higher the number, the stronger the pain. Using the faces and wording below, choose a number from 1 to 10 that describes your pain. NoPain MildPain ModeratePain SeverePain WorstPain

0 1 2 3 4 5 6 7 8 9 10

It does It hurts It hurts a It hurts It hurts a It hurts not hurt. a little bit. little more. even more. whole lot. the worst.

I can ignore Keeps me Keeps me Severely Can’t do the pain. from doing from limits anything normal concentrating my activity tasks

Pain relievers Mild pain medicine Prescribed, stronger to are not needed. relieves or lowers strongest medicine lowers pain. or only partly lowers pain.

5. When did the pain first start?On __________________________________________________________ (Day of the week) (Month) (Day) (Year)

6. How long have you had it?_______days _______weeks _______years

7. Does it occur with any other problems or symptoms?List other symptoms you have with the pain:_____________________________ ______________________________ _____________________________ ___________________________________________________________ ______________________________

3. Can you explain the pain?To help explain your pain, check off any of the words listed below that describes what your pain feels like. After each word you check off, write a number for how much it hurts. Use the pain scale on page 9.

WordtoExplainthe

Pain

q Achingq All overq Beatingq Comes and goesq Crushingq Dullq Gnawingq Like menstrual crampsq Long-lastingq Penetratingq Pinchingq Pressingq Pulsingq Scaldingq Shootingq Splittingq Stabbingq Suffocatingq Tearingq Throbbingq Tingling

HowMuchItHurts

1(mild)→10(severe)(Seepage9.)

WordstoExplainthePain

q Agonizingq Annoyingq Burningq Crampingq Cuttingq Excruciatingq Intenseq Local (what area of the body?)q Naggingq Piercingq Poundingq Prickingq Radiatingq Sharpq Soreq Squeezingq Stingingq Tautq Tenderq Tightq Wrenching

HowMuchitHurts

1(mild)→10(severe)(Seepage9.)


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8. What makes the pain worse?(Doing certain activities, sitting for too long, eating, not eating, heat, taking or not taking medicine, etc.)_____________________________ ______________________________ _____________________________ ______________________________

9. What medicines have you taken to relieve the pain?

Over-the-CounterMedicines&Supplements(Pills, topical ointments, herbs, etc.)

Name of Item Amount Used How Often?

PrescribedMedicines Name of medicine Dose Prescribed by:

10. What non-medicine treatments have you used?_____________________________ ______________________________ _____________________________ ______________________________

11. How has the pain affected your life?Change in activity level, ability to work, change in mood, sleep habits, relationships, enjoying life, etc.)__________________________________________________________________________________________________________________________

25 Methods to Manage PainYou have many options to manage pain. A brief summary of 25 methods is listed from A to Z on this page and the next 2 pages.

1. Acupuncture.Atrainedtherapistinsertshair-thinneedlesatspecificareas just below the skin (acupoints) to stimulate the body’s self-healing abilities. Electroacupuncture adds wires to the needles to stimulate nerve endings. Some researchers believe this activates endorphins.

2. Biofeedback. This is a process of learning how to control and change internal functions to manage pain and other conditions. Biofeedback devices measure your breathing, heart rate, blood pressure, or other functions. Through training in relaxation or imagery, you learn to alter bodily functions to feel more relaxed and to help manage pain.

3. Cognitive-behavioraltherapy(CBT). This helps a person identify and then modify thoughts and behaviors that focus on pain.

4. Coldtreatment. Examples are placing an ice pack, a bag of frozen vegetables, or a cold washcloth on the area that aches. Apply cold treatment for 20 minutes at a time. For pain from an acute injury, use coldtreatmentforthefirst48hours.

5. Counseling. This can be individual, family, or group therapy that provides emotional support and teaches ways to identify and deal with stress and emotions that increase pain.

6. Dietarysupplements. Examples are capsaicin for arthritis pain and gingertoreduceinflammation.Note: Follow your doctor’s advice for dietary supplements.

7. Distraction. This focuses your attention on something other than the pain, such as watching a movie, working on a hobby or project, and helping others.

8. ElectricalstimulationcalledTENS. (This is transcutaneous electrical nerve stimulation). This uses a device that sends gentle electrical impulses through the skin at certain pain sites of the body to block pain signals before they reach the brain. Sample. Do not reproduce.

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9. Endorphins. These are painkilling proteins that occur naturally in the body. The word endorphin is a Greek term that means “the morphine within.” Brisk walking, running, and other aerobic exercises may release endorphins. The endorphins lower pain.

10. Exercise.Stretchingandflexibility.Thesehelpwithrangeofmotionandreduce stiffness in joints that could lead to pain.

11. Heattreatment. Examples are a heat pack, a hot water bottle, a heating pad (set on low), or warm shower water on the area that hurts. Apply heat treatment for 20 minutes at a time. For pain from an acute injury, use heat treatment after using cold treatment for 48 hours.

12. Hypnosis. This uses refocusing techniques to block or transform pain.

13. Massage. This gives a temporary relief of pain due to muscle stiffness and muscle spasms.

14. Medications − Over-the-counter (OTC)• Oral pain relievers. Examples are acetaminophen, aspirin, ibuprofen,

and naproxen sodium. These also reduce fever and, except for acetaminophen, reduce swelling.

• Topical cremes, lotions, ointments, and gels. These offer temporary reliefforlocalizedareasofpain,suchasfingersandkneesduetoarthritis. Substances in these include menthol, eucalyptus, capsaicin, and salicylates.

15. Meditcations − Prescribed• Opioids. Examples are codeine, hydrocodone (Vicodin),

memperidine (Demerol), morphine, and oxycodone (OxyContin).• Non-opioids.Theseincludenonsteroidalanti-inflammatory

drugs (NSAIDS), such as piroxicam (Feldene), naproxen, and nambumetone (Relafen). These are commonly prescribed for arthritis pain.

• Adjuvants. These include antidepressants, anticonvulsants, antimigraine drugs, muscle relaxants, and corticosteroids. They may be prescribed along with other medications that relieve pain.

• Local anesthetics

Prescribed medicines come in many forms. These include pills, liquids, skin patches, suppositories, and ones that are injected or infused. Pain medicine can also be given using a machine that you control. You push a button when you feel pain. It is set up so you can’t get too much pain medicine. This is called Patient Controlled Analgesia (PCA). Most often, it is used in the hospital and health care facilities.

16. Occupationaltherapy. This is learning how to do activities of daily living while managing pain.

17. Physicaltherapy.Thisfocusesonimprovingmobility,flexibility,strength and endurance through physical exercises and assistive devices.

18. Placebos. These use the power of suggestion that a pill, etc., without actual medicine, will treat the pain because a person believes it will.

19. Prayer. This is a spiritual way to meditate, which helps to lower heart rate and decreases muscle tension. Connecting to a higher power is a way to cope with pain and deal with things that cannot be changed.

20. Relaxation. Examples are deep breathing and progressive muscle relaxation.

21. Self-Soothing. This is giving compassion and reassurance to yourself like when a mother soothes a child who is in pain or is distressed. It is giving yourself permission to accept the pain and trying to stay calm and relaxed, even in the midst of your pain. It also includes seeking physical comfort, such as taking a warm bath.

22. Supportgroups. These allow emotional support and a shared understanding for dealing with pain.

23. Surgery. This may be needed to correct a physical problem that causes pain.

24. TaiChi. This form of exercise uses slow, gentle movements to improve balanceandincreaseflexibility.

25. Yoga. This uses breathing exercises, postures, and movements to unite the body, mind, and spirit. It also improves blood pressure and circulation.

The Arthritis Foundation recommends doing tai chi for

pain relief.


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Abdominal PainThe abdomen is the body region between the lower ribs and the pelvis. Many vital organs make up this body region. It is divided into four sections called quadrants. Each of these has certain organs.

Signs & Symptomsn Mild to severe and dull to sharp

painn Acute (sudden) pain or

chronic pain

The type of pain, its location, and other symptoms point to the cause.

CausesThere are many causes of abdominal pain. Some of these are:n Abdominal aortic aneurysmn Appendicitisn Blockedarteriesoroneswithpoorbloodflown Cancern Celiac diseasen Constipationn Crohn’s diseasen Diverticulosis and diverticulitisn Food poisoningn Gallstonesn Heart attack (see pages 28 and 30)n Heartburnn Hepatitisn Infections, such as ones in the digestive tract and urinary tract

When is Medical CareNeeded for Pain?

This guide helps you choose when to seek medical care for pain and when you can treat it on your own. Common health conditions that involve pain are found on pages 15-63. Find the one(s) that apply to you on page 3 in the Table of Contents and go to the pages they are on.n Read about the health condition(s), signs and symptoms, causes, and

treatments.n Read the “Questions to Ask.” Start at the top. Answer YES or NO to

each question until you get to one of the instructions listed below:

GetMedicalCareFastIf your symptoms direct you to this symbol, get medical care without delay. For problems that could threaten life, call 9-1-1

or go to a hospital emergency department. (Ask your doctor for a list of reasons you should get these levels of care.) If symptoms do not threaten life, call your doctor or health care provider right away or go to an “urgent care” center. Find out if your health insurance requires you to use a certain ambulance service.

SeeDoctorIf your symptoms direct you to this symbol, you should be seen by yourdoctorforamedicalevaluation.Contactyourdoctortofind

out how soon you need to be seen. The term “doctor” is used for a number of health care providers:• Your physician • A walk-in clinic • Your psychiatrist• Physician assistants (P.A.s), nurse practitioners (N.P.s), and certifiednurses(C.N.s)whoworkwithyourdoctor• Your nurse advice line • Your home health care provider

CallDoctorCall your doctor or health care provider and state the problem for advice on what to do.

UseSelf-CareYou can probably take care of the pain yourself. Use the Self-Care / Prevention measures that are listed. If these do not bring relief or if your pain worsens, call your doctor.

Four sections of the abdomen

n Irritable bowel syndrome (IBS)

n Kidney stonesn Menstrual cramps in

femalesn Ovarian cysts in femalesn Pancreatitisn Pregnancy complicationsn Refluxofstomachacidsn Stomach ulcers


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TreatmentTreatment depends on the cause. The key is to know when it’s just a minor problem, like a mild stomachache or when it’s something worse. Pain that persists can be a sign of a medical condition or illness. Very severe abdominal pain usually needs medical care right away.

Questions to Ask

With abdominal pain, are any signsandsymptomsofaheartattack listed on pages 28 and 30 present?

Call911!With abdominal pain, are any of these problems present?• You vomit without stopping or you vomit blood or material

that looks like coffee grounds.• You vomit, have a fever and shaking chills, and feel pain in

one or both sides of your mid-back or shoulders.• You have dry mouth, excessive thirst, little or no urination,

and dry skin that doesn’t spring back after you pinch it.• Your stools have blood or are tarlike and black in color.• You had a recent injury to the abdomen.• Pain is so bad that you can’t move or it gets a lot worse when

you move.

With abdominal pain, do you have any of these problems?• The pain spreads to the back, chest, or shoulders.• You feel a mass in the abdomen that throbs or pulsates.• Your abdomen is very tender when touched.• You don’t know why your abdomen is swollen, but it keeps

getting worse.

Is pain in the abdomen very severe or sudden, extreme, and constant?

Flowchart continued on next page

Are all of these symptomsofappendicitis present?• You have not had your appendix removed.• Pain and tenderness started in the upper part of your stomach

or around your belly button and moved to the lower right part of your abdomen. The pain can be sharp, severe, and felt more when the lower right abdomen is touched.

• Nausea, vomiting, or no appetite• Fever

With abdominal pain, are these symptomsofkidneystones present?• The pain started in your side before it moved to your abdomen

or groin.• Pain persists no matter what position you are in.• It is painful to pass urine.• Your urine is bloody, cloudy, and/or has a foul odor.• You pass urine often, but only pass small amounts.• You are unable to pass urine.

With abdominal pain, do you have any of these problems?• The whites of your eyes or your skin looks yellow.• Pain recurs in your upper abdomen and it is temporarily

relieved by antacids.• Severe diarrhea or constipation lasts for more than a week.• Skin on the abdomen is sensitive or you have a skin rash on

one side of the abdomen.• You have a bulge and/or discomfort (when pressed) anywhere

in the abdomen.• You have pain or burning when you pass urine.• You have pain and a vaginal discharge.

Do you pass urine more often than usual or is your urine bloody or cloudy?

Is swelling or discomfort in the groin made worse when you cough or lift heavy objects?



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With abdominal pain, do you have any of these problems?• Continued belching, nausea, gas, or gurgling noises• Pain worsens when you bend over or lie down.

Self-Care / Preventionn Find a comfortable position. Relax.n Take an over-the-counter pain

medicine as directed on the label.n Apply a heating pad set on low

(adults only).n Use a hot water bottle or heat pack on

the area that aches.n Wearloose-fittingclothes.n Don’t exercise too hard.

For more information, contact:Crohn’s & Colitis Foundation of Americawww.ccfa.org

National Institute of Diabetes & Digestive & Kidney Diseases (NIDDK)www2.niddk.nih.gov

Use a hot water bottle or heat pack on the area that aches.

Arm Pain & Hand Pain Signs & Symptomsn Pain ranging from dull to severe. Increased pain

with movement.n Numbness. Weakness. Tenderness.n Stiffness. Swelling.

CausesThere are many causes of arm and/or hand pain. Common causes are:n Arthritis. Repetitive motion injuries (RMIs), such as

carpal tunnel syndrome.n Circulation problems, such as angina and a heart

attackn Skin rashes. Skin wounds. Infections.n Injuries, such as sprains, strains, and broken or dislocated bones

Other symptoms with the pain and how long they have occurred help diagnose the cause. See, also, NeckPain&ShoulderPain on pages 50-53 and Sprains,Strains&SportsInjuries on pages 59-61.

TreatmentTreatment depends on the cause and how severe the problem is.

Questions to Ask

Are any signsandsymptomsofaheartattacklisted on pages 28 and 30 present?

Call911!If you have been diagnosed with angina, do you have aching in one or both arms and chest pain that do not respond to prescribed medicine? Or does the pain not go away in 10-15 minutes?


Repeated use of tools that vibrate

the hand and wrist can lead to RMIs.

Call911!


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Did you have a serious injury that caused arm or hand pain and/or are any of these signs present?• A bone sticks out or bones in the injured area make a grinding

sound.• The injured body part looks crooked or the wrong shape.• After a crushing injury, pain increases.• You can’t move the injured body part or put weight on it.• The injured area is blue, pale, numb, or feels cool, but the

same limb on the other side of your body does not.

Do you have any of these problems?• Burningpaininafinger,especiallyatnightand/orwhenyoubendyourwristandfingersupwardthendownward

• Shooting pains from your hand to your wrist and sometimes to your forearm.

• Numbnessandtinglinginyourfirst3fingersandthumb• Hand pain, numbness, and tingling for more than 2 weeks• Youhaven’tbeenabletomakeafistforoveraweek.

Do you have any of these problems?• Your shoulder hurts, is stiff, and is hard to move.• You have pain, tenderness, and limited motion in your

shoulder, arm, or hand.• Tenderness and pain over an elbow• Pain when you twist your arm or hand, such as when you use

a screwdriver or play tennis• A weak grip• Any signofaninfection listed on page 57?

Do you have pain and stiffness in joints with these problems in yourfingers?• Puffiness,hardening,andthickeningoftheskin• Your skin looks shiny or waxy or blue in color.• Coldness and numbness


Call911!

Do you have any of these problems?• A growth on your wrist that feels tight, hard, and painful• Your hands turn pale, then red, and get painful and numb

when exposed to the cold and/or when you are stressed.• Pain in your arm or hand wakes you from your sleep.

Have you started to have a hard time writing with a pen or pencil, opening a jar, or buttoning a blouse or shirt?

Self-Care / PreventionToHelpTreatArthritisn Follow your doctor’s advice for exercise, medications, and the use of

supplements,suchasglucosamine,chondroitin,andflaxseedoil.n Follow a healthy diet. If you are overweight, lose weight gradually

(1-2 pounds a week). Losing weight too fast and fasting raise uric acid levels and increase the risk for gout.

n Protect your joints from injuries. Wear knee pads, etc.n Don’t put too much stress on your joints. Take regular pauses and breaks

from activities that do this.

ToHelpPreventOsteoarthritisn Get to and stay at a healthy weight.n Do regular physical activity, but don’t overdo it. If you feel pain, stop.n Prevent falls and sports injuries. (Use tips under Prevention on page 61.)


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ForCarpalTunnelSyndrome(CTS)This is much easier to treat and less likely to cause future problems if it is found early. Once CTS is diagnosed, treatment includes:n Preventing further damagen Wearing a wrist brace, splint,

etc. as advised by your doctor. This may need to be worn during the day and while you sleep.

n Taking OTC medicines to reduce pain and swelling.

n Physical therapyn Occupational therapyn Cortisone shots in the wrist

arean Surgery, if needed

For more information, contact:Arthritis Foundation800.283.7800www.arthritis.org

National Institute of Arthritis and Musculoskeletal and Skin Diseases (NIAMS)www.niams.nih.gov

A physical therapist can show you what exercises to do at work and at home to treat

CTS.

Back PainSigns & SymptomsBack pain can be sharp, dull, acute or chronic. There may also be swelling in the back area.

CausesThe most common cause is muscle strain of the lower back. Other causes include back injuries, osteoarthritis, osteoporosis, and bladder infections.

TreatmentMost backaches caused by strained muscles and ligaments can be treated with self-care. (See Self-Care / Prevention on page 24-26.) Other causes need a medical evaluation andtreatmentspecifictotheproblem.

The goals of treatment are to treat the cause, relieve the pain, promote healing, and avoid re-injury.

Questions to Ask

Is the back pain extreme and felt across the whole upper back? Did it come on suddenly (within about 15 minutes) without a reason, such as an injury or back strain? (These may be symptoms of a dissecting aortic aneurysm.)

Are any of these problems present?• The back pain was sudden with a cracking sound.• The pain occured with passing out and/or severe abdominal

pain.• The pain came after a recent fall, injury, or violent movement

to the back and you are having a hard time moving your arm or leg. You also have numbness or tingling in your legs, feet, toes, or hands, and/or loss of bladder or bowel control.


Sitting too long can stiffen back muscles.


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Do any of the following describe or occur with back pain?• The pain came on all of a sudden after being in a wheelchair

or a long stay in bed.• You are over 60 years old.• The pain is severe (but not a result from a fall or injury to the

back) and has lasted for more than 5-7 days.• There is a sense of weakness, numbness, or tingling in the feet

or toes.• You have burning or pain when you pass urine.• Your urine is bloody or cloudy or you pass urine more often

than usual.• The back pain travels down the leg(s), especially below the

knee(s).• It hurts more when you move, cough, sneeze, lift, or strain.

With back pain, do you have any of these problems?• Fever, joint stiffness, and joint pain• Fever, redness, heat, or swelling in affected joints• Fever, cracking or grinding sounds with joint movement• The pain is felt on one side of the small of your back, just

above your waist, and you feel sick.

Self-Care / PreventionRelievethePainTake an over-the-counter medicine for pain. Acetaminophen will help the pain, but not the swelling. Don’t “overdo it” after taking a painkiller. You can hurt your back more and then it will take longer to heal.

ActivityContinue your regular activities as much as you can, but stop activities that increase pain. Rest the back if you must, but don’t rest in bed more than 1 to 2 days even if your back hurts a lot. Your back muscles can get weak if you don’t use them or if you stay in bed longer than 2 days. Rest should only be used for persons with severe limitations (due mostly to leg pain).

OtherTipsn Get comfortable when you lie down, stand, and sit. For example, when

youlieonyourback,keepyourupperbackflat,butyourhipsandkneesbent.Keepyourfeetflatonthebed.Tipyourhipsdownandupuntilyoufindthebestspot.

n Put a pillow under your knees or lie on your side with your knees bent. This will take pressure off your lower back.

n When you get up from bed, move slowly, roll on your side, and swing yourlegstothefloor.Pushoffthebedwithyourarms.

ColdTreatmentCold helps with bruises and swelling. For the first48hoursafterbacksymptomsstart,applyacold pack (or bag of ice) to the painful area. Lie on your back with your knees bent and put the cold pack under your lower back. Do this for 5 to 10 minutes at a time, several times a day.

HeatTreatmentHeatmakesbloodflowwhichhelpshealing.Heat also helps relieve muscle spasm. Don’t use heat on a back strain until 48 or more hours after backsymptomsstart.Usecoldtreatmentfirst(see “Cold Treatment” above). If used sooner, heat can make the pain and swelling worse. Use a moist heating pad, a hot-water bottle, hot compresses, a hot tub, hot baths, or hot showers. Use heat for 10 minutes at a time. Do this several times a day. Be careful not to burn yourself.

BracesorCorsetsBraces and corsets help to support your back and keep you from moving it too much. They do what strong back muscles do, but they won’t make your back stronger.

MassageMassage won’t cure a backache, but it can loosen tight muscles.

Apply ice or a cold pack for the first 48 hours after

symptoms start.


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SpinalManipulationThis treatment, usually done by a chiropractor or osteopath, uses the hands to apply force to “adjust” the spine. This may be helpful for some people thefirstmonththeyhavelowbacksymptoms.Consultyourdoctoraboutspinal manipulations. Your health insurance plan may not cover costs. Or, it may require a referral from your doctor before it pays anything for spinal manipulation.

MoreTipsn Try some mild stretching exercises (in the morning and afternoon) to

make your stomach and back muscles stronger. Ask your doctor for his or her advice on exercising. Yoga may help.

n Don’t sit in one place longer than you need to. It strains your lower back.n Sleeponafirmmattress.Don’tsleeponyourstomach.Sleeponyour

back or side with your knees bent.n If your back pain persists or doesn’t get better on its own, see your

doctor to evaluate your needs. Your doctor may refer you to a chiropractor, physical therapist, or physiatrist (a physical therapy doctor).

Lifting Do’s and Don’ts to Prevent Back StrainLiftingDo’sn Wear good shoes with low heels, not sandals or

high heels.n Stand close to the object you want to lift.n Plant your feet squarely, shoulder width apart.n Bend at the knees, not at the waist. Keep your

knees bent as you lift.n Pull in your stomach and rear end. Keep your

back as straight as you can.n Hold the object close to your body.n Lift slowly. Let your legs carry the weight.n Get help or use a dolly to move something that is too big or very heavy.

Proper lifting

LiftingDon’tsn Don’t lift if your back hurts.n Don’t lift if you have a history of back trouble.n Don’t lift something that’s too heavy.n Don’t lift heavy things over your head.n Don’t lift anything if you’re not steady on your

feet.n Don’t bend at the waist to pick something up.n Don’t arch your back when you lift or carry.n Don’t lift too fast or with a jerk.n Don’t twist your back when you are holding something. Turn your whole

body, from head to toe.n Balance the load. Don’t lift something heavy with one hand and

something light with the other.n Don’t try to lift one thing while you hold something else. For example,

don’t try to pick up a child while you are holding a bag of groceries. Put the bag down or lift the bag and the child at the same time.

SciaticaSciaticaisinflammationofthesciaticnerve,whichstartsinthelowerspine and goes down the back of the legs. Pressure on the nerve (from tight muscles, herniated disk, etc.) causes a sharp pain that can be felt in a buttock and may extend to the thigh, knee, or foot. To prevent sciatica:n Don’t strain the muscles in your lower back. (See LiftingDo’sand

Don’tstoPreventBackStrain on page 26 and this page.)n Do exercises to strengthen your stomach muscles. These exercises

help make your back stronger.

Treatment for mild sciatica is rest, heat, and an over-the-counter medicine for pain. Physical therapy may be helpful. In some cases, surgery to repair a herniated disk may be needed.

For more information, contact:National Institute of Arthritis and Musculoskeletal and Skin Diseases (NIAMS)www.niams.nih.gov

Improper lifting


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Chest Pain

Signs&Symptoms

• Chest pressure, squeezing, burning, tightness, or pain (may spread to the arm, neck, back, tooth, or jaw)

• Chest discomfort with: Shortness of breath; sweating; nausea, fast or uneven pulse; lightheadedness; fainting

• Chest pain that does not respond to medicine for a person with angina or heart problems

• Severe chest pain and extreme pain felt across the upper back (not just on one side) that came on within 15 minutes without an injury, back strain, etc. The pain can spread to the abdomen.

• A knife-like sensation from the chest area to the back

• Dizziness and fainting

Chest pain that gets worse when taking deep breaths and occurs with any of these conditions:• Sudden shortness of breath and

several problems breathing• Rapid heartbeat• Cough with bloody sputum• Sudden onset of chest pain with

calf pain• Recent surgery or illness with

prolonged bed rest or a very long trip by car, bus, train, or plane

WhatItCouldBe

HeartAttack. (See, also, OtherHeartAttackWarningSigns on page 30.)

Dissectingaorticaneurysm.This is a tear in the main artery from the heart.

Bloodclot(s)tothelungs

WhattoDo

Call9-1-1!

Call9-1-1 or go to the emergency department of a hospital! Do not take aspirin.

Call9-1-1 or go to the emergency department of a hospital!

• Sudden and sharp chest pain or tightness with breathing

• Increasing shortness of breath

Squeezing, pressure, indigestion feeling, or pain (often dull) in the chest. The pain may spread to the arm, neck, jaw, or back. Symptoms come on or are made worse by stress or physical exertion. They ease with rest.

The pain is on only one side of the chest and is not affected by breathing. A burning feeling and a skin rash are at the site of the pain.

Vague pain in the chest (if any). Shortness of breath; chronic fatigue; cough with phlegm or blood; night sweats; appetite loss; weight loss; and fever.

Burning feeling in the chest or just above the stomach that comes and goes before, during, or after eating. It gets worse when you bend over or lie down.

Chest pain that worsens with deep breaths, coughing, or touching the chest or ribs

Collapsedlung. Trauma to the chest is the main cause.

Angina

Shingles

Tuberculosis(TB). Chronic lung infection with a certain bacteria.

Heartburn or hiatalhernia. Note: This could also signal angina or a heart attack. (See pages 28-30.)

Pleurisy. The membrane that surrounds the lungsisinflamed.Musclestrainorribinjury.

Call9-1-1 or go to the emergency department of a hospital.

Take medicine as prescribed. If symptoms do not go away in 10-15 minutes, call9-1-1 or go to the emergency department of a hospital!

See ShinglesPain on page 54.

See doctor.

Use prescribed treatment for heartburn or hiatal hernia or consult doctor.

See doctor for diagnosis. See Sprains,Strains&SportsInjuries on page 59, too.

Signs&Symptoms WhatItCouldBe WhattoDo


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Chest pain with fever and coughing up green, brown, yellow, or gray mucus.

Sudden, sharp pain below the left nipple that lasts less than a minute or so.

Pain and tender feeling in the upper part of the chest. The pain gets worse when pressure is applied to the area. It can get worse with deep breaths, too.

Flu,pneumonia,bronchitis, or other upper respiratory infection.

Precordialcatchsyndrome. This harmless, recurrent problem usually occurs in young adults.

Costochondritis. This is inflammationwhere the ribs attach to the breastbone.

See doctor.

See doctor for diagnosis. Try daily stretching exercises to reduce getting these pains.

See doctor for diagnosis. Take an OTC medicine for pain and swelling. Apply a heating pad set on low or a hot water bottle to the area of pain.

Other Heart Attack Warning Signsn Unusual chest, abdominal, or stomach painsn Dizziness; nausea; trouble breathing; jaw or arm pain

without chest painn Fast or uneven heartbeat or pulsen Sweating for no reason; pale, gray, or clammy skinn Signs more likely to occur in women than in men are an

uneasy feeling in the chest with:• Unexplained or extreme anxiety• Unusual fatigue or weakness• Fluttering heartbeats• Severe indigestion that doesn’t go away with an antacid

Ear PainSigns & Symptomsn Mild to severe ear painn Feeling of fullness or

discomfort in the earsn Tugging at the ear and

restlessness in children

CausesThe most common cause of ear pain is a plugged Eustachian tube. This goes from the back of the throat to the middle ear. The pain is due tofluidorpressureinthepluggedtube.Thisiscausedbyaninfectionofthemiddle ear, a cold or sinus infection, or allergies. Other things that can cause ear pain include changes in air pressure in a plane, something stuck in the ear, too much earwax, tooth problems, and a ruptured eardrum.

TreatmentTreatment includes pain relievers and methods to dry up or clear the blocked ear canal. Self-care can be used to treat many earaches. Severe and/or constant ear pain needs a medical diagnosis. Often, antibiotics are not needed for middle ear infections in children. Let your child’s doctor decide if and when an antibiotic should be prescribed.

Questions to Ask

Did ear pain start after a blow to the ear or recent head trauma?

With ear pain, do any symptomsofmeningitis occur?• Severe, persistent headache• Stiff neck (can’t touch the chin to the chest)• Lethargy• Seizure• Red or purple rash that doesn’t fade when the skin is pressed• In an infant, bulging of the fontanelle (soft spot of the skull)



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With ear pain, do any of these problems occur?• Vomiting• Fever• Sticky, green, or bloody discharge from the ear• The ear pain is severe or worsens when wiggling the ear lobe.• Sensitivity to the light

Does a child show these signs, especially after a cold or other respiratory infection, air travel, or if the child has had ear problems?• Constant pulling, touching, or tugging at the ear(s)• No response to a whistle or a loud clap• Fever• Crying that won’t stop. Or, the child acts cranky and restless,

especially at night or when lying down.• Ear(s) that are hot and hurt when touched

Does pain persist, is it more than mild, and does it occur after any of the following?• A mild ear injury or blowing the nose hard or many times• A small object (or insect) is in the ear and cannot safely be

removed.• A cold, sinus, or upper respiratory infection• Exposure to extremely loud noises, such as rock concerts,

heavy machinery, etc.

With pain, do you also have hearing loss, ringing in the ears, dizziness, or nausea?

Does the pain occur with jaw pain, a headache, and a clicking sound when you open or close your mouth?

Self-Care / PreventionToReduceEarPainn Place a warm washcloth next to the ear. Or put an ice bag or ice in a wet

washcloth over the painful ear for 20 minutes.n Take an over-the-counter (OTC) medicine for pain, as directed.

ToOpenUptheEustachianTubesandHelpThemDrainn Sit up. Prop your head up when you sleep. Yawn.n Chew gum or suck on hard candy. (Do not give to children under 5 years

old.) This can help with pressure changes that take place during air travel and when waking up with ear pain.

n When traveling by air, stay awake when the plane takes off and lands. Wear earplugs that lower up to 25 decibels (dB) of sound.

n Take a steamy shower. Use a cool-mist vaporizer, especially at night.n Drink plenty of cool water.n Gently,butfirmly,blowthroughyournosewhileholdingbothnostrils

closed until you hear a pop. This can be done several times a day.n If okay with your doctor, take a decongestant. (Do not give

decongestantsandotherOTCmedicinestotreatcolds,coughs,andflusymptoms to children under 4 years old.)

n When you give a baby a bottle, hold the baby in an upright position.

ToTreataMildCaseof“Swimmer’sEar”n Shake the head to expel trapped water. Clean and dry the outer ear canal

gently. Use a clean facial tissue. Twist each corner into a tip and gently place each tip into the ear canal for 10 seconds. Repeat with the other ear using a new tissue. Do not remove earwax.

n Use an OTC product, such as Swim-Ear, as directed.

ToHelpPreventEarPainn Don’t put cotton-tipped swabs, bobby pins, etc. in your ears. Don’t blow

your nose with too much force.n If you can, avoid places that have very loud noises (construction sites,

etc.). Wear earplugs when exposed to loud noises.n Keep the volume on low when using earphones with iPods, etc. If

someone else can hear the music, the volume is too loud.n Don’t swim in dirty water. Swim on the surface not underneath the water.

Wear wax or silicone earplugs. Wear a bathing cap.

For more information, contact:National Institute on Deafness and Other Communication Disorders (NIDCD)800.241.1044 | www.nidcd.nih.gov


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Fibromyalgia PainFibromyalgia is a chronic, arthritis-like illness that affects muscles, not joints.

Signs & Symptomsn Chronic widespread pain in 11 or more of 22

“tender points.” The pain can be severe and lasts for at least 3 months.

n Fatigue. Disturbed sleep. Anxiety. Depression.n Memory lapses. Problems concentrating.n Gas. Constipation. Diarrhea.

CausesThe exact cause is not known. These factors may play a role:n An illness caused by an infection. Emotional or physical trauma.n Hormonal factors. Women are affected more often than men.n Brain chemicals and/or muscles don’t function like they should.

TreatmentTreatment includes exercise therapy, medications to treat symptoms, and massage therapy.

Questions to Ask

Doesapersonwithfibromyalgiahaveseverepain,depression,or anxiety? Is prescribed treatment not helping?

Self-Care / Preventionn Follow the treatment plan advised by your doctor for exercise,

medication, etc.n Use biofeedback. Use relaxation techniques. Meditate.n Take warm baths. Use a heating pad. Massage sore muscles.

Foot Pain

Signs&Symptoms

Pain from a fall or injury to your foot (not just a toe) with any of these problems:• Severe bleeding.• Your foot is misshaped.• You can’t move your foot.• Your foot looks blue or pale and

is cold and numb.• Your foot is so painful and/or

swollen that you can’t put any weight on it.

Sudden onset of pain in your feet and legs. The skin on your feet rapidly changes color: White, red, blue, grayish, or black.

A foot wound with: Fever; redness, tenderness, or warmth; swelling; pain; and/or pus.

Severe pain in a foot joint, often the big toe. The pain is not due to an injury. The joint hurts a lot when anything touches it. The area is red, swollen, and tender.

Joint pain and morning stiffness in joints that lasts more than 1 hour. Fatigue.

Pain in only one toe after an injury to the toe.

WhatItCouldBe

Brokenbone(s) in the foot (not just a toe)

Peripheralvasculardisease

Infection

Gout

Rheumatoidarthritis

Brokenorsprainedtoe

WhattoDo

Get medical care fast!


See doctor.

See doctor.

See doctor.

Use tips ForInjuries on page 38.

Tender points of fibromyalgia


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Open sores (ulcers) on the toes. Pain on the instep and cold, pale skin which improves with rest.

Tenderness and pain under heel bone

Sharp and burning pain on the ball of the foot.

Painful growth on the ball or heel of the foot. Black pinholes or spots in the center.

Discomfort, pain, tenderness, and/or redness under the corner of a toenail and nearby skin.

The big toe points inward or outward. A bony bulge at side of the big toe. Thickened skin. Possiblefluidbuild-upnearthebigtoe. Stiffness or pain.

Pain between the heel and the ball of the foot (due to walking, running, or putting weight on the foot).

Red,sometimesfluid-filledsorescauses by shoes that rub the foot.

Charley horse or muscle spasm in the foot. Often, this occurs at bedtime.

Pain and curled or claw-like position in a toe (usually the 2nd toe). A corn forms on the top of the toe.

Buerger’sdisease

Heelspurs

Morton’sneuroma

Plantarwart

Ingrowntoenail

Bunion

PlantarFasciitis. This is a problem in the foot arch.

Blisters

Footcramp

Hammertoe

See doctor.

See doctor.

Use tips ForMorton’sNeuroma on page 39.

Use tips ForPlantarWarts on page 39.

Use tips ForIngrownToenails on page 38.

Use tips ForBunions on page 37.

Use tips ForPlantarFasciitis on page 39.

Use tips ForBlisters on page 37.

Use tips ForFootCramps on page 37.

Use tips ForHammertoes on page 37.

Signs&Symptoms WhatItCouldBe WhattoDo Self-Care / PreventionForBlistersn Don’t break a blister. If it breaks on its own, apply an antibacterial spray

or ointment and cover the area with a bandage or sterile dressing.n Don’t cut away or pull off the broken blister’s loose skin. This protects

the new skin below it.

ForBunionsn Don’t wear high heels or shoes with narrow toes. Wear sandals.n Use moleskin or padding to separate overlapped toes.n Try arch supports to reduce pressure.n Use ring-shaped pads over a bunion.n Cut out an old pair of shoes to wear in the house.n Soak your feet in warm water.n If needed, take an over-the-counter (OTC) pain reliever, as directed.

ForFootCrampsn Stretch the foot muscles.n Pullthefootbackintoaflexedposition.Pushthefootintothefloor.

ForHeelSpursn Use a cushion or heel cup under the heel.n Do not jog or run. Avoid prolonged standing.n Lose weight, if overweight.n Roll a tennis ball under ball of the foot.n Put ice on the heel for 10 minutes. Remove it for 10 minutes. Repeat

many times.n If needed, take an OTC pain reliever, as directed.

ForHammertoesn Wear wide, roomy shoes. Change shoes during the day. Try athletic

shoes.n Massage the toes or get a foot rub.n Use small pads over the center of the toe to lessen pressure.


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ForIngrownToenailsToTreatanIngrownToenailn Soak your foot in warm, soapy water for 5-10 minutes, 1-3 times a day.n Gently lift the nail away from the reddened skin at the outer corners with

thetopofanailfile.Soakasmallpieceofcottoninanantiseptic,suchasBetadine. Place if just under the outer corners, if you can.

n Repeat the previous 3 steps, daily, until the nail begins to grow in correctly and pressure is relieved. Wear roomy shoes during this time.

n Another method is to cut a “V” into the top center of the nail. This may help the nail grow out from the edges.

ToPreventanIngrownToenailn Cut nails straight across. Don’t cut the nails shorter at the sides than in

the middle. {Note: If you have diabetes or circulation problems, follow your doctor’s advice about clipping your toenails.}

n File the nails if they’re sharp after clipping them.n Wearshoesandsocksthatfitwell.

ForInjuriesUse R.I.C.E. {Note: Tape an injured toe to the toe next to it for 7-10 days.}n Rest the injured area for 24-48 hours.n Ice the area as soon as possible and keep doing so for 10 minutes every

2hoursforthefirst48hours.Useanicepack,iceinaheavyplasticbagwith a little water, a bag of frozen vegetables, etc.

n Compress the area. Wrap with an elastic bandage. Do not cut off blood flow.Removethebandageevery3-4hours,for15-20minuteseachtime.

n Elevate the area above heart level, if possible. Place it on a pillow, folded blanket, stack of newspapers, etc.

ForMinorInfectionsn Soak the foot in warm, soapy water for 20 minutes, 4-6 times a day.

Pat the infected area dry. Use extra care if you have peripheral vascular disease. Make sure the water is not hot.

n Apply an OTC antibiotic ointment, such as Neosporin. Cover it with a sterile cloth or bandage.

ForMorton’sNeuroman Wear wide shoes with soft insoles. Put pads or arch supports in your

shoes to help take pressure off the area.n Take an OTC medicine for pain, as directed.

ForPlantarFasciitisn Rest the foot as much as you can. Use R.I.C.E. (See page 38.)n Take an OTC medicine for pain and swelling, as directed.n Wearshoeswithasolidarchsupport.Befittedfororthoticshoeinserts,

if advised.n Stretch the sole of the foot daily.

• Stand on a step on the balls of your feet. Hold on to the rail.• Slowly lower the heel of the foot that hurts until you feel a stretch.• Hold for 20-30 seconds.• Repeat 10 times.

ForPlantarWartsn Do not pick at plantar warts.n Try salicylic acid plasters or other over-the-counter products, such as

Wart-Off. Follow package directions.n Use cushions in shoes.n Wash your hands after touching warts to avoid re-infection.n Wear sandals in the shower or public areas, such as pools.

ToHelpPreventFootPainn Wearshoesthatfitwell.Don’twearshoeswithpointedtoesoronesthat

fittootightly.n Wash and dry your feet daily. Keep your feet moisturized.n Inspect your feet every day for early signs of problems.n Elevate your feet to rest them.n Persons with diabetes and/or circulation problems need to take special

care of their feet. Good foot care can prevent some foot infections. It may be necessary for a health care professional to cut the toenails.

{Note: If self-care measures do not help or if your foot pain gets worse, contact your doctor.}


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HeadachesA headache is pain or discomfort in the head, scalp, or neck. Most headaches are not due to serious problems.

Signs, Symptoms & Causes of Common HeadachesForTensionorMuscularHeadachesn A dull ache in the forehead, above the ears, or at

the back of the headn Pain in the neck or shoulders

Most headaches are this type. Muscles in the shoulders, jaw, neck, or scalp become tense or contract. This can be a response to stress, depression, anxiety, overwork, or lack of sleep.

ForClusterHeadachesn Sharp, burning, and intense pain on one side of the

head. The pain is so severe; you can’t lie down or keep still.

n Pain in or on the sides of the eyes. The eyes water. Pupils look smaller. Eyelids droop.

The cause is not known. These headaches are four times more common in men than in women. Heavy drinkers and smokers are at an increased risk for cluster headaches.

Cluster headaches usually occur once or twice a year. They attack in groups, every day for a week or more at a time. Cluster headaches can last from 15 minutes to 3 hours. They can interrupt sleep.

ForMigraineHeadachesn One side of the head may hurt more than the other.n Nausea or vomitingn Light hurts the eyes. Noise bothers you. The

headache is worse with activity.n After the headache, some people have a drained

feeling with tired, aching muscles. Others feel great.

Tension headache

Cluster headache

Migraine headache

Migrainescanoccurwithorwithoutanaura.Withanaura,spotsorflashinglights occur 10 to 30 minutes before the headache.

These headaches happen when blood vessels in the head open too wide or close too tight. They occur more often in females than in males.

ForSinusHeadachesn Pain in the forehead, cheekbones, and nose. The pain

is worse in the morning. Pain increases when you bend over or touch your face.

n Stuffy nose

Symptomsoccurwhenfluidsinthenosedon’tdrainwell.This builds up pressure in the sinuses. A cold, allergies, or airplane travel can cause a sinus headache.

OtherCommonCausesofHeadachesn Analgesic rebound from regular or repeated use of over-the-counter or

prescribed pain relieversn Caffeine withdrawal. Cigarette smoke, pollution, etc.n Eating or drinking something very cold, such as ice cream. {Note: It

helps to warm the ice cream for a few seconds in the front of the mouth.}n A symptom of a health problem, such as allergies, dental problems, the

flu,andvisionproblems,suchasnearsightedness.n Low blood sugar. Hunger. Sensitivity to certain foods and drinks. (See

Foods&DrinksThatMayCauseHeadaches on page 42.)

SeriousCausesofHeadachesRarely, a headache can be a symptom of a serious health problem, such as:n Broken blood vessel or aneurysm. Stroken Brain infection, such as meningitis. (See symptomsofmeningitis on

page 31.)n Brain tumorn Giantcell(temporal)arteritis.Thisischronicinflammationofcertain

blood vessels, often in the temple region.n Glaucoman Pinched nerve in the neck

Sinus headache


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Foods&DrinksThatMayCauseHeadaches

Alcoholic beverages, especially red wineAspartame(artificialsweetenerinNutraSweet®)Bananas (if more than ½ of one/day); Citrus fruits (if more than ½ cup/day).Caffeine from coffee, tea, cola, other soft drinks, chocolate, or some medications. Suddenly stopping caffeine intake.Cured meats, such as frankfurtersFood additives, such as MSGHard cheeses like aged cheddar or provoloneNuts. Peanut butter.Onions. Sour cream.Soy sauce. Vinegar.

Less often, a headache is a symptom of a serious health problem that needs medical care without delay. Examples are acute glaucoma and stroke.

Children’sHeadachesn Headaches tend to last less time than they do in adults.n Sometimes, an upset stomach and vomiting occur.n Headaches come in groups. These may be spaced months apart.

Children’s headaches that come once in awhile can be treated with ibuprofen or acetaminophen. Makesuretousetherighttypeanddoseforthechild’sweight. Don’t give aspirin to anyone younger than 19 years of age due to its link to Reye’s Syndrome. If the child complains of head pain on a regular basis, take the child to his or her doctor.

TreatmentSelf-care can treat headaches caused by tension, fatigue, and/or stress. Certain over-the-counter medicines and prescribed medicines can treat migraine headaches.

Headaches that are symptoms of health problems are relieved when the condition is treated with success.

Questions to Ask

Is the headache linked with any of these problems?• A serious head injury or passing out• A blow to the head that causes severe pain, enlarged pupils,

vomiting, or confusion• Symptomsofmeningitis listed on page 31 and the headache

is severe

Is the headache linked with any of these problems?• Severe pain in and around one eye• Blurred vision or double vision• Slurring of speech• Mental confusion• Personality change• A problem moving the arms or legs• Unusual sleepiness

Has the headache come on fast and does it hurt much more than any headache in the past?

Are any of these problems present?• The headache has lasted more than 2-3 days and the pain

keeps getting worse and lasts longer.• Nausea or vomiting occurs with a headache that doesn’t go

away or that recurs.• Symptomsofaclusterheadache or migraineheadache

listed on page 40 occur.• A pregnant female, has swelling of the legs, hands, and/or

face with the headache.• The headache occurs in a person with high blood pressure.• The headache is not relieved by OTC pain relievers and

occurs with signsandsymptomsofasinusinfection: - Fever- Stuffy nose. Green, yellow, or bloody-colored nasal discharge- Foul smelling or tasting postnasal drip- Swelling around the eyes, nose, checks, and forehead- Pain between the nose and lower eyelid - Cheek or upper jaw pain



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Do you have a headache at the same time of a day, week, or month, and do OTC pain relievers not help the pain?OR Do you take pain relievers more than 3 times a week for at least 3 weeks for headaches or did you get headaches only after taking a new medicine?

Self-Care / Preventionn Don’t smoke. If you smoke, quit.n Try to stop the headache when it starts.n Take an OTC medicine for pain, as directed.n Massage the back of your neck with your thumbs. Work from the ears

toward the center of the back of your head. Also, rub gently along the sides of your eyes. Gently rub your shoulders, neck, and jaw.

n Get a massage.n Take a warm bath or shower. Place a cold or warm washcloth or OTC

hot or cold pack over the area that aches.n Relax. Picture a calm scene in your head. Meditate or breathe deeply.n Exercise on a regular basis. Get adequate rest.n Try using a different pillow and/or sleep position.n If you grind your teeth, tell your dentist or doctor.n Keep a diary of when, where, and why headaches occur. Avoid Foods&

DrinksThatMayCauseHeadaches listed on page 42.)n To help prevent headaches and nausea caused by a hangover, try an OTC

product, such as Chaser-Freedom From Hangovers.n For a hangover: After drinking alcohol, take an OTC pain reliever. Eat

solid foods. Rest or sleep. Have 2 or more glasses of water before you go to sleep. Drink 2 or more glasses of water when you wake up.

For more information, contact:National Headache Foundation888.NHF.5552 (643-5552)www.headaches.org

Leg Pain & Ankle PainPain in the legs or ankles can range from mild to severe. The type and amount of pain depends on the cause.

Signs&Symptoms

Pain, redness (may have shades of red, purple, and blue), or swelling in one ankle or leg. May be followed by severe shortness of breath that came on all of a sudden. May include coughing up blood or pink-frothy sputum. Chest pain.

Swelling of both ankles at the same time. Shortness of breath. May have a dry cough or a cough with pink, frothy mucus.

Muscle pain in one or both legs. Fatigue in the thighs, calves, and feet which improves with rest. Open sores on the lower leg, ankles, or toes. Weak or no pulse in the affected limb. Cold or numb feet. Pale, bluish-colored toes.

Any of the signs that follow occur after a leg or ankle injury. A bone sticks out or bones in the injured limb make a grating sound. The injured limb looks deformed, crooked, or the wrong shape. You lose feeling in the injured limb. The skin under the affected injured area is cold and blue. The limb is very painful and/or swollen or you can’t bear weight on the limb or move it.

WhatItCouldBe

Deep-veinthrombosis(DVT) with or without a blood clot to the lung

Heartfailure

Peripheralvasculardisease

Brokenboneordislocation

WhattoDo






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Pain in the leg or ankle after an injury that does not keep you from moving the limb

Pain with fever, redness, tenderness, warmth, and pus at a wound site. A red streak up the leg (rarely).

Sudden, severe pain in a toe, knee, or ankle joint. The joint area is swollen, red, or purplish in color. It also feels warm and is very tender to the touch.

Leg pain that spreads from the lower back. Pain or stiffness in the knees. Bowing of the legs or other bone deformity. Unexplained bone fractures. May have headache, dizziness, hearing loss, and/or ringing in the ears.

Sharp pain from a buttock down the leg. Leg numbness and tingling.

Pain, stiffness, and sometimes swelling of the knee or ankle joints. Often, the joint has gotten tender over months or years and may look enlarged or deformed. Dry mouth and dry eyes.

Pain, stiffness, and swelling, usually in both knees or ankle joints. The joint looks deformed. Weakness and fatigue.

Sprain,strain,orsportinjury. Other overuse injury.

Infection. Could also be Cellulitis.

Gout

Paget’sdisease. This is a bone disorder that progresses slowly. Most persons with this disease do not develop symptoms.

Sciatica

Rheumatoidarthritis

Osteoarthritis

See Sprains,Strains&SportsInjuries on page 59.

See doctor (right away for a red streak up the leg).

See doctor.

See doctor.

See Sciatica on page 27.

See doctor.

See doctor.


Self-Care / PreventionForPain,inGeneraln Take an over-the-counter (OTC) medicine for pain as directed on the

label. If the pain is not better after a few doses, call your doctor.n Use a heating pad (set on low), a hot pack, or a moist, warm towel on the

area of pain. If the pain is due to an injury, don’t use heat for 48 hours. Use R.I.C.E. (See page 38.)

Signs&Symptoms

Leg or ankle pain with gradual loss of height; stooped posture; backache; and/or past bone fractures, especially in the wrists and hips.

Pain or itching in the legs with swollen and twisted veins that look blue and are close to the surface of the skin. The veins bulge and feel heavy. Swelling in the legs and ankles.

Muscle or joint pain and chronic swelling of the knee joints. These problems develop months or years after a deer-tick bite and a bulls-eye red rash with pale centers.

Pain and swelling around the knee joint. The pain gets worse with movement. Fever (maybe).

Sudden, sharp, tightening pain in the leg, often the calf. The muscle feels hard to the touch. The pain subsides after a minute or so and the muscle relaxes.

WhatItCouldBe

Osteoporosis

Varicoseveins

Lymedisease

Arthritis,bursitis,or a ligamentinjury

Legcramp

WhattoDo

See doctor.

See doctor.

See doctor.

See doctor.

Use tips ForLegCramps on page 48.


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ForPaget’sDiseasen If needed, take an OTC medicine for pain as directed on the label. Take

other medicines as prescribed by your doctor.n Get regular checkups to detect hearing loss.

ToHelpPreventLegPain&AnklePainn Get to and stay at a healthy weight.n Get regular exercise to keep ankle and leg muscles strong. Before you

exercise, stretch and warm up your muscles. When you are done, cool them down.

n Protect your knees. Use knee pads when you garden or kneel. Always land on bent knees when jumping. Avoid deep knee bend exercises.

n Don’t wear high-heeled shoes. Keep your shoes in proper shape.n Take good care of your feet.

ForLegCrampsn Walk on the leg.n Shake the leg and then elevate it.n Sitwithyourlegflatonthefloor.Flexyourfootupward,thentoward

your knee. Reach for your toes and pull them toward your knee. This stretches the calf muscles.

n Havesomeonemassagethecrampedmusclegently,butfirmly.n Apply a heating pad (set on low); a hot pack; or a moist, warm towel to

the muscle cramp.n Rub the muscle that is cramping. Rub upward from the ankle toward the

heart. {Note: Do not rub a leg if you suspect phlebitis or thrombosis.}

ToPreventLegCrampsn Get good sources of calcium, potassium, and magnesium. See lists

below. Take calcium, potassium, and magnesium supplements as advised by your doctor.

n Drinkplentyofwaterandotherfluids.Limitdrinkswithcaffeine.Avoiddrinks with alcohol. Doing these things can help prevent dehydration which could cause leg cramps.

n Warm up your muscles before you exercise. Cool down your muscles when you are done.

n With your doctor’s okay, wear elastic stockings while you are awake.n Before you go to bed, stretch your calf muscles. Here’s one way:

• Stand an arm’s length away from a wall. Lean against the wall with the palms of your hands.

• Bend your left knee. Keep your right leg straight behind you. Keep bothfeetflatonthefloorandyourbackstraight.

• Lean forward. Feel your right calf muscle stretch. Hold the stretch as you count to 10 slowly.

• Repeat, switching leg position.n Another way to stretch your calf muscles is to ride a stationary bicycle

for a few minutes.n Take a warm bath before bedtime.n Sleepwithloose-fittingblanketsandnightclothes.Keepyourlegswarm.n If you have severe leg cramps or get them often, tell your doctor. Ask if

any medication you take could cause leg cramps and what you should do.

GoodSourcesofCalciumn Nonfat milks n Calcium-fortifiedcerealsandjuicesn Cheeses n Collard greens, broccoli, and spinachn Yogurts n Tofu, if calcium is used in processingGoodSourcesofPotassiumn Citrus fruits and juices n Bananas n Avocadosn Bran cereals n Fish n Potatoes GoodSourcesofMagnesiumn Nuts, especially peanuts n Whole-grain breads and cerealsn Dried beans n Wild ricen Black-eyed peas n Tofu


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Neck Pain & Shoulder PainSigns & Symptomsn The pain can be mild to severe. It can be

felt in one spot, in a large area, or travel to another area. Movement can cause the pain or make it worse.

n Stiffness and/or swelling may occur.

Causesn Overuse and wear and tear on neck and

shoulder muscles and jointsn Neck fracture or strainn Broken or dislocated shouldern Poor posture. Awkward sleeping positions.

Sleeping on a soft mattress.n Pinched nerve. Pain from a pinched nerve

usually runs down one side of the arm.n Frozen shoulder. This can result from lack of use due to pain from an

injury.Atfirst,painoccurswithmovement.Overtime,thepaingetsbetter, but stiffness remains.

n Torn rotator cuff. This is a tear in a tendon that holds the shoulder in place. Symptoms are pain at the top and outer sides of the shoulders, especially when you raise or extend your arm. You may also feel or hear a click when the shoulder is moved.

n Tendinitis. This is swelling of a tendon (tissue that connects a muscle to bone). Left untreated, tendinitis can turn into “frozen shoulder.” “Wry” neck is a similar problem.

n Bursitis. This is swelling of the sac (bursa) that surrounds the shoulder joint. Bursitis can be caused by injury, infection, overuse, arthritis, or gout.

n A whiplash injuryn Osteoarthritisn Infections that cause swollen lymph nodes in the neck

Tension can cause neck muscles to go into spasms.

TreatmentTreatment for shoulder pain and/or neck pain depends on the cause. Emergency medical care is needed for:n A serious injuryn A broken bonen A heart attackn Meningitis. This is an infection of the membranes that surround the

brain. (See symptomsofmeningitis on page 31.)

Questions to Ask

With shoulder pain or neck pain, do you have any of these problems?• A serious head or neck injury• Any signsandsymptomsofaheartattacklisted on

pages 28 and 30• Any symptomofmeningitis listed on page 31

After an injury to the neck or shoulder do you have any of these problems?• The shoulder popped out of place.• A burning, shooting pain or weakness is felt in a shoulder.• The shoulder looks misshaped.• The pain is very severe.• Your arm is numb and can’t be moved at all.

Do you have any of these problems?• Severe or persistent pain, swelling, or spasms in a shoulder• Painful and stiff shoulder that is very hard to move at all• Pain, tenderness, and limited motion in the shoulder• Throbbing shoulder pain or numbness that goes down the

shoulder into the arm• A possible whiplash injury after being hit from behind• Fever and redness or swelling around the shoulder



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Do you have both of these signs of a gallbladderattack?• Pain in the right shoulder• Pain in the right upper abdomen

Is your neck pain or shoulder pain severe enough to interfere with sleep? Or, does the pain not get better after using self-care for 7 days?

Self-Care / PreventionForPainn Take an OTC medicine for pain and/or swelling.n To relieve tension and improve circulation, take walks. Start with 3 to

5 walks a day, each lasting 5 to 10 minutes. Gradually increase walking times.

ForBursitis,Tendinitis,oranInjuryThatDoesNotAppearSeriousn Use R.I.C.E. (See page 38.)n Try liniments and balms. These provide a cooling or warming sensation,

but only mask the pain. They do not promote healing.

ToTreatNeckPainfromaWhiplashInjuryorPinchedNerveIf you are riding in a motor vehicle that is hit from the rear, you may have a whiplash injury. Consult your doctor for diagnosis and treatment. These things can help ease neck discomfort:n Rest as much as you can by laying on your back.n Use cold and hot packs.n Improve your posture. When you sit, use a chair with a straight back.

Make sure your buttocks go all the way to the chair’s back. When you stand, pull in your chin and stomach.

n Use a cervical (neck) pillow or a rolled hand towel under your neck.n Avoid activities that may aggravate your injury.n Cover your neck with a scarf if you go outside when the weather is cold.

WaystoPreventShoulderPain&NeckPainn Avoid repeated activities that twist or put strain on the neck and

shoulders. When you do repeated tasks, use proper posture, equipment, and techniques.

n Wear seat belts in vehicles. Use protective gear when you take part in sporting events. Don’t dive into shallow water.

n Don’t sleep on your stomach. You may twist your neck in this position. Useafirmpolyesterpillow,aneck(cervical)pillow,orarolledtowelunder your neck.

n Practice good posture. Stand straight. Don’t let your shoulders slump, your head droop, or your lower back slouch.

n When you carry things, such as a shoulder bag, switch from one shoulder to the other.

n Don’t prop a telephone between your ear and shoulder.

n Stretch and warm up before activities that require joint movement, such as sports. If you are out of condition, strengthen your muscles gradually.

n Do exercises to keep the muscles in your shoulderandneckstrongandflexible.Forexample:• Sit straight in a chair. Flex your

neck slowly forward and try to touch your chin to your chest. Hold for 10 seconds. Go back to the starting position. Repeat 5 times.

• Look straight ahead. Slowly tilt your head to the right trying to touch your right ear to your right shoulder. Do not raise your shoulder to meet your ear. Hold for 10 seconds and straighten your head. Repeat 5 times on the right side and then on your left side. Lateral bend of the neckSample. Do not reproduce.

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Shingles PainShingles (herpes zoster) is a skin condition. It is triggered by the chicken pox virus, which is thought to lie dormant in the spinal cord until later in life. Most often, shingles occurs in people over 50 years old.

Signs & Symptomsn Pain, itching, or a tingling feeling before a rash

of painful red blisters appears. Most often, the rash appears on one side of the body or on one side of the face.

n Fever and general weakness can occur.n The blisters crust over. The crusts fall off,

usually within 3 weeks.n Pain can persist in the area of the rash. This

usually goes away within 1 to 6 months. Chronic pain called postherpeticneuralgia(PHN) can last longer, even for years. The older you are, the greater the chance that this is the case. The recovery time may also take longer.

n Blindness can occur if the eye is affected.

CauseThe virus that causes chicken pox – varicella zoster virus (VZV) causes shingles. To get shingles, you must have had chicken pox. You are more likely to get shingles after an illness or taking medicine that lowers the immune system. Stress or trauma can also increase the risk for shingles.

TreatmentMost cases of shingles are mild, but if you think you might have shingles, see your doctor right away! He or she can prescribe:n An oral antiviral medicine. This can make symptoms less severe and

help you get better sooner. To help, this medicine needs to be started within24-72hoursaftertherashfirstappears.

n Medicine for pain. This includes OTC pain relievers and capsaicin topical cream. Pain that persists after sores have healed may be treated with prescribed medicines. These include an antiseizure medicine called gabapentin, a skin patch called Lidoderm, and a tricyclic antidepressant.

Questions to Ask

Are any of these problems present with a rash of painful blisters?• The eye is affected.• Blisters itch all the time or are very painful.• Fever and/or general weakness occurs.• You have a chronic illness, such as diabetes or HIV/AIDS.• You take medications that weaken the immune system.• You are over age 60.

Self-Care / Preventionn A vaccine may help prevent getting shingles. It can also reduce the pain

due to shingles. The vaccine is advised for persons age 60 and older.n Unless your doctor has prescribed pain medicine, take an over-the-

counter one (OTC), as directed.n Don’t wear clothing that irritates the skin area where sores are present.n Keep sores open to the air. Until the blisters are

completely crusted over, do not go near children or adults who have not yet had the chicken pox. Do not go near persons who have a condition which weakens their immune system. Examples are cancer, HIV/AIDS, and chronic illnesses. They could get chicken pox from exposure to shingles.

n Wash blisters. Don’t scrub them.n To relieve itching, apply calamine lotion to the

affected area. You can also use a paste made of 3 teaspoons of baking soda mixed with 1 teaspoon of water.

n Avoid drafty areas.n Put a cool compress, such as a cold cloth dipped in

ice water, on the blisters. Do this for 20 minutes at a time.n Drink lots of liquids.

Wear loose-fitting clothes over the rash

area.

Shingles rash. (Photo courtesty of the Public Health Image Library (PHIL)

of the Centers for Disease Control and Prevention)


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Skin Injuries & Wound PainSigns & SymptomsCuts slice the skin open. This causes bleeding and pain. Scrapes are less serious than cuts, but more painful because more nerve endings are affected. Punctures are stab wounds. This causes pain, but may not result in bleeding. Bruises cause black and blue or red skin. As they heal, the skin turns yellowish-green. Pain, tenderness, and swelling also occur.

CausesForCuts,Scrapes&PuncturesThe cause can be any object that penetrates the skin. This includes cut glass, a splinter, stepping on a nail or tack, falling on pavement, etc.

ForBruisesCommon causes are falls or being hit by some force. Bruises result when broken blood vessels bleed into the tissue under the skin. Persons who take blood-thinners bruise easily.

TreatmentTreatment depends on the cause and how severe the skin injury is. Simple wounds can be treated with self-care. An antibiotic treats a bacterial infection. Medical care, such as stitches, may be needed for deep cuts or ones longer than an inch.

Questions to Ask

With an injury, do any of the following occur?• Loss of consciousness. • Severe bleeding or blood spurts from the wound. (Apply

direct pressure on the wound site while seeking care.)• Bleeding continues after pressure has been applied for more

than 10 minutes (or after 20 minutes for a minor cut).• A deep cut or puncture appears to go down to the muscle or

bone and/or is located on the scalp or face.• A cut is longer than an inch and is located on an area of the

body that bends, (e.g., the elbow, knees, etc.).• The skin edges of the cut hang open.


Does any signofaninfection occur?• Fever and/or general ill feeling• Redness. Or, red streaks extend from the wound site.• Increased swelling, pain, or tenderness at or around the wound

Do you have any of these problems?• The cut or puncture is from a dirty object, a rusty nail, or an

object in the soil. A puncture went through a shoe, especially a rubber-soled one.

• Bruises appear often and easily, take longer than 2 weeks to heal, or occur more than 3 times a year for no known reason.

• Vision problems occur with a bruise near the eye.

Self-Care / First AidForSevereBleedingn Without delay, apply direct pressure to the wound using a sterile dressing

or clean cloths. {Note: If the cut is large and the edges of it gape open, pinch the edges of the wound while you apply pressure.}

n Call 9-1-1 or take the person to the nearest hospital emergency department.

n Do not remove an object that is stuck in a wound. Pack it in place with padding. Put tape around the padding so it doesn’t move.

n If bleeding continues before getting medical help, put extra cloths, etc. on top of existing ones. Keep putting pressure on the wound until bleeding stops or until medical help takes over.

n The most important thing to do is to apply pressure on the bleeding site.


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ForMinorCutsandScrapesn Clean in and around the wound thoroughly with soap and water.n Press on the cut for up to 10 minutes to stop the

bleeding. Use sterile, wet gauze or a clean cloth. Dry gauze can stick to the wound. Don’t use a bandage to apply pressure.

n If still bleeding, lift the part of the body with the cut higher than the heart, if possible.

n After the bleeding has stopped and when the area is cleananddry,applyafirst-aidcream.

n Put one or more bandages on the cut. The edges of the cut skin should touch, but not overlap. Use a butterflybandageifyouhaveone.

n Keep a scrape clean and dry. Cover it with gauze andfirst-aidtape.Changethisevery24hours.

ForPuncturesthatCauseMinorBleedingn Let the wound bleed to cleanse itself.n Remove the object (e.g., splinter). Use clean tweezers. Hold a lit match

orflametotheendsofthetweezerstosterilizethem.Letthemcoolandwipe the ends with sterile gauze.

n Clean the wound area, daily, with soapy water. Dry it well and apply an antibacterial cream. Do this for several days.

ForBruisesn Apply a cold pack to the bruised area as soon as possible (within 15

minutes of the injury). Keep the cold pack on for 10 minutes at a time. Apply pressure to the cold pack. Take it off for 30 to 60 minutes. Repeat several times for 2 days.

n Rest the bruised area and raise it above the level of the heart, if practical.n Two days after the injury, use warm compresses for 20 minutes at a time.n Do not bandage a bruise. Try to avoid hitting the bruised area again.

Use butterfly bandages to bring cut edges of skin

together.

Sprains, Strains & Sports InjuriesSigns & SymptomsForSprainsAsprainhappenswhenyouoverstretchortearaligament.(Thisisfibroustissue that connects bones.) A joint is affected, but there is no dislocation or fracture. Symptoms are rapid pain, swelling, bruising, and a warm feeling at the injured site.

ForStrainsA strain is an injury to the muscles or tendons. (These are tissues that connect muscles to bones.) Symptoms are pain, tenderness, swelling, and bruising.

ForSportsInjuriesSports injury symptoms depend on the injury. They include pain, tenderness, swelling, and bruising. Bones may be broken or dislocated.


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CausesSprains occur from an accident, injury, fall, etc. A strain occurs when you overstretch or overexert a muscle or tendon (not a ligament). This is usually due to overuse and injuries, such as sports injuries.

TreatmentTreatment for sprains, strains, and sports injuries depends on the injury and on the extent of damage. Self-care may be all that is needed for mild injuries. Sports injuries and sprains may need medical treatment. Some sprains need a cast. Others may need surgery if the tissue affected is torn.

Broken bones (other than broken toes) need medical care right away.

Questions to Ask

Are symptoms of a head, neck, or spinal injury present?• Paralysis. The head, neck, or back can’t move.• Loss of consciousness, dizziness, or confusion occurs with a

head injury.• Inabilitytoopenandclosethefingersormovethetoesorany

part of the arms and legs.• Feelings of numbness in the legs, arms, shoulders, or any

body part.• It looks like the head, neck, or back is in an odd position.• Neck pain is felt right away.

Are any of these signs present?• A bone sticks out or bones affected make a grinding sound.• An injured body part looks bent, shortened, or misshaped.• You can’t move the injured body part or put weight on it.• The injured area is blue, pale, or feels cool, but the same limb

on the other side of the body does not. Or the pain gets worse.

Are any of these signs present?• You can’t bend or straighten an injured limb.• Bad pain and swelling occur. • Pain is felt when you press along the bone near the injury.

Self-Care / First Aidn If the injury is not serious, stop what you are doing and use R.I.C.E. (See

page 38.)n Ifyousprainedafingerorhand,removerings.(Ifyoudon’tandyour

fingersswellup,theringsmayhavetobecutoff.)n Take an over-the-counter medicine for pain, if needed. {Note: Many

sports medicine providers do not recommend aspirin-like medicine at first,becauseitcanmakebleedingandbruisingworse.}

n Try liniments and balms. These give a cooling or warming sensation by masking the pain. They do not promote healing.

n Once the injury begins to heal, use M.S.A.:• Movement. Work toward a full range of motion as soon as possible.

Thiswillhelpmaintainflexibilityduringhealingandpreventanyscar tissue from limiting future performance.

• Strength. Gradually strengthen the injured area once the swelling is controlled and a range of motion is back.

• Alternative Activities. Do regular exercises that do not strain the injured part. Start this a few days after the injury, even though the injured part is still healing.

Preventionn Learn and do proper stretching techniques before you start the activity.n Wear the right protective gear and clothing for the sport (e.g., a helmet;

shoulder, knee, and wrist pads; a mouth guard, etc.).n Train in the sport so you learn how to avoid injury. “Weekend athletes”

are prone to injury. Follow the rules that apply to the sport.n Ease into any exercise program. Build up gradually.n Avoidrunningonhardsurfaceslikeasphaltandconcrete.Runonflat

surfaces. Running uphill puts added stress on the achilles tendon.n Don’t lock your knees. When you jump, land with your knees bent.n Wearshoesandsocksthatfitwell.Thewidestareaofyourfootshould

match the widest area of the shoe. You should be able to wiggle your toes with the shoe on when you sit and when you stand. Wear shoes that provide shock absorption and stability.

n Stop if you feel pain. Resume the activity when you can do it without pain.n Cool down after exercise. Do the activity at a slower pace for 5 minutes.


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ToothachesSigns & Symptomsn Pain in or around a tooth that throbs or occurs with a fever and/or general

ill feeling. Tooth pain occurs after you eat or drink or have something hot, cold, or sweet.

n Gums are red, swollen, and/or bleed.n Earache and/or swollen glands on one side of the face or neck

Causesn A food particle gets stuck between the gum and a tooth.n Tooth grinding (bruxism)n A cavity or infection is beneath or around the gum of a tooth. A tooth

abscess (swelling and/or infection in the bone and/or the tooth’s canals).n Gum (periodontal) diseasen Impacted teeth. Teeth may not fully erupt or can grow at odd angles.n Temporomandibular joint (TMJ) syndromen An injury to a tooth or temporary pain from recent dental workn A symptomofasinusinfectionn A symptom of angina (see page 29) or a heartattack (see pages 28 and 30)

TreatmentEmergency care is needed for a heart attack. A dentist or doctor can diagnose and prescribe proper treatment for other problems.

Questions to Ask

With tooth pain, do you have any of these problems?• Gnawing pain in the lower teeth or neck• Chest discomfort beneath the breast bone• Pain that travels to or is felt in the arm or neck


Do you have any signsorsymptomsoftoothaches listed on page 62?

Self-Care / PreventionToTreatToothPainUntilYouSeetheDentistn Gargle with warm salt water every hour. Hold an ice pack on the jaw.

Don’t drink hot or cold liquids. Avoid sweets, soft drinks, and hot or spicy foods. It may be best not to eat at all until you see your dentist.

n Gentlyflossaroundthetoothtoremovefoodparticlesthatcouldbebetween the teeth.

n Take an over-the-counter pain reliever. Don’t place a crushed aspirin on the tooth, though. Aspirin burns the gums and destroys tooth enamel.

n For a cavity, pack it with a piece of sterile cotton soaked in oil of cloves. You can get this at a drug store.

ToProtectTeethFromDamageandInjuryn Don’t chew on ice, pens, pencils, etc.n Don’t use your teeth to pry things open.n If you smoke a pipe, don’t bite down on the stem.n Ifyougrindyourteethatnight,askyourdentistifyoushouldbefitted

for a bite plate.n If you play contact sports like football, wear a protective mouthguard.

Mouthguards may also be useful for non-contact sports, such as gymnastics. Discuss the need of using a mouthguard with your dentist.

n Always wear a seat belt when riding in a car.n Don’t suck on lemons or chew aspirin or vitamin C tablets. The acid

from these wears away tooth enamel.

Note: If a tooth is knocked out, pick it up by the crown, not the root. Gently put the tooth back in its socket or hold it under your tongue. Otherwise, put the tooth in a glass of milk, cool salt water, or a wet cloth. Don’t let the tooth dry out.n See a dentist right away!


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Pain Management Resources n AmericanAcademyofPainMedicine(AAPM)

4700 W. Lake Glenview, IL 60025 847.375.4731 www.painmed.org

Provides a “Patient Portal” that gives information on the diagnosis, treatment,andmanagementofpain.Alsoprovidesatooltofindaphysician who has a specialty in Pain Management.

n AmericanChronicPainAssociation(ACPA) P.O. Box 850 Rocklin, CA 95677-0850 800-533-3231 www.theacpa.org

Provides support and information for people with chronic pain and for their families. Includes a consumer guide for pain medication and treatment. Has tools that promote good communication with doctors.

n AmericanPainFoundation 201 North Charles Street Suite 710 Baltimore, MD 21201-4111 888-615-PAIN (7246) www.painfoundation.org

Provides extensive information on pain and managing pain; a pain resource locator; an interactive online community resource; and information on pain-related clinical trials.

n NationalFoundationfortheTreatmentofPain P.O. Box 70045 Houston, TX 77270-0445 713-862-9332 www.paincare.org

Provides information and support for people who have pain that is hard to manage and for their physicians, families, and friends.


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