Arthritis and pain

by Nathan Wei, MD, FACP, FACR

Nathan Wei is a nationally known board-certified rheumatologist and author of the Second Opinion Arthritis Treatment Kit. It's available exclusively at this website... not available in stores.

Click here: Second Opinion Arthritis Treatment Kit

Pain is one of the most difficult parts of having arthritis.

The first step is having the correct diagnosis because each type of arthritis is treated differently.

Each person needs a pain management plan. What works for one person may not work for someone else.

Pain is the body's warning mechanism that tells the patient something is wrong.

Pain often is "educational." For example, if one touches a hot stove, pain signals from the brain tell the person to pull their hand away.

Arthritis pain is caused by several factors, such as:

•Inflammation, the process that causes the redness and swelling in your joints;
•Mechanical damage to joint tissues;
•Fatigue that results from the disease process, which can magnify pain;
•Depression or stress.

People react differently to pain for several reasons. Pain thresholds vary and emotional and social factors come into play.

Pain is aggravated by several factors including:

• Increased disease activity
• Stress
• Excessive physical activity
• Dwelling on pain
• Fatigue
• Anxiety
• Depression

Pain is relieved by:

• A positive attitude
• Exercise
• Relaxation
• Medications
• Massage
• Guided imagery
• Topical pain relievers
• Heat and cold treatments

There are different types of pain. They include neuropathic pain (shingles), central nervous system neurotransmitter mediated pain (fibromyalgia), inflammatory pain (rheumatoid arthritis), and pure nocioceptive pain (a cut).

Endorphins, morphine-like painkilling substances, are produced by the brain in response to a number of stimuli.

The body also produces endorphins in response to factors such as medicine. External pain control methods, such as heat and cold treatments, can stimulate the body to either release endorphins as can exercise.

Most forms of arthritis are associated with pain that can be divided into two general categories: acute and chronic. Acute pain is temporary. It can last a few seconds or longer but gets better as healing occurs. Some examples of things that cause acute pain include burns, cuts, and fractures. Chronic pain, such as that seen in people with osteoarthritis and rheumatoid arthritis, ranges from mild to severe and can last weeks, months, and years to a lifetime.

Topical treatment

Cold should be used the first 48 to 72 hours following an acute injury. This means you should use cold rather than heat the first 2 to 3 days after an injury, such as joint sprain or muscle strain.

Cold should only be applied for 15 to 20 minutes at a time. Protect the skin!

Heat should never be used during the first 48 to 72 hours after an injury. This can cause the injury to worsen and the pain to increase. Heat can be very effective during the subacute and chronic stages on an injury. Heat can effectively decrease pain, promote healing by increasing circulation, help tight muscles or muscle spasms to relax, and prepare stiff joints for movement.

Heat should only be applied for 20 to 30 minutes at a time.The other big problem with prolonged use of heat is the risk of burns. Even if the heating pad is set on low, prolonged use can cause burning.

Like cold, heat penetrates more deeply if it is moist instead of dry. There are several commercial moist heating pads available on the market today. Never place heat on an area that is still red from a previous heat application!

Heat should not be used in the acute stage of an injury.

Heat should not be used by persons who have decreased or impaired sensation. Examples are: diabetes with neuropathies, stroke, head injury, and nerve damage.

Heat should not be used where there is compromised circulation. This could include peripheral vascular disease (PVD), arterial insufficiency, cardiac conditions, and diabetes.

Heat should not be used over malignant tumors.

Heat should not be used over open wounds or areas of suspected infection.

Heat should not be used over an area that has moderate or severe swelling (edema).

Heat should not be used over skin conditions, such as cellulitis.


Arthritis medicines fall into three broad categories. The first are analgesics. These medicines control pain but do not control inflammation. Examples include acetaminophen, tramadol (Ultram), propoxyphene, and other narcotic pain relievers. Narcotics in the form of pills, capsules, patches, and rubs are an alternative for those with severe pain. The danger, obviously, is addiction.

The second group consists of non-steroidal anti-inflammatory drugs (NSAIDS). These drugs control inflammation so that symptoms such as swelling, redness, heat, and pain are relieved. Examples of drugs that are in this category include ibuprofen (Advil), naproxen (Aleve, Naprosyn), nabumetone (Relafen), etodolac (Lodine), celecoxib (Celebrex), and meloxicam (Mobic).

The last category of drugs are the anti-rheumatic disease-modifying drugs (DMARDS). These drugs slow down the progression of arthritis and thus reduce pain. Examples of these drugs include hydroxychloroquine (Plaquenil), sulfasalazine (Azulfidine), methotrexate, azathioprine (Imuran), and the newer biologic drugs such as Enbrel. Remicade, Cimzia, Simponi, Humira, Actemra, Orencia, and Rituxan.

Newer pain medicines have recently emerged. Ziconotide (Prialt) is derived from the poisonous venom of a marine snail known as Conus magus. Prialt is s N-type calcium channel blocker. It works by blocking transmission of pain sensation by specifically targeting and blocking the N-type calcium channels on nerves that transmit pain. It is both more potent and more toxic than morphine. As a result, the FDA has restricted use of this drug to people with severe pain from bone disease, severe burns, or cancer. A benefit is that, unlike morphine and other narcotics, Prialt is not considered addictive. Prialt is administered through small infusion pumps that can either be implanted or worn externally. Side effects seen in clinical trials included dizziness, confusion, and unsteady walking. Patients with a history of psychological symptoms and neurological impairment should not take Prialt.

Lyrica is a successor to gabapentin (Neurontin) which itself has been used to treat chronic pain. The FDA recently approved Lyrica for the management of neuropathic pain – a particularly agonizing and debilitating type of pain caused by nerve damage associated with diabetes and shingles. Lyrica works by restoring the action of overactive nerves to more normal levels. Lyrica is more potent than Neurontin, so it is more effective at lower doses. Side effects seen in clinical trials included dizziness, sleepiness, dry mouth, bloating, blurred vision, weight gain, and difficulty with concentration and attention.

A patch containing an anesthetic- the Lidoderm patch- has been used to treat localized pain. It is relatively safe and easy to use.

Alternative medicine

In 1998 half of the people in the United States used some form of alternative medicine, there are now more visits to alternative practitioners annually then there are to traditional physicians. Many health care plans are now covering a portion of alternative costs.

Why are we turning to alternatives? More often than not, it is for the treatment of chronic pain. Modern medicine has extended the average life expectancy but has failed to cure many painful conditions, such as arthritis. We are living longer with pain. In one study, one third to one half of the people with arthritis surveyed admitted to using some type of alternative therapy.

Does it work? It depends on whom you ask. Ask someone diagnosed with OA whose treatment of glucosamine and chondroitin sulfate was successful and you will hear a resounding "Yes!" Ask a rheumatoid arthritis patient whose experiment with magnet therapy was an expensive failure and you'll likely be told it is a scam. The truth is probably somewhere in the middle.

No one alternative treatment will work for everyone, just as no medication works on all people. Explore alternatives with an open but cautious mind and you should do just fine.

Get more information about arthritis and pain as well as...

• Insider arthritis tips that help you erase the pain and fatigue of rheumatoid arthritis almost overnight!

• Devastating ammunition against low back pain... discover 9 secrets!

• Ignored remedies that eliminate fibromyalgia symptoms quickly!

• Obsolete treatments for knee osteoarthritis that still are used... and may still work for you!

• The stiff penalties you face if you ignore this type of hip pain...

• 7 easy-to-implement neck pain remedies that work like a charm!

• And much more...

Click here Second Opinion Arthritis Treatment Kit

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