Arthritis help for 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
When patients present with arthritis, the first option is to let them know what types of “non-medicine” methods are available for controlling pain.
For instance, weight reduction for a patient who complains of knee pain and is grossly overweight is an important part of treatment.
Thermal modalities such as heat and cold will also help.
Assistive devices, physical, and occupational therapy are also advisable. This should also include an exercise program that emphasizes stretching, strengthening, and non-impact aerobic components.
Sometimes cognitive therapies such as hypnosis, guided visualization, and other techniques are beneficial.
After these have been introduced, then medicines can be started...
Many different types of medicines can help control the pain and swelling of arthritis. Sometimes over-the-counter medications may be all that is required. In other instances, prescription medications will be needed. Much depends on the type of arthritis, how much pain there is and other factors, such as co-morbid conditions.
Analgesics are drugs that help relieve pain, but not inflammation. Acetaminophen is one example of an analgesic that give temporary relief of common arthritis pain, but does not reduce swelling. It is available over-the-counter. However, it should be used only as directed because it can lead to liver and kidney damage.
Non-steroidal anti-inflammatory drugs (NSAIDs) help reduce joint pain, stiffness and swelling. NSAIDs cut down on the production of prostaglandins, which are substances that promote inflammation. Examples of over-the-counter NSAIDs include aspirin, ibuprofen and naproxen sodium. Other NSAIDs are available by prescription only. NSAIDs can cause side effects including gastrointestinal bleeeding and cardiovascular complications such as heart attack and stroke.
Glucocorticoids are drugs related to the cortisol, the natural steroid produced by the adrenal glands. Scientists have developed synthetic forms of cortisone that can be taken in pill form or injected directly into joints or other tissues. These drugs help relieve pain by reducing swelling and inflammation. Glucocorticoid injections must be used carefully. No more than three injections into the same site per year.
Disease-modifying anti-rheumatic drugs (DMARDs) often are used to control inflammation and slow progression in diseases such as rheumatoid arthritis. While their main function is to reduce inflammation, and suppress the immune system, these drugs also can help relieve pain. The drugs may take several weeks or months to begin working. Examples of DMARDs include methotrexate, hydroxychloroquine, azulfidine and lefunomide.
Biologic agents are used to modulate the immune system. Multiple biologics have been approved by the Food and Drug Administration for the treatment of rheumatoid arthritis. They include the TNF-alpha inhibitors: Enbrel, Humira, Remicade, Cimzia, and Simponi; the interleukin-1 inhibitor, Kineret; the interleukin-6 inhibitor Actemra; the T-cell co-stimulatory blocker, Orencia; the B-cell depleter, Rituxan. Many other biologics are on the near horizon
Antidepressants can help relieve chronic pain. They are typically prescribed for the chronic pain of fibromyalgia rather than for arthritis. However, because of their neurotransmitter properties, they may help reduce pain at the central level. Cymbalta, an anti-depressant was approved by the FDA for the treatment of osteoarthritis-related pain. These drugs also can help improve sleep quality, which in turn may help reduce pain.
Topical pain relievers can temporarily relieve the pain of arthritis. They include creams, rubs and sprays that are applied to the skin over a painful muscle or joint. Some topical pain relievers may contain combinations of salicylates, skin irritants like capsaicin, and local anesthetics that relieve pain in one area.
Salicylates decrease the ability of the nerve endings in the skin to sense pain.
Other over-the-counter topical creams containing capsaicin (the chemical that makes chili peppers taste "hot") may be used alone or with other medications to temporarily relieve pain. This preparation works by decreasing the effects of substance P, which sends pain signals to the brain.
Narcotics and other strong painkillers have been prescribed mainly for short-term and intense pain. But some physicians believe that with careful monitoring these types of drugs can be effective in treating chronic pain. Narcotics such as morphine and codeine reduce pain by blocking pain signals that travel to the brain.
Tranquilizers and muscle relaxants reduce painful muscle spasms that may occur with some types of arthritis. However, these drugs can be habit-forming if they are used for a long period of time.
Trigger point injections are injections of anesthetic and glucocorticoid into painful areas of muscle spasm. These are used to treat patients who have fibromyalgia and radiculopathy (pinched nerves.)
Nerve blocks are injections of anesthetic drugs into areas next to nerves. Nerve blocks can help relieve nerve, tendon, ligament and muscle pain; however, they are not effective for chronic pain.
Botox, the chemical used in cosmetic surgery, has pain-relieving properties and has been used to treat painful arthritic and muscle conditions.
Transcutaneous nerve stimulators or TENS units help to block pain externally. These devices which are the size of a pack of cigarettes and have wires that connect to electrodes that are applied to the painful area, are often quite effective.
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