Arthritis joint pain relief
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
A joint is the meeting of two or more bones. Bones that articulate with each other are covered by a thin layer of hyaline cartilage that permits gliding and helps with shock absorption.
Joint are often labeled by the amount of motion they allow. Some joints are fixed. For example, joints, like those between the vertebrae of the spine, allow for some movement, but nearly as much as, say the shoulder.
Joints are encased in a capsule lined by synovial tissue. Because of this arrangement- bones interacting with each other surrounded by a synovial capsule- arthritis can develop. This is because arthritis is not just a matter of cartilage wear and tear. There is also an inflammatory compopnent that affects the synovium as well.
Different types of joints are affected by arthritis and joint pain:
Ball and Socket Joint: This kind of joint permits a wide range of rotation and movement. Examples are the shoulder and hip.
Condyloid Joint: This type of joint opens and closes in one dimension. There is no rotation. Examples of condyloid joints are the jaw and fingers.
Gliding Joint: This kind of joint permits bones to glide past each other. There are gliding joints in the ankles, wrists and spine. The knee is a gliding joint, although it has rotational and hinge movement as well.
Hinge Joint: This type of joint permits movement similar to that of a door hinge. The knee, in part, and the elbow are hinge joints.
Pivot Joint: This type of joint allows bones to rotate around other bones. There are pivot joints in the neck and the radius of the elbow.
Saddle Joint: This type of joint has both back and forth and side to side motion but restricted rotation. The best example is the base of the thumb (carpo-metacarpal joint).
What causes joint pain?
Local inflammation of the lining of the joint- the synovium- is the primary culprit. Stretching of the joint capsule by bony spurs, called osteophytes, can also cause pain. Mechanical factors that lead to joint instability ,such as advanced osteoarthritis of the knee, can also cause pain. Also, nerve root irritation can cause pain. An example would be the radicular pain seen in the neck and low back.
The treatment of joint pain involves a multi-modal approach. Weight loss is a key part of treatment in patients carrying excessive poundage.
Unloading the joint with braces, splints, canes, and walkers may be effective.
There are multiple drugs available for the pain control of arthritis.
Over-the-counter topical agents that contain capsaicin, may be helpful since they cause irritation of the small sensory nerve fibers surrounding the joint which leads to reduction of pain.
Analgesics are drugs that help relieve pain, but not inflammation. Acetaminophen is an example. It is available without a prescription. Tramadol (Ultram) is another analgesic pain medicine. Narcotic pain relievers are sometimes used for patients with severe arthritis pain when all other therapies have failed.
Non-steroidal anti-inflammatory drugs (NSAIDs) help reduce joint pain, stiffness and swelling. NSAIDs block 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. NSAIDs can cause gastrointestinal problems such as ulcer, and are also responsible for an increased risk of cardiovascular side-effects such as heart attack and stroke.
Glucocorticoids ("cortisone") are powerful anti-inflammatory compounds that are chemically similar to the natural hormone, cortisol. Scientists have developed synthetic forms of cortisone that can be taken orally or injected directly into joints. These drugs help relieve pain by reducing inflammation. Glucocorticoid injections should not be given into the same joint more than three times per year.
Disease-modifying anti-rheumatic drugs (DMARDs) often are used to control inflammatory conditions such as rheumatoid arthritis. These drugs reduce inflammation, slow down disease progression, and by doing this can also relieve pain. The drugs are slow-acting and may take several weeks or months to work. Examples of DMARDs include methotrexate, hydroxychloroquine, azathioprine, azulfidine and leflunomide.
Biologic drugs are used to modify abnormalities in the immune system that cause chronic inflammation. These act like laser beams on specific immunologic targets. Examples of biologics are Enbrel, Humira, Kineret, Remicade, Cimzia, Simponi, Orencia, Actemra, and Rituxan.
Antidepressants also have pain relieving properties. They are often prescribed for the chronic pain of fibromyalgia. These drugs work by altering neurotransmitter function in the brain. Antidepressants are sometimes used to treat other forms of arthritis as well. Cymbalta has been FDA approved to manage the pain of osteoarthritis. These drugs also can help improve sleep quality, which in turn may help reduce pain.
GABA stimulators are also being used for chronic pain. These include drugs such as Neurontin and Lyrica.
Topical pain relievers can temporarily relieve the pain of arthritis. They include creams, ointments, and sprays that are applied to a painful muscle or joint. Some topical pain relievers may contain combinations of salicylates, skin irritants such as capsaicin and local anesthetics that relieve 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. It works by decreasing "substance P", a neurotransmitter chemical which sends pain signals to the brain.
Narcotics and other strong painkillers have been prescribed mainly for short-term and intense pain. But these types of drugs can be effective in treating chronic pain as well. Narcotics such as morphine and codeine reduce pain by blocking pain signals that are traveling to the brain.
Muscle relaxants, such as cyclobenzaprine or carisoprodol, may relieve pain by relieving muscle spasms that often trigger pain signals. They should only be used for short periods of time.
In addition to medicines, there are other measures that provide relief for joint pain.
In addition to medication, physical and occupational therapy may be of benefit in reducing inflammation and pain. Different modalities such as ultrasound, diathermy, cold, and electrical stimulation are valuable. Chiropractic and osteopathic manipulation often relieve pain.
Assistive devices such as canes, walkers, and splints are sometimes required.
Alternative therapies such as herbs, acupuncture, hypnosis, and diet may help some patients.
Exercise is an often overlooked form of treatment. All patients with arthritis should engage in a program of exercise that incorporates low impact cardio, resistance training, and stretching.
More aggressive invasive procedures such as arthroscopy (looking inside a joint with a small telescope and removing damaged or diseased tissue) and joint replacement surgery may be required.
Get more information about arthritis joint pain relief as well as...
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Click here Second Opinion Arthritis Treatment Kit
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