Most of us turn to acetaminophen (Tylenol) and ibuprofen (Advil, Motrin) for pain relief- but there can be more effective approaches, including combining conventional and natural pain relievers.

Caution: Check with your doctor before taking any new medication or supplement.

Arthritis

There are two types of arthritis- osteoarthritis, in which cartilage between bones wears away...and rheumatoid arthritis, an autoimmune disease that inflames joints. For relief, people who have either type often take nonsteroidal anti-inflammatory drugs (NSAIDs), such as aspirin, ibuprofen and naproxen (Aleve, Naprosyn)- but 16,000 Americans die annually due to side effects from these drugs. And thousands more may have died from taking the recently recalled Vioxx and Bextra. Instead, try...

For Osteoarthritis

Glucosamine sulfate. Take 1,500 milligrams (mg) of this supplement-made from chitin, which is derived from shellfish-along with 3 grams (g) a day of methylsulfonylmethane (MSM), a natural substance in the human body. These nutrients repair cartilage, reducing arthritis pain within six weeks. For maximum tissue repair, take these supplements for two to five months. For chronic arthritis, you may continue for up to a year.

Lidoderm. Put a patch, available by prescription, on the joint. It contains the anesthetics Novocain and Lidocaine. -Wear it for approximately 12 hours a day (one patch lasts that long) for two to six weeks. For a large area, some people may use as many as four patches (the package says three). Many patients experience a 30% to 50% decrease in pain within two weeks.

Willow bark and Boswellia. These herbs work as well as Vioxx and Motrin. Take240 mg of willow bark and 1,000 mg of Boswellia dally. It can take six weeks to work. For chronic arthritis, you may need to take these for up to a year to feel the full effect.

For Rheumatoid Arthritis

Fish oil. Studies show that fish oil (one to two tablespoons a day for at least three months) can reduce inflammation and pain. Eskimo-1, available at health-food stores, and Nordic Naturals (800-662-2554, www.nordicnaturals.com) are two reputable brands. Keep taking the fish oil after the pain is gone as a preventive measure.

Back Pain

Back pain can occur for no apparent reason and at any point on the spine.

Lidoderm. For low back pain, apply a Lidoderm patch in the morning and remove it in the evening. Expect relief in two to six weeks.

Colchicine. Approximately 70% of all back pain can be eliminated without surgery, through six intravenous injections of the gout medicine colchicine. It enters the space between the discs of the vertebrae and reduces inflammation. Colchicine's main risk is a rare but severe allergic reaction (similar to that caused by penicillin).

Carpal tunnel Syndrome

When a nerve passing underneath a ligament through two bones in the wrist becomes swollen and pinched, it causes pain, numbness and tingling in the hand or forearm. For relief...

Vitamin B-6 and thyroid hormone. Take 250 mg a day of B-6. Also, ask your doctor about a prescription for natural thyroid hormone. The combination of B-6 and thyroid hormone decreases swelling and usually clears up the problem in six to 12 weeks. You can remain on this treatment for six months to avoid a recurrence. During treatment, wear a wrist splint at night and, if possible, during the day.

Headaches

Tension headaches begin and end gradually. They can last for minutes or sometimes hours. The pain comes from tightened muscles across the forehead and/or at the base of the skull.

Tramadol hydrochloride (Ultram) is often overlooked, but it is an effective prescription pain reliever. Take up to 100 mg as many as four times a day.

Migraines-severe headaches that may be preceded by lights flashing before your eyes and may be accompanied by nausea, vomiting, sweating and dizziness-can last for hours, even days. Natural remedies are more effective than prescription drugs at preventing migraines...

Butterbur, from the butterbur plant, can prevent-and even eliminate-migraines. Take 50 mg three times a day for one month, then one 50-mg dose twice a day to prevent attacks. Take 100 mg every three hours to eliminate an acute migraine. Use only high-quality brands, such as Enzymatic Therapy (800-783-2286, www.enzy.com) and Integrative Therapeutics' Petadolex (800-931-1709, www.integrativeinc.com).

Sumatriptan (Imitrex). When a migraine is developing, 75% of patients experience tenderness and pain around the eyes. Sumatriptan knocks out930/o of migraines if it is taken before the pain around the eyes occurs. When it is taken later it helps in only 13% of cases. Therefore, if you have a migraine, it is best to take sumatriptan within the first five to 20 minutes.

Magnesium. In the doctor's office or the hospital emergency room, intravenous magnesium can eliminate a migraine in five minutes.

Irritable Bowel Syndrome

Irritable bowel syndrome (IBS), also known as spastic colon, is a digestive disorder characterized by bloating, abdominal cramps and diarrhea and/or constipation . Consider...

Peppermint oil. For symptomatic relief, take one or two enteric-coated peppermint oil capsules three times a day. Peppermint oil decreases spasms of the bowel muscles. Effective brands include Enzymatic Therapy (800 -783 2286, www.enzy.com) and Mentharil, available at most health food stores.

Hyoscyamine (Anaspaz, Levsin). Take this prescription antispasmodic as needed. it relaxes the muscular contractions of the stomach and intestines. Dosages range from 0.125 to 0.375 mg, taken 30 to 6O minutes before a meal.

Shingles

This itchy, blistering rash-called shingles or herpes zoster-is caused by the same virus that causes chicken pox. It strikes in middle or old age and usually afflicts one side of the upper body. The virus affects the nerves, so it can leave victims in chronic pain, a condition called postherpetic neuralgia (PHN). Discuss these options with your doctor...

Ketamine. This prescription anesthetic can decrease shingles pain within days in 65% of the cases. Apply a gel containing 5% ketamine two to three times daily to the painful area.

Lidoderm. Place a patch over the area of maximum pain.

Neurontin. This prescription medication can also reduce pain. To avoid side effects, start by using 100 to 300 mg, one to four times a day.

Tricyclic antidepressant. A prescription tricyclic such as amitriptyline(Elavil) can relieve nerve pain. To avoid side effects, use a low dose of 10 to 50 mg.

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