Dr. Gary L. Craig, M.D.

This question is way more complicated than it looks. The answer below assumes that the cause for the pain is not entirely "fixable"-this obviously needs to be assessed before use of more potent pain approaches.


In general, the easy part is trying regular use of acetaminophen and anti-inflammatories (ASA, ibuprofen, naproxen and others)-most of which are available over the counter-pain meds beyond these levels require prescriptions, necessitating a discussion with your physician unless you want to buy them on the street (and given the recent spate of lethal doses of fentanyl cut into street narcotics this is a really lousy idea). Other options commonly tired are alcohol-not great for pain but lots knocks you out (and has lots of social consequences) and cannabinoids, with possibly more pain control but also complicated with mind altering issues (try passing a field sobriety test when you are stopped by a cop for debatable driving). No great pain control trials with THC or CBD to support long term use anyways (despite widespread public use for pain).


Beyond these easier steps, most more potent pain meds are narcotics- these are great for intense short term pain but have 2 issues that make them poor for long term use. First, they tend to lose benefit over time-requiring increasingly high doses for the same benefit-and second, they are addictive). Great for short term post op pain but terrible for long term use. The higher doses eventually used over long durations kill huge numbers of Americans annually. Their use was encouraged by federal agencies decades ago but now increasingly strict controls are being levied by federal and state agencies and individual physicians' prescribing of these meds are carefully tracked. MDs are appropriately increasingly wary of prescribing more than tiny amounts of this med class unless patients have a painful terminal illness.


2 other important issues affect pain severity-exercise levels and sleep. Numerous trials have shown that that cardiovascular fitness programs-typically something easy like walking 30-40 minutes 3 times weekly- substantially lowers chronic pain and improving sleep time/quality does as well (ie-avoid caffeine and other stimulants, no alcohol/late evening food, sleep supporting night environment, targeting 6-8 hours etc). Sometimes sleep patterns can be helped by low dose antidepressant use; if depression is thought to be contributing to pain severity more full dose antidepressants can be considered. As well, occasionally meds that interfere with pain pathways like gabapentin can help though these often lose benefit over time. Changing exercise patterns and sleep habits take significant patient input-not popping pills easily like most of us would like to do-so this info is poorly received by patients. Cognitive behavioral therapy-typically not cheap and not covered by health plans (but cheaper than wrecking your life with narcotic use), and thought of as rather "voodoo-like by many patients, has also been shown to reduce chronic pain levels and improve function.


Perfect pain control in situations of chronic pain where a definitive "curative" therapy is not available is rare so improvement to a level that a patient can function is really the goal of intervention here, a target not often appreciated by patients who often expect a pill to solve the pain issues completely.

This is a minor lab abnormality and may not be reported to you as abnormal by your physician. Most typically seen if a person is a bit "dry" from inadequate fluid intake or use of diuretics (which may be an isolated med or part of a combination antihypertensive prescription). May even be seen if the lab draw was early in the AM after a long night's sleep and no breakfast. Totally reversible with adequate fluid intake. Incidentally, the creatinine is pretty low (reflecting overall good kidney function) for someone in their 40s.

Highly individual and not predictable; may often just read MD or DO. Occasionally you will see other initials which might indicate specialty college membership/fellowship which can give a hint of specialty-eg FACOG for obs/gyn; FACP for an internist, FACC for cardiologist-but most practices/institutions don't add these. In internal medicine, most subspecialists have to qualify as internal medicine specialists then go to subspecialty training.

?Addendum-some patients also have a positive Rheumatoid factor and many have high antibody levels(elevated gammaglobulins).

Nodes that come and go and are tender are generally benign. The orzo pharynx is heavily supplied with lymphatic tissue, presumably to identify and react to the large host of pathogens that enter us through the nose and mouth, and nodes will normally enlarge when dealing with challenges. Lymphomas, the most common cancers to involve neck nodes, usually are not tender and consistently get bigger (rather than wax/wane in size). Nodes that are over 1 cm, and/or are very hard or bound down need biopsy. The level of concern is also higher in smokers given their substantially higher risk of ENT malignancies that can spread to neck nodes.