Q: I have sciatic pain. I do my best to mitigate the pain with exercise. The only painkiller I can tolerate is aspirin. I have been approved for physical therapy, but that doesn’t start for another six weeks. When I stand up, the pain is intense, and I just force myself to walk, because then it goes away. My blood pressure is now elevated and has been elevated for several days. I feel unwell. This morning it was 141/90. Can pain raise blood pressure like this? – J.B.

A: In a healthy person with onset of acute pain, blood pressure very frequently increases. This is not usually a concern, as a healthy person’s vascular system is robust, and it is unlikely to cause harm in the relatively short period of time it takes pain to resolve (although it may feel like a very long time).

Chronic pain is a different issue. People in chronic pain generally do not have an increase in their blood pressure. Even people who live in chronic pain who have acute worsening in pain may have no change in their blood pressure. This is particularly important for physicians to realize. When I trained, I saw many, many people with sickle cell disease come in with painful crises. Unfortunately, both physicians and nurses disbelieve the patients based on the results of a normal blood pressure reading. In people with chronic pain, blood pressure is not a reliable indicator of the pain a person is suffering.

In your case, six weeks is a far longer a wait than I, and I’m sure you, would like. In the meantime, have you tried some nontraditional choices, such as an anti-inflammatory cream, such as Voltaren? An ice pack or hot pack might help. You could also try a topical anesthetic patch, such as lidocaine. Your doctor could also consider prescribing a tricyclic antidepressant or anti-seizure medicine, both of which can reduce pain, even though they aren’t traditional pain medicines. You might be able to tolerate them.

Q: I passed my first kidney stone and don’t want to have another. I’ve been drinking lemon juice in water every day. I’ve been eating veggie burgers, and some say they are high in oxalates, some say low. So, I’m confused. Which is correct? – C.L.

A: Veggie burgers can be made from a wide variety of vegetables and grains, so you will need to look up the ingredients to be 100% certain. Or you could write to the manufacturer. If you see that the burger is using lots of soy, beets or spinach, it’s very likely this is high in oxalates. In general, veggie burgers do tend to be high to very high in oxalate.

Lemon juice is an effective way of reducing kidney stone risk, but lemon juice daily isn’t so good for your teeth, so you might consider taking citric acid by prescription.

The best site for information on kidney stones and diet is at https://kidneystones.uchicago.edu/how-to-eat-a-low-oxalate-diet/.

Q: I have had three colonoscopies over the past several years. The preps were uncomfortable, but not overwhelming. Compared with the discomfort of colon surgery, chemotherapy and radiation therapy for colon cancer, colonoscopy prep is a piece of cake. – D.P.

A: That puts things in perspective, Dr. Pansch.

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