AUTHOR: Marc Mitnick DPM

REVIEWED BY: Podiatric Medical Review Board

TREATMENT OF PAIN

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The treatment of this subjective sensation is directed at symptomatic relief and is guided by the classification of pain and patient specific factors. Acute pain is managed differently than chronic and patient allergy history, co-morbidities, medical profile contraindications and body weight/age are all factors involved in the health care provider’s decision making process.

Acute pain can be generally managed with acetaminophen (APAP, Tylenol), non-steroidal anti-inflammatory (NSAIDs), steroids (catabolic-resembling those produced by the body during physical/emotional stressors), and opioids/narcotics. By definition, usage for acute pain is of short duration and their intermittent dosage in most patients is of little risk. Chronic pain, due to the less than optimal response to analgesics (pain relievers), is different and prolonged use carries a greater patient risk of adverse reactions. Improvement or pain reduction is possible but is not always possible and patient with diagnosed chronic pain must be made aware and fully understand the outcome expectation. To reduce toxicity (adverse effect of medication) often combination of drug and non-drug treatment is utilized to increase relief of pain and lessens the possible toxicity. An example being a modality such as ice or heat and one or more analgesic with different modes of action (poly-pharmacy) in lessened dosages.

Though therapy should be regulated in a step-wise progression as individual responses vary and the efficacy of analgesics do change over time, a generalized schematic approach can be attempted for nociceptive (pain receptor stimulated) pain. For acute, non inflammatory pain, acetaminophen may be the first step, followed by low doses (i.e. OTC –over the counter) NSAIDs.. For those patients with gastric (stomach) problems the prescription medicine, Celebrex- a specific NSAID with reduced gastric complications (known as a COX-2 inhibitor) may be substituted. If no relief is experienced, a second line agent such as Tramadol may be used. The regiment is different for inflammatory acute pain; in step one low dose OTC NSAID with/without ice is indicated. In cases of chronic pain, non-drug therapy with physical therapy, heat or ice pending the problem, glucosamine for arthritic pain, and acetaminophen with a possible topicals such as capsaicin(a pepper extract) is the first step. Tramadol, then prescription strength NSAIDs with an opioid/narcotic along with patient education may be necessary.

Since analgesic efficacy may vary with prolonged treatment, patients require periodic evaluations. Though acetaminophen is indicated as mentioned for the initial treatment of osteoarthritis, patients may only experience a short period of response of relief and then will require a change in medication. Another reason for change may be poor tolerance, for example codeine which may cause constipation or too much sedation. Laboratory and other diagnostic tests may be indicated with untoward reaction to prolonged usage of NSAIDs. Renal (kidney), gastrointestinal (GI) bleeding in 1% of patients, with increases to 4% in patients over 60 years of age, necessitate examination as deemed necessary by the health care provider. Patient self medication with the increasing OTC products along with patient co-morbidities can cause deleterious reactions Goals then are a thorough understanding of the underlying pain etiology, patient’s total health and past psychological responses to pain so that therapy can be properly individualized for maximum relief with minimal risks.

References

RX Consultant, Vol IX, #5, May 2000

RX Consultant, Vol XI #5, May 2002

ORTHOTICS for multiple types of foot pain best buy in a pre-made orthotic click link below



ORTHOTICS for heel and arch pain for those who must wear dress shoes click link below

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I've been doing some aggressive research lately (it's how I found your incredible website) and realize now that my symptoms are not consistant with the diagnosis. Jennifer

Hunterville, NC

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….after reviewing your amazing site (great for the avg. jill). So thank you very much!!!

Liesbeth

NY

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I am really, really impressed with your plain-speak explanations for the various conditions.

Jacqueline

NJ

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This was an extremely helpful site. I have an appointment on the 18th and your info. Was right on target…..

Jack

Fla

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A well organized site containing much information written in a manner that the average reader can comprehend.

Jean

Ontario, Canada

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I found your website and articles most interesting.

Andrew

Fla.

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Thank you for a quick response. I think your site is the best information site on foot pain and I have viewed many.

Judy

(location unknown)

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I came to your website, footspecialist.net via www.foot-pain explained .com which I think is also your website? I thought explanations for different types of problems were well addressed and thoughtfully stated for the patient in mind.

L.W.

New York

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You have an amazing and extremely informative site. I enjoyed looking through all of the data and stats.

Yvette

Memphis, TN

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Thanks again so much for the information in the article. Very interesting.

Anna

Scotland

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Great article. I have had plantar fasciitis since I was in high school……..

J. Simmons

(location unknown)

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Dear Dr. Mitnick, The orthotics arrived four days ago and I slipped them into my shoes immediately. I was skeptical as to the usefulness of the item, they really didn't look very exotic. I have to say though, after using them for just four days, I have experienced grand relief from my foot pain. Even the very first day, I was able to do a lot of work while on my feet with at least a 75% reduction of pain. It has only gotten better every day, and I go nowhere without my shoes with the orthotics. I had been experiencing extreme heel and sole pain for about six months and had to take extended breaks off my feet many times a day as well as regular doses of Ibuprofen. Since getting the orthotics, my life has returned to normal and I feel good again. Just wanted to say thanks for the recommendation for a very effective item, I had no idea what a change this item could affect.

Yours truly,

J.C. Forbes

Tennessee

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Thanks for the Response, you hit it on the head.

Steve

Redondo Beach, CA

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Thank you for your time and expertise in answering my question…..

LH

(location unknown)

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First, thanks for putting together this website. Its the most informative site I have found dealing with foot problems. Last June I started having pain and swelling at …….

Joe

(location unknown)

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First of all, thank you for having all this useful information available in one place. I've been through most of your website and based on my research, pain and evaluations I think I've narrowed things down quite a bit.

Pete M.

(location unknown)

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Thank you for the best site I have found when researching foot pain.

Glenda B.

Madison, Alabama

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Thanks for replying so quickly. I was a bit concerned. I think your website is great, and chock full of info.....

Carol

Denison, TX

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Dr. Marc, Thank you so much for your reply which seemed to be right on. I have researched many sites but you put me on the right path to the possible answer. My foot pain may not rule the rest of my life after all! I believe I'll make a sign that reads, "THE END IS NEAR!" Thanks Very Much,

Dawn

West lafayette, IN

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Dear sir...no doubt you get positive comments re your site...May I please be added to the list of your admirers. In all of my years of web surfing I would say your site is right there with the very best. Thank you for taking the time to write the terrific info you provide and for putting things into laymen terms for us mere mortals. I pray you have much on going success and thank you again for a deed well done. As for me I did not find much help for my symptoms and will continue on my quest. Were you anywhere in the South I would make and appointment...Thanks again dear sir...m.e.

Michael E.

Tampa, Florida 33624

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Hi. This is a great site! I'm a healthy middle aged woman who is in good health, but.....

Kelly

Texas

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Just a wee word of thanks for your wonderful website...It is a terrific service...Thank you for providing your knowledge and help...With highest regards, m ebeling

Michael D. Ebeling

Tampa, Florida 33624

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Thanks for a most interesting website, which has helped a lot.

Steve

UK

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Dear Dr.Mitnick

I usually do my research on the Mayo clinic website. I think your website is the most informative site I have found when researching foot pain.

I thank you for putting together this incredible website.

Regards,

Dragica W.

Edmonton,Canada

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....I have been told that it is not hard enough to be cut off. Please help, I am not sure what to do now! THANKS FOR A WONDERFUL AND VERY HELPFUL SITE!

Roxy

South Africa

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You have an unusually clear, informative and well-written website for laypersons. Thank you for that.

Matthew W.

Mansfield Ctr, CT

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First, I'd like to thank you for all the information that you provide on your website and the opportunity to write to you.

Steve

Placentia, California

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First, I want to let you know that you have the best web site I've found related to foot issues. (The only thing I had difficulty finding was the "ask a question" page.)

Unknown

Unknown location

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I received the orthotics Monday afternoon and began wearing them Tuesday. After two days I would say that I have noticed a huge improvement in the discomfort I have been experiencing. My foot feels better than it has in months.

Ric J.

Unknown location

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I greatly admire someone like you who would donate and dedicate so much time and effort to helping strangers with no compensation. Truly, it is uncommonly kind. And your site is so intelligently arranged.

Ron R.

Pacific Grove, CA

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I used to work for a podiatrist (front desk) back during summers in college years ago, so I know the benefits of good care. Again, I want to thank you for an EXCELLENT website. It was so great to get to your site (top of google search) and actually find all the answers I needed EASILY and QUICKLY! Clearly you put a ton of work into it and I really appreciate it.

All the best,

Victoria

Alameda, California

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By the way, millions of websites could use yours as a guideline on how to organize information and make the site user-friendly. Kudos to you!

Anonymous

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Thank you for your very interesting and informative site!

Anonymous

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Hi. I come to your site often looking for information. It is really informative and I appreciate it very much. I have RA and have been having considerable amount of foot pain...... Dee RN

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Thanks very much for the wonderful informative site.

Catherine

New Zealand

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Thank You for my answer! I have been schedule for a bone density scan, allingment, and I am in the process of getting orthotics made, and checking out the natural remedies. Thank again! What a great web site!

Sincerely

Josette

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Yes I want both pair of orthotics. You don't have an option of ordering 2 at one time so I had to place the order twice. Thanks. My husband likes these and wants to put them in all of his shoes. (referring to Superstep orthotics)

Cindy H.

Arizona

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I searched the internet everywhere for a clear description and illustration of my symptoms/problem. https://www.foot-pain-explained.com/ was where I ended my search with answers. If I lived in Jersey (left 30 years ago) and didn't live in Florida I would definetly make an appointment with Dr. Mitnick.

Thanks, Kathy

Florida

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1st of all THANKS A LOT for your great site......

Anna

Poland

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Thank you so much for your response. I will let you know how I am doing if you would like. Your website is awesome!

M P

South Carolina

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Hello! I want to thank you for such an informative website! I found you based on my ankle pain search and am happy to realize that there may be a relatively simple cause and solution....

Natalie

unknown location

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...Thanks for your fantastic service.

Gary

Arlington, VA

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Thank you so very much, that would be much appreciated. I love those insoles, by the way. (referring to Superstep orthotics)

Kelly W.

San Clemente, CA

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Dr Marc is fantastic...He seems to know exactly what you are feeling with the problems you are having. I wish he was in my home town so I could go to him with my problems!!!!!!!!!!!!!

Pam

location unknown

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Great insights! Thanks Doc, you're the best.

Glen

location unknown

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I have been experiencing foot pain of various sorts and am working to figure out what it is. I found this site and can only say BRAVO!! What an excellent site! The time it must have taken to put all this together must've been a daunting task! I am sure it has helped so many people. Thank you so very much for doing this.

Bre

location unknown

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Dr. Mitnick, Thank you so much for your reply. I did let my physician know and they took an x-ray - all is well! Also, thank you for providing this wonderful site, it is very helpful with lots of useful information! I appreciate your gift of time! God bless.

anonymous

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Dr. Mitnick, Thank you, you were 100% correct. The pain finally brought me to the ER. I spent 8 days in the hospital. The Doppler you spoke of was able to show that there was no pulse in that foot. This was an arterial clot that split and traveled throughout my leg. My leg was almost amputated. I am in rough shape but have all my parts intact!! You certainly know what you are talking about. Thank you for taking the time to answer. Yours Truly!

anonymous

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Staying at home after hallux surgery I spend quite a lot of time seaching info useful for avoiding problems which might come back. Today I found your site and I am .... delighted it happened. It's one of the best site I found last days.

Anna

Poland

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Thanks for taking time to read and answer so many questions. It is truly a public service!

Esh

Seattle, WA

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I just wanted to say that I am very greatful for this website!!

Bonnie

location unknown

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Also, and importantly, just want to praise this web site. Thorough and thoughtfully presented, it certainly must be of considerable assistance to anyone with a foot problem. Terrific -- and very interesting.I trust the address comes up easily for those seeking information.

Bill

New Jersey

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Thanks so much for answering my question. You've been more help to me than my own Dr. has been lately. Thanks again....I hope to be able to walk without pain someday.

Debbie

location unknown

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Wow, that is exactly the information needed!!! thank you thank you thank you!!! I appreciate this help so very much from Marc Mitnick DPM. Excellent information and help to improve One's life.

Chrissy

location unknown

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Thanks so much for this website Dr. Marc! It is so nice that you have this ask the doctor feature..I'm sure I'ts been helpful for alot of people. I will try what you suggested and see if it helps...thanks again!

Tracy

Evansville, IA

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Dear Marc

I just want to say thank you for the quick response and the good info. I find it amazing and a super nice thing that you do here by answering medical questions at no charge.

Russ W.

location unknown

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Your website is full of a lot of helpful information, and I am very impressed with the time in which you responded to my post. Thank you again for your time and consideration in your response.

-Sunny.

location unknown

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Thank you very much for the information, I will consider it. Excellent web site.

Jackie

San Diego, CA

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Dr. Mitnick, Just want to say thank you so very much for your quick response and very informative reply! After reading what you had to say, I called the doctor's office and was able to get in and see him the same day as my injury. Toe was x-rayed and luckily, it is not broken or fractured. Very badly bruised and will probably lose the toe nail. And although my toe and toe nail are still very black and blue and very sore, they ARE both starting to feel a little better. So again, thank you! I am so very happy that I came across your website. The service you provide is outstanding and immeasurable!

Rivi,

Albany, NY

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Thank you so much for all of your advice. In searching the web for people dealing with this same issue i can tell you that you are a Knight In shining Armor! If I lived in Jersey I would gladly be your Spokesperson. Hopefully next time you hear from me it will be good news. God Bless,

Jill S.

location unknown

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THANK YOU SO VERY MUCH FOR YOUR TIME AND EFFORTS, YOU ARE SO VERY APPRECIATED. THANK YOU FOR ALL YOU DO.

Jackie

Whichita, KS

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thanks again, this site is very helpful.

mark

Boston, MA

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Like others have stated...This site is amazing and I am so thankful that it was created.

....Keep up what your doing. Your a life saver.

Michelle

Colorado

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Thanks again for the information provided on your site. It's easy for non-medical folk to understand your writing, and helps provide better communication between patient and doctor.

annielou

Colorado

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Wonderful advice

by: Anonymous

This is the best site for foot problem info.

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Thank you for this information. This description fits my pain and inflammation behind my 2nd toe perfectly.

by: Max

location unknown

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Again, I really appreciate that you responded to my inquiry, and that your mention of Parkinson's helped me to find my way to a diagnosis of this difficult to diagnose disease. Most patients see on average 16 doctors before they are diagnosed. I hope that you can help other people that ask for your expertise in the future.

Barb D.

Canada

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I just wanted to say that I am very greatful for this website!! I have had a fusion in my rt foot and am finally getting a little bit better......

Bonnie

location unknown

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Again, Thank you from the bottom of my heart for taking the time to answer my question....your an angel!

Nancie

Wisconsin

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Thank you for your response. You have provided some great insight (to my question)....

Julie

location unknown

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Thank-you so very much for responding so quickly and in such detail to my question!! I will give my surgeon a call today!! This website is terrific!!!! Thank-you again!

Renae

North Carolina

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Many Thanks Dr Marc!
Thank you for your response. It sounds like a good plan to me. He did not cut the wart out first ...

KG

location unknown

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Thanks again doc for having this website and we STILL need qualified Podiatrists in beautiful sunny Tampa Bay (Bradenton) Florida.

Bessie Mae

Florida

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Dear Dr. Mitnick, Thank you so very much for taking your time to answer my question. You have greatly relieved my anxiety related to the continual tingly I feel in my feet. I will share your response with my podiatrist next week. God bless you for having this question and answer page on your website! Most gratefully,

Lynne T.

location unknown

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Your webpage is excellent, I commend you on sharing your knowledge to the public.

Robert

New Jersey

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Thank you. you were more detailed than what others have told me they finally called from the last xrays and my son is now in a cast for 2 weeks he did have a fracture that was not noticeable.

a mom

location unknown

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I have read your website and I have to admit that I am amazed at all the information that is on here. I have learned more than the three years I have been going to several doctors that I have seen!!

Melody

Lenoir, NC

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Thank you so much Doc for a quick and thorough response!

Rustam

Bellevue, WA

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I cannot thank you enough for your response, opinion, and suggestions! I want you to know how much it means to me, and I'm sure everyone else who has ever asked you a question! I feel like you're a lifesaver and have empowered me to take a stronger role and stand up for myself and my feet!

Jodi

location unknown

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