Arthritis pain management
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
Dealing with pain can be the most difficult part of having arthritis.
The first step is knowing which type of arthritis or condition a patient is dealing with because there are more than 100 different kinds of arthritis and each is treated differently.
And just as there are different types of arthritis, there are also different types of pain.
Each person needs a pain management plan. What works for one person may not work for someone else.
Pain can be acute such as hitting your hand with a hammer.
Chronic pain, such as the kind that accompanies arthritis indicates there's a problem but the pain persists. This is the kind of pain that has a deleterious effect on quality of life.
Arthritis pain is caused by several factors, such as:
•Inflammation, the process that causes the redness and swelling in joints;
•Damage to joint tissues, which results from the disease process;
•Depression or stress.
Both physical factors including the sensitivity of the nervous system and the severity of your arthritis as well as emotional and social factors including anxieties about pain and previous experiences with pain affect the response to pain.
Pain can be alleviated by:
• Mental imagery
Pain signals travels through an intricate system of nerves in the brain and spinal cord.
One modulating factor in regards to pain is the body's ability to produce natural pain-relieving chemicals called endorphins.
Endorphins can be produced in response to pleasant environmental stimuli, external pain relieving modalities such as heat and cold treatments, and medications.
Pain management encompasses many modalities.
Cold should be used the first 48 to 72 hours following an acute injury.
After 2 to 3 days, it is then called a sub-acute injury. After a week, the injury has entered the chronic stage. In the sub-acute and chronic stages of healing, both cold and heat can be of benefit.
Cold should only be applied for 15 to 20 minutes at a time.
Medical conditions where cold is relatively contraindicated are: Raynaud’s Disease, systemic lupus erythematous (SLE), peripheral vascular disease (PVD), scleroderma, or Buerger’s Disease (thromboangitis obliterans).
Heat should never be used during the first 48 to 72 hours after an injury. This can increase circulation to the area and aggravate swelling and microscopic bleeding causing the injury to worsen and the pain to increase.
The big problem with prolonged use of heat is the risk of burns.
Like cold, heat penetrates more deeply if it is moist instead of dry.
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, and nerve damage.
Heat should not be used where there is a circulation problem. This could include peripheral vascular disease (PVD), 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 with acute inflammation.
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), and narcotic pain relievers.
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.
Lyrica is a GABA stimulator. It has a similar mode of action as Neurontin, which is also used to treat chronic pain. The FDA approved Lyrica for the management of neuropathic pain – a severe pain caused by nerve damage associated with diabetes and shingles. It is also used to treat centrally mediated pain such as that seen with fibromyalgia.
Antidepressant medicines also act via a central mechanism to reduce pain. An example is Cymbalta.
A patch containing an anesthetic- the Lidoderm patch- has been used to treat localized pain. It is relatively safe and easy to use.
Chronic pain due to spinal disorders can often be treated with injections such as epidural and facet injections. Radiofrequency ablation of nerves is also used.
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Click here Second Opinion Arthritis Treatment Kit
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