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A not-so-favorite game played by many older adults is “pain of the day,” where they share what currently hurts and how much.

Most often, new aches, known as acute pain, are short-term and go away on their own or diminish with a combination of rest and over-the-counter remedies. But sometimes, acute pain persists and worsens until it becomes a serious chronic pain.

“People may shrug off the occasional acute pain as the price of advancing age and learn to live with it,” says Dr. Edgar Ross, senior clinician of the Pain Management Center at Harvard-affiliated Brigham and Women’s Hospital. “But ignoring any level of pain often leads to greater problems that become difficult to treat and manage.”

Pain names

Most acute pain comes from damage to body tissues. It’s known as nociceptive pain and results from physical trauma like a sports or exercise injury, a broken bone, a medical procedure, or a household accident like stubbing your toe, cutting a finger, or bumping into something. The pain can feel sharp, aching, or throbbing and often heals within a few days to a few weeks.

In comparison, chronic pain lasts at least two to three months, often long after you have recovered from the injury or illness, and may even become permanent. Symptoms and severity of chronic pain vary and may include a dull ache, shooting, burning, stabbing, or electric shock–like pain and sensations like tingling and numbness.

Chronic pain can be related to ongoing tissue injuries or inflammation, as with arthritis. However, more often long-lasting pain signals originate in the brain even when nociceptive pain has resolved. The brain itself has been rewired to experience pain even when there is no active involvement from body tissues.

According to the CDC, 20% of adults have chronic pain — with people ages 65 and older affected the most — and 7.4% experience chronic pain that limits their activities.

Seeking help

Sometimes acute pain becomes chronic because not enough attention was given to addressing the problem early on. “People feel they can live with it, or they adjust their lifestyle to accommodate the pain, so they don’t get appropriate treatment,” says Dr. Ross.

Another barrier is psychological. “Sometimes people need regular movement, exercise, or physical therapy as part of their acute pain treatment, but because it may hurt or be uncomfortable to do, they avoid it, which can worsen their condition,” says Dr. Ross.

Avoiding treatment and allowing acute pain to linger also may make people more sensitive to pain. “This makes their pain feel worse than it is and makes it harder for people to cope,” says Dr. Ross.

The best way to stop acute pain from becoming chronic is to confront it straight on. “Don’t ignore it. Seek medical advice, and follow proper pain management, whether that’s heat and ice therapy, physical therapy, medication, rest, or some combination,” says Dr. Ross. “The longer your acute pain lingers without proper treatment, the more likely it could become chronic.”

Individual treatment

Chronic pain can be difficult to reverse, and sometimes even impossible, in which case the goal may be to restore function, manage flare-ups, or reduce symptoms.

Of course, every treatment strategy depends on the person’s medical history, the source of the chronic pain, and its severity. A traditional course of action is to work with a pain specialist to devise an individualized treatment plan. This could include a combination of options like prescription pain medication, steroid injections, physical therapy, complementary treatments, and behavioral therapy.

Sometimes a psychological evaluation is recommended. Chronic pain can be traumatizing and cause depression and anxiety that must be addressed. There also could be personal stressors that exacerbate chronic pain, like relationship issues or financial problems.

“It is not easy sharing personal issues, but exploring them can support and improve your treatment and management strategy,” says Dr. Ross.

Addressing chronic pain takes time and dedication. Depending on how long the pain has been around, therapy could last several months or even years. “Even so, dealing with chronic pain is not a hopeless situation,” says Dr. Ross. “There are many options to help people improve their quality of life.”

Image: © Yagi Studio/Getty Images

You were recently started on antibiotics for an infection and you are now doing well. But slowly your skin begins to itch, and the telltale signs of a rash are already popping up — first on your torso, and now spreading to your arms and legs. What do you do? Should you worry? Should you see a medical professional?

Rashes are a common and pesky side effect of many medications. It can be so disheartening to be getting better from one ailment only to discover that you have another issue to address. While these itchy eruptions can be annoying, they usually run their course over a week or two and can be treated with topical medications.

But not all drug rashes are created equal — and some can even be deadly. Luckily the scary ones are pretty rare, but it’s still a good idea to know how to spot them. How can you tell the serious rashes from ones that are just a nuisance, but will get better with time and treatment?

Types of drug rashes

There are two main allergic rashes that may happen after taking a drug. The most immediate type of reaction happens within hours. Hives appear and move around the skin. Since this process is related to the release of histamine, antihistamines (available over the counter at a drugstore) are the typical treatment.

There is also a delayed type of drug rash that comes up four to 14 days after you start taking a medication. Pink and red bumps appear on your chest and back, and spread to the arms and legs over the course of days. Unlike hives, these bumps don’t move around, and after a few days things may start to get better, but you may have peeling skin much like a healing sunburn.

This delayed type of rash doesn’t respond as well to antihistamines, but an over-the-counter topical cortisone cream (or one of its stronger prescription-strength versions) can help speed the healing process along.

When is a drug rash cause for concern and a visit to the ER?

With hives, the main concern is that you’re experiencing a whole-body reaction that goes beyond the skin, one that can make breathing difficult or dangerously drops your blood pressure. If you experience either of these symptoms, it’s very important to get to the ED.

These immediate, life-threatening reactions can be treated with steroids, epinephrine, and higher-dose antihistamines than you can find at the drug store. While they are scary, these types of allergic reactions to a drug are not hard to identify, and many doctors are skilled at spotting dramatic changes in your breathing or blood pressure. It’s important to tell the doctor you see what medications you have taken and how long ago you took them.

Know the signs of severe cutaneous adverse reactions (SCARs)

In the more delayed type of rash, symptoms can be more difficult to diagnose. The most common triggers for these types of rashes include antibiotics, antiseizure medications, antigout medications like allopurinol, and even over-the-counter medications like NSAIDs. (This isn’t a complete list, and any new medication should be regarded with caution.)

As for the rash, when it’s just itching things are usually fine, but still a nuisance. When the skin starts to hurt, or turns a deeper purple color, doctors worry about something more serious. If your skin starts to blister up or you see pustules, or if you notice sores in your mouth, eyes, or your genitalia, these are red flags and you should get to an urgent care clinic or the ER and ask for a dermatology consultation. Sores in the mouth can be so severe that drooling becomes a common symptom, because patients avoid swallowing due to the pain.

If you start to feel ill, like you have the flu, or if you’re getting puffy from swelling, especially in the face, this could mean it’s a severe drug hypersensitivity syndrome. Sometimes people develop a fever, a drop in their blood pressure, or their liver, kidneys, and heart can all be affected by drug hypersensitivity syndromes. These are so severe that most patients need to be admitted to the hospital, and sometimes even to the burn or intensive care unit.

While there are different names for different types of severe drug reactions, including Stevens-Johnson syndrome (SJS), drug rash with eosinophilia and systemic symptoms (DRESS), and acute generalized exanthematous pustulosis (AGEP), they are often grouped together as severe cutaneous adverse reactions (SCARs).

What happens if you develop a SCAR from a medication?

The first step is getting evaluated by a specialist, either in a dermatological clinic or the hospital. Finding someone who has expertise in managing these types of reactions is critical. A doctor (usually a dermatologist) may biopsy your skin, and they may have to start systemic medications that suppress your immune system. Sometimes, patients with SCARs also require a stay in a hospital.

The most important thing you can do is to keep an eye on your skin and its symptoms if you’re taking a new medication, or even if you’ve increased the dose of an old medication. If you suspect that you may be dealing with one of these SCARs, be sure to seek help from an expert, like a board-certified dermatologist, so that you can rest assured that you’re getting the care you need. Patients who are treated appropriately generally do well. Your doctors should also report these reactions to the FDA.

Once you’re on the mend, things can start to get back to normal, but it’s important to follow up with your doctors because there are some long-term issues that are important to pay attention to. Ultimately your doctors and healthcare team will advise you on what exactly is safe in the future. Remember that if you’re worried about one of these reactions, it’s important to stop the medication as soon as possible, but with the input of your doctors.