Arthritis and pain
Just as there are different types of arthritis, there are also different types of pain. Even your own pain may vary from day to day. Each person needs a pain management plan. What works for one person may not work for someone else. You may need to try several different treatments before you find the one that works for you. Pain is your body's alarm system that tells you something is wrong. When your body is injured, nerves in the affected area release chemical signals. Other nerves send these signals to your brain, where they are recognized as pain. Pain often tells you that you need to act. For example, if you touch a hot stove, pain signals from your brain make you pull your hand away. This type of pain helps protect you. Long-lasting pain, like the kind that accompanies arthritis or fibromyalgia, is different. While it tells you that something is wrong, it often isn't as easy to relieve. Managing this type of pain is essential to enhance your quality of life and sense of well-being. Arthritis pain is caused by several factors, such as: Inflammation, the process that causes the redness and swelling in your joints; Many people with arthritis have found that by learning and practicing pain management skills, they can reduce their pain. Pain is aggravated by: Increased disease activity Positive attitude and pleasant thoughts The body also produces endorphins in response to external factors, such as medicine. Codeine is one example of a powerful pain-blocking medication. Other external pain control methods, such as heat and cold treatments, can stimulate the body to either release endorphins or block pain signals in other ways. The word arthritis literally means joint inflammation, but it is often used to refer to a group of more than 100 rheumatic diseases that can cause pain, stiffness, and swelling in the joints. These diseases may affect not only the joints but also other parts of the body, including important supporting structures such as muscles, bones, tendons, and ligaments, as well as some internal organs. Pain is the body's warning system, alerting you that something is wrong. The International Association for the Study of Pain defines it as an unpleasant experience associated with actual or potential tissue damage to a person's body. Specialized nervous system cells (neurons) that transmit pain signals are found throughout the skin and other body tissues. These cells respond to things such as injury or tissue damage. For example, when a harmful agent such as a sharp knife comes in contact with your skin, chemical signals travel from neurons in the skin through nerves in the spinal cord to your brain, where they are interpreted as pain. 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 wanes 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.
Cold can be an ice pack or a purchased product you place in your freezer and reuse. Generally, 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. The use of heat in this first days can cause increased swelling in the area and result in more pain.
After an injury is 2 to 3 days old, the body starts trying to heal the injury in a different way. It is then called a sub-acute injury. If the injury persists over a week, the bodys healing process then turns to yet another means of healing. This is called the chronic stage. The chronic stage persists as long as the injury is present. In the sub-acute and chronic stages of healing, both cold and heat can be of benefit. Cold may continue to be of more benefit when swelling remains in the area. Many times cold used during these stages can be more beneficial in reducing swelling over heat. Cold can also be very useful when muscle spasms are present.
First, cold should only be applied for 15 to 20 minutes at a time. In most cases, whatever type of cold application you are using will have thawed by this time so there is little risk of the complications discussed below. What you dont want to do is keep reapplying new cold packs one behind the other so the total time of the cold treatment exceeds 15 to 20 minutes. If you do this, then you will over freeze the area decreasing the circulation to the area too much and could very well end up with a nasty case of frostbite. You can also wind up over cooling the nerves in the area end up with damage to the nerves. However, you can reapply cold several times a day. Once your cold pack has been off for approximately an hour and a half to two hours, it is safe to put on another cold pack. The effects of cold last longer than heat since it takes longer for the body to warm up than to cool off. In the acute stage of an injury, frequent application of cold in this manner can be very effective. Keeping the swelling to a minimum can speed up the bodys ability to heal itself. If you apply cold correctly, the area you applied the cold pack to will become red. This is the normal response. If there are blotchy white spots in the red area after you remove a cold pack, this means that the area has been cooled excessively and is a warning sign. You should decrease the amount of time the cold pack is left on the next time.
Cold should be used cautiously over areas that have previously been frostbitten, if you have high blood pressure (hypertension), in certain heart (cardiac) conditions, or over areas where there is nerve damage (neuropraxia). If you have one of these conditions, then you should consult your physician prior to the use of cold.
You can make your own reusable ice pack. The easiest way it to just place some ice in a Ziploc bag. Once the ice has melted, its time for the ice pack to come off. Then just place the Ziploc bag back in the freezer and it will be ready for the next time you need it.
You can also place a mixture of water and rubbing alcohol in a Ziploc bag. You should use about one part rubbing alcohol to four parts water. The rubbing alcohol will not freeze, so it will form a slush-like mixture. This allows the ice pack to fit better around the area and can be more comfortable. Once you have finished using the ice pack, place it back in the freezer so it will be ready for the next use. You may want to double bag these to avoid leaks.
Heat should never be used during the first 48 to 72 hours after an injury. This can increase the circulation to the area too much increasing the swelling and microscopic bleeding causing 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 is probably one of the most frequently used methods for home pain management. Everyone has probably used some form of heat at some point in time to help sore, stiff muscles or joints. The effects of heat do not last as long as cold, but can give temporary relief for up to an hour or more. Some common types of heat used in the home include: hot showers or baths, heating pads, microwavable heat packs, and warm compresses.
While heat is probably one of the most widely used home treatments, it is also probably one of the most incorrectly used treatments. Heat is like cold; you dont want to over heat the tissue are you can get some very bad results. Heat should only be applied for 20 to 30 minutes at a time. Let your muscles cool down for an hour to an hour and a half, and then reapply the heat. The other big problem with prolonged use of heat is the risk of burns. Even if you have your heating pad set on low, prolonged use can cause burning. The heat continues to accumulate is the tissues becoming hotter than the body can handle, and you end up with a burn.
Many people who use heat also use some type of analgesic rub or lotion. You should never use these rubs and heat at the same time. These rubs are basically a type of heat. They give warmth to the area and change the circulation to the area. This will lead to a burnm. If you have used a rub, then you should wait an hour or two before you use heat.
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. A hot compress is a form of moist heat. You will have to rewet the towel several times with warm water however since it will cool off fairly rapidly. If you have a regular heating pad, you can make your own moist heat. Place the heating pad in a plastic protective bag (you dont want to shock yourself!). Moisten a towel with warm water, wringing out the excess water well. Place the moist towel next to your skin and the heating pad wrapped in the plastic bag over the towel. If you use a microwavable form of heat, you can also wrap that in a warm moist towel to get the benefits of moist heat.
You should check the area you are heating frequently to be sure it is not overheating and trying to burn. Once you remove heat, the redness should disappear after 20 minutes or so. If it does not then it means that the area overheated and was trying to burn. If the redness is still there the next day, you gave yourself a first degree burn. 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. Some common instances where impaired sensation may be present include: 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.
Heat should not be used with acute inflammation. Medicines 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. 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, and Humira. 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 restroing 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
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.
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