When I had my gastric bypass surgery they told me that I would either have
to get a B Complex vitamin shot every month or take the sub-lingual B
Complex vitamins every day - so I'm guessing they're equivalent.  I've heard
that B vitamins are hard (or maybe impossible?) to absorb through the
stomach (Howard?).

All I know is that I have *never* had so much energy in my entire life - not
even when I was a kid (and that's saying something for a person with ADHD!).
;>

BTW, you can get the sublingual B Complex vitamins at Walgreens for about $5
for a 2 - 3 month supply.

Hugs,

CatNipped

Sure, but you have to specifically look for decaf.  Standard green tea
is caff.

It is one of my fond hopes that as new doctors are trained and enter
practice, there will be more and more knowledge of the science (and art)
of pain management. Unfortunately, the understanding of many of the
mechanisms of pain are recent enough that older practicing physicians,
who don't keep up with current research, simply aren't aware of it.

The subspecialty of pain medicine doesn't get the respect it should.
Melzack and Wall, who discovered the fundamental mechanism that causes
people to become aware of pain, as well as many of the secondary effects
of pain transmission, IMNSHO, deserved a Nobel Prize. AFAIK, no pain
researcher has ever been in serious consideration for the Nobel Prize in
Medicine or Physiology.

The particular mechanisms I was talking about is directly associated
with muscle tissue, but I see no reason why a joint inflammation
couldn't cause it. The particular pathway that I was talking about comes
from the "lower" brain in response to pain in soft tissue, but the same
inflammatory substances are released from arthritic joints.

Prostaglandins, incidentally, cause uterine contractions, and they have
been used to induce abortion or labor. By taking a prostaglandin
antagonist before the crampy stage of the menstrual cycle, so there's a
blood level before the prostaglandins hit, often can avoid or minimize
cramps.

So, the muscles around the joint could go into spasm from the same
chemicals, but released from the joint rather than the brain. Ibuprofen,
naproxen, and prescription NSAIDs block the enzymes (COX-1 and COX-2)
that produces these irritants. Aspirin does as well, but has somewhat
different mechanisms.

It turns out, however, that not all the products of the two enzymes are
bad. Some of the products of COX-1 produce the mucus that normally
protects the stomach wall.  When you suppress COX-1, you take away
protection from acid, which is why aspirin and NSAIDs upset the stomach.  
The newer selective inhibitors of COX-2 only, such as Vioxx and
Celebrex, allow the stomach protection to work normally.

Nothing in pain pharmacology tends to be simple. Some people only get
pain relief from COX-2 inhibitors, enough that the US Food and Drug
Administration approved their being used again, with lots of warning and
cardiac monitoring. We understand why COX-2 inhibitors prevent stomach
upset, but we are not sure why they are especially effective for pain
relief in some, but not all, patients. Like many drugs, there is a
delicate balance between risk and benefit.

Acetaminophen (Tylenol), or paracetamol across the pond, does not block
COX enzymes except in the brain. This is why it has less of a general
anti-inflammatory action than the other drugs. It does block pain,
however, which, in turn, can block the secondary brain-directed release
of prostaglandins in muscle tissue.  This may give the effect of
decreasing inflammation, but it's really a matter of preventing
inflammation.