What you need to know about medication and surgery for pain

Many surgeries have little or no clinical evidence proving their effectiveness, and some show no more benefit than the placebo, or sham, surgeries used in medical research studies.

Back surgery is a prime area to be cautious. Many doctors recommend spinal fusion surgery for chronic back pain. But a study comparing the surgery to exercise found that both were as effective in reducing pain.

Disk bulges and protrusions identified by MRI are just as common in people without back pain as in people with back pain, according to a study published in theNew England Journal of Medicine. That means if your surgeon tells you that you need surgery to correct a bulging disk, get a second opinion.

The disk may not have anything to do with your pain.

Another major study found that a common surgery performed on patients with arthritis of the knee was no better at relieving pain or improving knee function than a sham, or fake, operation in which incisions were made but no surgery was performed.

Bottom line: if your doctor recommends surgery for chronic pain or other chronic conditions, get a second and even a third opinion, and don't go under the knife until you exhaust all your other options.

Don't take acetaminophen for arthritis.

If your doctor is still recommending acetaminophen for arthritis pain, then she's not reading the medical journals. A major study published in the respectedArchives of Internal Medicinefound that acetaminophen worked no better than a sugar pill at relieving arthritis pain. Plus, in large doses it could cause kidney damage and liver damage.

Instead, work with your doctor to find alternative means of managing your pain, ranging from exercise to nonsteroidal medications like ibuprofen.

Studies find it works much better than acetaminophen for this type of inflammatory pain.

Don't mix pain relievers for different pains. 

You're taking ibuprofen for your arthritis and acetaminophen for your headache and an over-the-counter flu remedy that, unbeknownst to you, also contains acetaminophen. Whoa! You've just overwhelmed your liver. So read the labels of your pain relievers and cold and flu remedies before popping another pill.

Go for the lowest dose of painkillers. 

First you pop an all-day naproxen for your sore back. But a few hours later, your back still sore, you unthinkingly shake out a couple of Motrin from the bottle in your purse. That night before you go to bed, you take a couple of Tylenol PM to help you sleep. Keep on this way and you're putting yourself at risk for high blood pressure.

Seems that women who consume high doses of non-aspirin pain relievers like acetaminophen and ibuprofen are much more likely to develop high blood pressure than women who don't.

Start keeping a medication diary in which you note the time, dose and type of over-the-counter drugs you're taking; the total amount just might surprise you.

Pick pain medication on price, not symptom.

Even though it's become a major marketing ploy for over-the-counter pain relievers to tout their "specialty" on the label (for instance, Excedrin Migraine), such products all contain the same basic ingredient regardless of the type of pain they're purported to address.

So check the label of the product you're interested in, note the amount of active ingredient in each dose, then pick up the cheapest generic brand containing the same thing and save yourself a few bucks (and another headache!).