Arthritis pain treatments
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
The pain of arthritis may come from different sources. These may include inflammation of the synovial membrane (tissue that lines the joints), the tendons, bursae (small sacs of fluid that protect joints) or the ligaments; muscle strain; and fatigue. In addition, there is growing evidence that pain from many types of arthritis has a central nervous system component as well.
The pain of arthritis varies greatly from person to person. because of individual thresholds and tolerance for pain.
There is no single treatment that works for everyone with arthritis, but rather a customized management plan designed for a specific patient is the optimal approach.
• Medications-- Pain relievers such as acetaminophen (Tylenol*) may be effective early on. Some patients, though, require something a bit stronger such as nonsteroidal anti-inflammatory drugs (NSAIDs) like ibuprofen (Motrin or Advil). Still others need prescription strength NSAIDS.
• Heat and cold--Both work but different situations call for different approaches. Generally, acute injuries are an indication for ice therapy. Chronic pain conditions often respond to heat. Moist heat, such as a warm bath or shower, or a heating pad, placed on the painful area for about 15 minutes may relieve the pain. An ice pack (or a bag of frozen peas) wrapped in a towel and placed on the sore area for about 15 minutes may help to reduce swelling and stop the pain. People with circulatory problems should not use cold packs.
• Joint protection--Using a splint or a brace to rest joints and protect them from injury can be helpful.
• Transcutaneous electrical nerve stimulation (TENS)--A small TENS device - about the size of a pack of cigarettes- that directs mild electric pulses to nerve endings that lie beneath the skin may relieve some arthritis pain. TENS works by blocking pain transmission to the brain and also by modifying pain perception.
• Massage--This increases blood flow and to an injured area.
Topical agents containing capsaicin, emu oil, aloe,, or salicylates may be helpful.
Injections of local anesthetic and glucocorticoid may also provide short term relief.
Osteoarthritis and rheumatoid arthritis are chronic diseases that last a lifetime. Learning how to manage pain over the long term is an important factor in controlling the disease and maintaining a good quality of life.
Non-steroidal anti-inflammatory drugs (NSAIDs)--These are a class of drugs that are used to reduce pain and inflammation in people with osteoarthritis and rheumatoid arthritis. Examples include ibuprofen and naproxyn. NSAIDs also include Celebrex, a COX-2 inhibitor, that blocks the enzyme that causes inflammation but does not block the enzyme that protects the stomach as other NSIADS do.
Disease-modifying anti-rheumatic drugs (DMARDs)--These are drugs used to treat people with inflammatory forms of arthritis to slow down disease progression. Examples are methotrexate, Arava, Azulfidine, and Plaquenil. These drugs impact abnormalities in the immune system responsible for a perpetuation of chronic inflammation. Treatment with these medications requires careful monitoring by the physician to avoid side effects.
Corticosteroids--These are chemicals synthesized to mimic natural anti-inflammatory hormones. They are very effective in treating arthritis but also cause many side effects. Corticosteroids can be taken by mouth or given by injection. Prednisone is the corticosteroid most often given by mouth to reduce the inflammation of rheumatoid arthritis. In both rheumatoid arthritis and osteoarthritis, injections of corticosteroid into the affected joint may be given to stop pain. Because frequent injections may cause damage to the cartilage, they should be done only once or twice a year in the same joint.
GABA stimulators- such as Neurontin and Lyrica may be effective for some types of pain.
Muscle relaxants- Sometimes pain is due to muscle spasm. This is particularly true for people who have low back and neck pain syndromes. Occasionally the use of muscle relaxants help provide pain relief.
Biologic drugs--These relatively new drugs used for the treatment of rheumatoid arthritis reduce inflammation in the joints by blocking the a substance called tumor necrosis factor, an immune system protein messenger that is pivotal in producing chronic inflammation. These drugs include Enbrel, Humira, Remicade, Cimzia, and Simponi. Other biologic drugs with different mechanisms of action are also available.
Non-narcotic and narcotic analgesics- Tramadol is considered a non-narcotic analgesic. A preparation called Ultracet combines tramadol with acetaminophen. There are also a number of narcotic analgesics that are sometimes used. Despite best efforts, sometimes patients will require these medicines to control pain.
Other products--Hyaluronic acid products like Hyalgan, Supartz, Orthovisc, Euflexxa, and Synvisc mimic the naturally occurring synovial fluid that helps lubricate and nourish cartilage. These products, when injected into the knee using ultrasound guidance, help reduce pain and improve function.
• Weight reduction--Excess pounds put extra stress on weight-bearing joints such as the knees or hips. Studies have shown that overweight patients who lost as little as five pounds had symptomatic improvement in the pain of knee osteoarthritis. Other studies suggest that weight reduction can actually slow progression of disease. Research as also shown that fat cells produce pro-inflammatory cytokines, proteins that aggravate inflammation. Another reason to shed pounds.
• Exercise--Swimming, walking, low-impact aerobic exercise, and range-of-motion exercises may reduce joint pain and stiffness. In addition, stretching exercises are helpful.
• Surgery--In select patients with arthritis, surgery may be necessary. The surgeon may perform an operation to remove the synovium (synovectomy), realign the joint (osteotomy), or in advanced cases replace the damaged joint with an artificial one (arthroplasty). Total joint replacement has provided not only dramatic relief from pain but also improvement in motion for many people with arthritis.
More recently, the use of autologous stem cells and platelet-rich plasma (PRP) have greatly expanded the arsenal of physicians to help heal damaged connective tissue such as cartilage, tendon, and ligaments. Stem cells have been used with success for osteoarthritis and PRP is considered the treatment of choice for tendon issues.
Other modalities to help cope with pain include physical therapy, cognitive-behavioral therapy, occupational therapy, biofeedback, relaxation techniques (for example, deep breathing and meditation), acupuncture, and hypnosis.
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Click here Second Opinion Arthritis Treatment Kit
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