Each prescription drug you take has a unique code that the government can use to track problems. But artificial hips and pacemakers? They are implanted without identification, along with many other medical devices.

In fact, the FDA doesn’t know how many devices are implanted into patients each year – it simply doesn’t track that data.

The past decade has seen numerous high profile cases of malfunctioning medical devices, which have led to injury or even death. Critics say the FDA’s minimal monitoring of devices contributes to these problems.

“If you’re lucky, you might find a sticker on the operating room note that was left over from the product,” said Richard Platt, who runs the Harvard Pilgrim Health Care Institute. Otherwise, there is little way of knowing what device was used.

Right now, the FDA depends mostly on voluntary reports from doctors, patients, manufacturers and hospitals to notify them of problems with devices already on the market.

The agency does have some power to require manufacturers to conduct further studies or track a particular device once it is sold. But many devices don’t get that level of surveillance.

“It’s much like a patchwork of streams of information getting to the FDA,” said cardiologist Frederic Resnic of Brigham and Women’s Hospital, who has worked with the FDA on medical device safety monitoring. “The FDA is relying on anecdotal and very variable information about the safety of medical devices.”

If manufacturers get word from a doctor or hospital about a death or injury that occurred as a result of their product, they are legally obligated to investigate the event and report it to the FDA.

But the process isn’t straightforward, as has become clear in the recent controversy over the malfunctioning St. Jude’s Riata defibrillator leadsb(wires that connect a defibrillator to the heart). The FDA said an individual doctor’s report helped alert them to the problem, but it was months before the device was recalled.

And after being notified of patient harm, manufacturers can minimize their own responsibility if they point the blame elsewhere, said health policy expert Diana Zuckerman, president of the National Research Center for Women & Families.

For example, if someone dies from complications in a surgery to remove an implant, the manufacturer may argue that it was the surgery – not the implant – that killed the patient.

The FDA responds to the criticism by pointing out that while every medical device carries a potential risk, the vast majority of devices perform well and improve patient health.

An FDA spokeswoman emphasized that the agency must evaluate thousands of medical devices each year, and is constantly looking for ways to better and more quickly identify problems.

While the FDA makes the adverse event reports publically available in a searchable database, it doesn’t have a standardized system for reviewing reports once they are sent in, said Vodra, the attorney.

A disclaimer on the site specifically states that the data is “not intended to be used either to evaluate rates of adverse events or to compare adverse event occurrence rates across devices.”

“What you would normally consider the simplest kind of data analysis is not done,” said Zuckerman. Often, doctors catch a malfunctioning device before the FDA ever notices.

In one case, a group of Pennsylvania doctors noticed that several patients were showing severe complications a few years after getting an IVC filter – a device designed to capture blood clots.

Bits of the filter were breaking off, causing chest pain and a dangerous build-up of fluid and pressure around the heart.

In 2010 the doctors conducted their own study and found that the filter broke in a quarter of all patients who used it.

On the day that study was published, the FDA issued a warning saying it had received over 900 reports of problems with IVC filters since 2006, and that the device was meant to be removed after a few months, not left in permanently.

There have been numerous attempts at reform. Five years ago Congress ordered the FDA to set up a post-market surveillance system to track the safety of all medical projects, but a system hasn’t yet been set up for medical devices.

A year later the FDA announced the Sentinel Initiative, which would combine existing data from electronic health records and medical claims to track drugs, vaccines, and devices.

Some groups of hospitals or other organizations have voluntarily set up registries to collect information about the make and model of devices.

While the FDA has made significant progress on tracking drugs, it’s not yet in a position to do the same thing for devices, according to Harvard’s Platt, who is the principal investigator of Mini-Sentinel, the FDA’s pilot program for the national system. The data isn’t there.

The FDA has long acknowledged the need for a unique device identifier system, and got permission from Congress to set one up five years ago.

No such system of ID-tags exists yet, but after several recent high profile medical device failures, the issue getting some attention from Congress.

A proposed Senate bill, which cleared the Health, Education, Labor and Pensions Committee last week, sets a timeframe for implementing a unique identification system, among other reforms.

“If UDI’s were used in a consistent way, we could use the same kinds of techniques we’ve developed for drugs for devices,” said Platt. “It would be a huge breakthrough.”

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Today, parents need to address serious issues like bullying and gun safety.

During National Safe Kids Week, April 21 – 28 (www.safekids.org), Polyclinic pediatrician Dr. Melissa Hathaway is offering tips for keeping kids safe from both every day threats to health and safety, and the life threatening issues of the day.

Review Safety Often

As a pediatrician, Dr. Hathaway reminds parents to review safety issues often to keep up with their growing and changing child.  “Make it a habit,” advises Dr. Hathaway.  “One of the reasons children have accidents is because they develop so fast that caregivers have a hard time keeping up.”

She recommends that parents and caregivers think about safety in terms of age and by situation – “at home, at play, as school, and on the go.”

Dr. Hathaway points out that as a community, we all have a duty to protect children from two of the biggest dangers: guns and bullying.

Gun Safety

“Sadly, there have been several recent gun-related tragic events in the Northwest, says Dr. Hathaway.  “The best way to keep your children safe from injury or death from guns is to never have a gun in the home, car, or anywhere your child has access to.

Talk to your children about the dangers of guns and what to do if they find themselves in a situation involving a gun.”

While parents may take every precaution at home, they should not forget to find out if there are guns in the homes where their children play.

“It can be hard for a parent or caregiver to ask about guns,” she points out.  “One way to ask is, ‘My child is very curious.  Do you have guns or anything dangerous that he might get into?’”

She suggests that for those who do choose to keep a gun in the home, always keep the gun unloaded and locked.  “Also lock up bullets and store them in a separate place, and make sure to hide the keys to the locked boxes.  Children are naturally curious, and their innate urge to discover new things can overcome any parent’s warnings.”

Bullying

Bullying is becoming increasingly common and can be a deadly problem.  Bullying is defined as unwanted, aggressive behavior that involves a real or perceived power imbalance.  The behavior is repeated, or has the potential to be repeated over time.

“Anyone and everyone can help prevent bullying by talking about it, promoting a safe environment, modeling respectful behavior and treating others with kindness,” says Dr. Hathaway.  “Talk to kids about what bullying is, what they should do if they see it happening, and how to stand up to kids who bully. Know the warning signs, talk about it, and intervene immediately if you see bullying behavior.”

Resources

It can be overwhelming for a parent or caregiver to keep track of all the risks inside and outside the home.  “Enlist the help of your family, friends and community to endure your child is safe wherever they go,” says Dr. Hathaway.

There are a variety of websites dedicated to education and awareness regarding safety in childhood and beyond.

Dr. Hathaway recommends:

• The American Academy of Pediatrics HealthyChildren.Org website.

• Washington State Medical Association webpage on bullying: www.wsma.org/patient_resources/bullying.cfm

The number deaths due to suicide, accidents and opioid overdoses also fell, the report says

Overall, 12,959 people died in the county last year.

Of those, 2,060 fell under the Medical Examiners jurisdiction, including suspicious, sudden, unexpected or violent deaths.

 Other findings in the report:

• Traffic fatalities declined by nearly one-third over the past ten years, falling steadily from 220 in 2001 to 150 last year.

• While accidental drug overdoses declined from 2009 to 2010, they still comprised more than a third of all accidental deaths.

• Firearms were the most frequent instrument of death in homicides and suicides.

Opioid deaths down

There was a substantial decrease in the number of methadone and oxycodone deaths from 2009 to 2010.

• Methadone was present in 77 deaths in 2010, compared to 129 in 2009, and was the primary cause of death in 67 of those deaths in 2010, compared to 85 in 2009.

• Oxycodone was present in 77 deaths in 2010 compared to 105 deaths in 2009.

To learn more:

• For a copy of the full King County Medical Examiner’s 2010 annual report, please call 206-731-3232 or visit www.kingcounty.gov/health/examiner
  .

Jim Young and his children

In January 2010, after beginning treatment for chronic Lyme disease, 53-year-old Jim Young lost significant weight and struggled to breathe.

Doctors admitted him to a private room in the hospital, but within 15 hours, his wife Erica Kosal received a call about his imminent transfer to the intensive care unit (ICU).

The first time seeing him in the ICU came as a shock to Kosal, 42, a college professor. “I can remember he was hooked up to all kind of machines. He looked so deflated. He was out of it and really sleepy and confused. He didn’t look like the same person and I wasn’t prepared for that,” Kosal said.

Several days after giving birth in 2003, marketing agency owner Ann Albergotti, then 35, woke to a throbbing headache and temporary blindness.

After doctors diagnosed her with a stroke in the ER, she spent 5 days in the ICU. Her nurses and doctors kept her and her family well informed: “I knew what was happening, what was going to happen and why,” Albergotti said.

But when her 76-year-old mother was admitted to the ICU last year for a collapsed lung, the flow of information between staff and family didn’t run so smoothly.

“When her condition worsened, it happened overnight and at a time when the family had left for the night to return in the early morning. We didn’t find out what happened until our return and we had specifically asked that if her condition changed while we were away, that we get a call. That was upsetting,” Albergotti said.

Like Young and Albergotti, every year more than 5 million people in the United States spend time in intensive care units for acute injuries or life-threatening illnesses.

For patients, family members and friends, the ICU experience is often emotional and confusing.

Who’s Who in the ICU

If you or a loved one is in the ICU (sometimes referred to as critical care), you’ll come in contact with a variety of medical professionals. Here’s a brief who’s who:

Intensivist:

Doctors who diagnose ICU patients and direct their care and treatment are called intensivists. These physicians, also called critical care doctors, have specialty and subspecialty training in treating critically injured and ill patients. Intensivists usually work in the ICU full-time.

 ICU nurse/critical care nurse:

ICU nurses implement the intensivist’s plan of care. They monitor the patient, assess pain, administer medications, and perform tasks such as placing tubes and managing ventilators and dialysis. They also work closely with families, explaining the patient’s condition and care.

Nurse manager:

The nursing unit manager, or charge nurse, oversees the nursing care in the ICU and assists the nurses when necessary.

Specialty physician:

“Whatever the patient’s primary sickness is, those doctors will be there in addition to the primary critical care doctor,” Adalja said. Inside the ICU, you may see other specialists, such as gastroenterologists, surgeons, neurologists and infectious disease doctors.

Pharmacist:

Pharmacists prescribe medicine dosages for ICU patients. Like intensivists, ICU pharmacists have specialty training in prescribing medicines for critically ill and injured patients.

Therapist:

Several types of therapists work with the critical care team. Respiratory therapists help ICU staff monitor the patient’s breathing. Physical therapists work to minimize permanent disabilities. Occupational therapists in the ICU help reduce patient’s disability at work and at home.

Social worker:

Families in the ICU may benefit from talking to a clinical social worker (sometimes called a case manager), a person trained to help with communication between medical team members and family. An ICU social worker may offer emotional support, provide referrals to community resources, assist with the transition out of the ICU and help families navigate the end-of-life decision making process.

Clergy/chaplains:

Hospital clergy members provide emotional and spiritual support to ICU patients and their families. Some ICUs have their own dedicated chaplains; others have a hospital chaplain that serves patients and family in all hospital units.

The Sickest Patients

Photo by Hamma

If you’ve ever visited a family member or friend in the ICU, your stomach sick with fear and worry, you may have wondered — why the ICU? Why not some other hospital unit?

“ICUs take care of the sickest patients in the hospital,” said Amesh A. Adalja, MD, FACP, a clinical assistant professor in the department of critical care medicine at the University of Pittsburgh Medical Center.

People who’ve experienced heart attacks, strokes, surgical complications and severe respiratory problems receive care in the ICU. The ICU also provides trauma care for those who’ve been severely injured in automobile accidents or from gunshot wounds, fires, falls or industrial accidents.

What sets the ICU — sometimes referred to as the critical care unit — apart from the emergency department or other hospital units is that ICU patients require continuous monitoring and sometimes, advanced machinery to support their life functions.

For example, a patient whose kidney function is impaired may receive intermittent dialysis in other areas of the hospital. But a patient who needs dialysis around the clock requires ICU care.

Patients who need regular suctioning of the respiratory tract, who require a ventilator to help them breathe or who need infusions of medicines to keep their blood pressure stable are other examples of those requiring ICU monitoring.

The ICU also differs from other hospital units in its much lower ratio of nurses to patients. ICU nurses typically care for only one or two patients. In other areas of the hospital, nurses may be responsible for six or more patients.

Not all ICUs are created equal, and the size of the hospital you’re visiting plays a role in the type of ICU environment you’ll experience. Smaller hospitals may have only one ICU that takes all types of patients.

In larger hospitals, there may be multiple ICUs, each specializing in a certain type of critical illness, such as stroke or cardiac or thoracic surgery.

How the ICU looks also varies from hospital to hospital and unit to unit. In general, though, ICUs tend to be more open, compared to other areas of the hospital. ICU “rooms” may not have a door, they may be enclosed only on three sides, or the door or room may be transparent so that staff can more easily monitor patients by sight from a central desk.

“Compared to other areas of the hospital, ICUs are also busier, faster, with a large number of people and lots of equipment around each bed. There is also more ambient noise than in many other hospital areas from things like monitors, ventilators and other medical devices,” said Linda Bell, MSN, RN, a clinical practice specialist with the American Association of Critical-Care Nurses.

Putting Family at Ease

Most of the time, patients admitted to the ICU come from other areas of the hospital. Like Erica Kosal, family members may receive a call from emergency services or another hospital unit letting them know their loved one is being transferred to the ICU.

“They’re stressed, so it’s important to put them at ease. We try to give them an overall picture of what’s going on with the patient,” said Michael Bergman, MD, director of the ICU at University Hospital of Brooklyn at Long Island College.

When families first get to the ICU, the nursing staff typically explains what will happen at the patient’s bedside, what type of monitoring they’re on and what the plan of care will be, said Barbara Maffia, RN, ICU Nurse Manager at University Hospital of Brooklyn at Long Island College. Nurses in the ICU may also ask the family whether the patient has a health care proxy, a person to make medical decisions for them.

Bergman points out that ICUs are stressful environments for both family members and medical staff. “In other hospital units, doctors may know the patient’s diagnosis before the patient is treated. In the ICUs, the diagnostic process goes on while treatment goes on. In ICUs, if the patient is sick, a lot of times we don’t have all the answers of what’s going on. You’re trying to stabilize blood pressure, fluid status and other issues while trying to figure out what caused all this,” said Dr. Bergman.

Keeping Family and Friends Informed

For some people, a phone-tree is an efficient way to pass along information (one person calls three people with updates, who each call three others, etc.) But for many, there’s no longer a need for a phone tree: the families of today’s ICU patients can easily keep out-of-town friends and family informed by creating a simple blog-style, privacy-protected patient website. Family members can update everyone on the patient’s condition at once, share photos and receive messages of support. Try these free resources:

• CarePages
• Caring Bridge
• LotsaHelpingHands
• MyLifeLine

Seeing Your Loved One

Finding out your loved one is in the ICU is difficult. Seeing your loved one in the ICU environment often proves startling and upsetting. Though this experience is usually emotional, knowing what to expect may help you remain strong when first arriving.

Your loved one’s appearance may have changed drastically from the last time you saw him or her. ICU patients may have bruising because of blood tests, clotting problems or injury. Many patients in the ICU experience facial swelling due to medications or from injury. The patient may have tubes in his or her nose or mouth. You may see bandages to help hold tubes in place. Your loved one may need a catheter to collect urine or a temporary or permanent opening in the stomach to collect urine and stool.

If you’re visiting someone in the ICU, don’t be surprised if you’re asked to leave during certain medical procedures, such as central or intravenous line placement or catheterization. The medical staff informs family of the need for these procedures beforehand, but encourages them to step away from the patient’s room—but with good reason.

“You may think that they’re being put through discomfort when they’re not. These procedures can be quite traumatic for families to watch,” and having family members in the room can cause added stress for medical personnel performing the procedures, Bergman said.

The aftereffects of certain procedures, such as breathing tube insertion, can cause pain in the throat, making speech difficult. In addition, fluctuations in body fluids and chemicals in the blood can interfere with a person’s cognitive ability, making it difficult to think clearly or talk.

Finally, the medicines used to manage the pain associated with critical illness may cause big changes in how your loved one talks and acts, causing disorientation, hostility or confusion.

Managing pain is an important aspect of ICU care for critically ill patients. “Many patients have pain, discomfort or agitation, either because of illness or because of the procedures being done. ICU teams put a great emphasis on relieving pain and discomfort,” Bergman said. Patients in ICU may receive analgesics, or pain-relieving medications, as well as sedatives to reduce anxiety.

As part of ICU care, nurses reassess pain regularly and administer medications as necessary. But if you notice distinct changes in your loved one’s personality or feel that the patient looks uncomfortable, it doesn’t hurt to advocate for your loved one. You should approach the ICU nurse, and say “to me, she looks uncomfortable,” Bergman said.

A Family Affair

When it comes to family member visitation in the ICU, the policies vary from hospital to hospital and from unit to unit. Nurses often have some discretion to either expand or limit family access, but generally any adult who wants to visit during visiting hours will be allowed to, Adalja said.

Bergman noted that his ICU limits patient visitation in the morning, when nurses and physicians are busiest assessing pain levels, performing procedures and administering medications.

In the busy ICU environment, family members may feel that getting the answers to their questions is a challenge. Bell recommends designating a single family member to act as the conduit for information for the rest of the family who is prepared to write down questions they may have to discuss with the clinical team at a convenient time. Critical care is full of jargon, so stopping a doctor to politely ask, “What does that mean?” is a useful strategy to get answers to your questions, Bergman said.

While you’re visiting your loved one in the ICU, it’s easy to feel helpless among the medical machinery and highly trained staff. But Bell notes that patients may benefit from the touch and assistance of friends and family.

“They might also want to ask if it’s okay for them to help with some of the routine care, things like combing hair, swabbing the mouth, massaging or putting lotion on the arms or legs,” Bell said.

To help ease Young’s ICU recovery, Kosal brought in photos of their children and a special pillow for him to use after his tracheostomy. Both Young and his daughter designated a special stuffed animal that they could hold when missing each other, Kosal said.

In the wake of stress and worry that invariably accompanies a loved one’s ICU stay, don’t neglect your own needs. “The hard part for family members will come when the patient is discharged and in need of additional care at home. So it is vitally important that family members take time to eat, rest and take care of their personal needs,” Bell said.

Photo of the ICU monitor by Hamma

Health Behavior News Service is part of the Center for Advancing Health

The Health Behavior News Service disseminates news stories on the latest findings from peer-reviewed research journals. HBNS covers both new studies and systematic reviews of studies on (1) the effects of behavior on health, (2) health disparities data and (3) patient engagement research. The goal of HBNS stories is to present the facts for readers to understand and use for themselves to make informed choices about health and health care.

Whether caused by injury, surgery or a toothache so bad it slams you awake in the middle of the night, acute pain is difficult. Receiving prompt and helpful treatment can make all the difference in the world. But lack of care or inadequate care means that the acute pain may develop into chronic agony.

Fortunately, acute pain is not always long lasting or overwhelming, such as when you have a short severe cramp or multiple bee stings that can be handled with time, over-the-counter medication and other home remedies [See Sidebar: Pain Treatment Options].

Since individuals’ tolerance for pain varies widely, the question of when pain itself requires urgent medical attention is difficult to answer.Chest pain should prompt a visit to the emergency room, of course—but other types of pain are trickier to call.

“If it hurts like hell, come to the E.R.,” says Dr. Sergey Motov, assistant program director for emergency medicine at Maimonides Medical Center in Brooklyn. “The problem is that it’s so subjective, there’s no really good objective way to tell when [help is required]. If it’s the worst pain you’ve ever experienced, [come].”

Once you seek medical attention, you should be treated promptly and with compassion. “If you don’t treat acute pain properly, it can become chronic,” Motov says. “If someone comes in with acute pain and it’s sub-optimally treated, they go home and come back in three days and it’s sub-optimally treated again and later on they’re in chronic pain, that started with us because we did not address the acute pain properly in the first place.”

So how should extreme acute pain be treated? Jan Adams, a retired general practitioner herself, describes receiving excellent care after she had back surgery following an injury. She was immediately given strong opioid medication because of the intensity of the pain.

“What they did right was allow me to manage how much pain medication I needed for the first few days,” she says. “I needed more at first and what they did right was to allow me to manage the pain, understanding that there’s a big difference between abuse of pain medication and acute pain use of narcotics.”

Mike Gaynes, a media consultant, received similarly caring treatment with opioids when he reached the ER suffering with kidney stones. Although he does not normally have high blood pressure, the pain had made it skyrocket.

“This was cork-popping,” he says, “They gave me I.V. morphine and it helped somewhat, then they gave me more and it helped a little more. It took the edge off but did not shut [the pain] down entirely.”

Toughing it out with severe acute pain is not recommended, because of the possibility that it could become a chronic problem. However, Dr. Kenneth Goldschneider, director of pain management at Cincinnati Children’s Hospital, says that complete elimination of pain is often an unrealistic goal because of the side effects of drugs.

Adams’ bad experience of pain management came during an emergency colonoscopy, which she needed during treatment for a rare form of mouth cancer. Radiation therapy had left her weakened and malnourished, cutting off the blood supply to her colon. Because of the painful cancer treatment, she was already taking an extremely strong opioid called fentanyl and had developed a tolerance to it.

That same medication was used for anesthesia during the procedure. Because of Adams’ tolerance and the physician’s choice not to use an additional anesthetic along with it, she was left in agony. “He’s pumping air into my colon and I’m feeling like raw hamburger,” she recalls. “The entire floor heard me screaming but he wouldn’t give me anything more,” she says, explaining that she has typically been stoic when in pain

To avoid having a similar experience, Adams suggests a conversation about pain management before surgery. She says to ask explicitly, ‘What do you think is appropriate pain management?’ “One thing you want to hear is that ‘I’ll be sure that either I or the nursing staff will be trying to evaluate your pain [regularly] to make sure you’ll be as comfortable as possible,” she says.

Patients should also discuss any medications they are taking with their doctors before surgery. If someone has a tolerance to a particular medication, the anesthesiologist needs to be prepared to use higher doses or choose a different drug.

Pain Treatment Options:

Pain can be treated in a number of ways, depending upon its severity and cause. Treatment options might include one or more of the following:

• Non-steroidal anti-inflammatory drugs (NSAIDs), a specific type of painkiller such as Motrin® or Aleve®
• Acetaminophen (such as Tylenol®)
• Narcotics (such as morphine or codeine)
• Localized anesthetic (a shot of a pain killer medicine into the area of the pain)
• Nerve blocks (the blocking of a group of nerves with local anesthetics)
• Acupuncture
• Electrical stimulation
• Physical therapy
• Surgery
• Psychotherapy (talk therapy)
• Relaxation techniques such as deep breathing
• Biofeedback (treatment technique in which people are trained to improve their health by using signals from their own bodies)
• Behavior modification

Some pain medicines are more effective in fighting pain when they are combined with other methods of treatment. Patients might need to try various methods to maintain maximum pain relief.

Adapted from The Cleveland Clinic Foundation.

“I would always encourage people to change physicians or get another opinion if something doesn’t seem right when you talk about pain,” Adams says.

A decade ago, the Joint Commission on the Accreditation of Health Care Organizations (now known as the Joint Commission), which sets standards for medical centers, labeled pain as the “fifth vital sign.” Hospitals are now required to assess pain when other vital signs are taken after surgery or more frequently with especially painful conditions.

Dental pain is one of the worst forms of common, acute pain. Lys Fulda, then in her early 20s, had a toothache so severe that she went to her dentist’s office before it opened to make sure she’d be seen as quickly as possible.

The dentist injected her with Novocain, but it didn’t completely alleviate the pain as he began to drill. He tried another injection, this time directly into the tooth. “It felt like lightning went through my entire body. It created innate deep fear of dentists,” Fulda says.

While it’s not always possible to avoid such incidents because people’s nerves are sometimes anatomically unusual, experienced dentists can almost always prevent them.

“You need to take pain seriously,” says Dr. Dennis Bohlin, a Manhattan dentist and the educational coordinator for the New York State Dental Association’s committee on chemical dependency. “Part of it is reassuring [patients] that there is going to be end to it. Part of the anxiety about pain is the fear that it will last forever. It’s not going to, we can handle it. That reassurance is really important.”

Organizations That Can Help

American Pain Foundation

The American Pain Foundation web site is an online resource for people with pain, their families, friends, caregivers and the general public. This site is devoted to patient information and advocacy, and provides many links to additional resources. www.painfoundation.org

Anxiety itself actually increases pain—so techniques that reduce anxiety are an important part of dealing with acute pain. With children, Bohlin says, it’s particularly important to calm the parents as well so that they don’t transfer their own anxiety to the child.

Incidents like what happened to Fulda or negative childhood experiences with dentists can create what Bohlin calls “subliminal anxiety,” which can drive avoidance of dentistry below conscious awareness.

“It’s hard enough to come as it is,” he says, adding that this type of anxiety makes dragging yourself to the chair even more difficult. Fulda found that a reassuring, sympathetic dentist was able to help her overcome her fear.

If dental pain strikes in the middle of the night or on a weekend, Bohlin suggests taking a drug like ibuprofen, naproxen or aspirin—all of which fight inflammation, which is a big part of dental pain. Don’t take antibiotics, which can make the dentist’s job harder when he or she tries to diagnose the problem.

Acute pain can be harrowing, but fortunately in most cases it can be rapidly relieved.

Treating Acute Pain at Home

Most acute pain is not serious and can be handled with home care methods. Some advice from Dr. Kenneth Goldschneider, director of pain management at Cincinnati Children’s Hospital:

For minor injuries, use a cold pack but for no longer than 20 minutes, he suggests.

For sore throats, gargle with salt water— the only advice that has changed since grandma’s time is that aspirin is no longer used for children or adolescents. Use children’s ibuprofen or acetaminophen instead, he says.

He adds that for infants under six months, sugar water has been found to have a short-term analgesic effect: In many hospitals it is now used for giving shots and placing IV’s and other procedures that produce brief, acute pain. It doesn’t work for older children or adults, however.

For toothache, Manhattan dentist Dennis Bohlin says that when you cannot immediately get to a dentist, use an NSAID drug like ibuprofen or naproxen that has anti-inflammatory properties, since inflammation is often a big part of the problem.

Health Behavior News Service is part of the Center for Advancing Health

The Health Behavior News Service disseminates news stories on the latest findings from peer-reviewed research journals. HBNS covers both new studies and systematic reviews of studies on (1) the effects of behavior on health, (2) health disparities data and (3) patient engagement research. The goal of HBNS stories is to present the facts for readers to understand and use for themselves to make informed choices about health and health care.