Arthritis 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

The word arthritis means joint inflammation. It refers to a group of more than 100 rheumatic diseases that can cause joint pain, stiffness, and swelling.

These diseases affect not only the joints but also other supporting structures such as muscles, bones, tendons, and ligaments, as well as internal organs.

Pain is a warning mechanism. 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. Neurons, nerve cells, transmit pain signals from the periphery to the central nervous system. An example might be if a person cuts himself, chemical signals travel from neurons in the skin to the spinal cord and on to the brain, where the perception of pain is produced.

Arthritis related pain can be either acute or chronic. Acute pain is temporary. An example might be a muscle strain or a "crick in the neck." Chronic pain, such as that seen with osteoarthritis and rheumatoid arthritis can last a lifetime.

Almost 70 million Americans are affected by some form of arthritis, and many have chronic pain that limits their daily activity. Osteoarthritis is by far the most common form of arthritis, affecting more than 30 million people, while rheumatoid arthritis affects approximately 2.1 million Americans.

The pain of arthritis comes from different sources. These may include inflammation of the synovial membrane (tissue that lines the joints), the tendons, or the ligaments; and muscle strain.

The pain of arthritis varies greatly from person to person. Each individual has a different tolerance for pain.

The assessment of pain is important in making a diagnosis and creating a treatment program. The doctor may ask the patient to describe the level of pain on a scale from 1 to 10. Descriptive terms such as aching, burning, stinging, or throbbing also provide clues.

A pain diary that describes the intensity of pain as well as the severity, and the personal response can be helpful.

The doctor will usually do the following:

• Take a medical history and ask questions such as, How long has the pain been going on? How intense is the pain? How often does it occur? What causes it to get worse? What causes it to get better?

• Review the medications a patient is taking

• Do a physical examination

• Order laboratory tests

• Order imaging procedures such as a CAT scan (computerized axial tomography) or MRI (magnetic resonance imaging) to help with diagnosis.

Once the doctor has all the data, he or she can design a comprehensive management approach for the pain.

Different specialists may be involved in the care of a patient with arthritis including rheumatologists, orthopedists, and physical and occupational therapists.

Short-Term Relief

• Medications--Some people may do fine with simple analgesics such as acetaminophen. Others may require stronger medicines such as such as non-steroidal anti-inflammatory drugs (NSAIDs), examples of which are ibuprofen and naproxyn. While these drugs are available over-the-counter, stronger prescription strength NSAIDS may be needed.

• Heat and cold-- Some problems respond to moist heat; others to cold. A physician or physical therapist should be consulted. Moist heat, such as a warm bath or shower, or a heating pad, 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. Patients with circulation problems should not use cold packs.

• Joint protection--A splint or a brace to rest and protect joints can be helpful.

• Transcutaneous electrical nerve stimulation (TENS)--A TENS device-about the size of a pack of cigarettes- that transmits mild electric impulses to nerve endings in the skin may relieve arthritis pain. TENS works by blocking pain signals to the brain, much like acupuncture.

• Massage-- increases blood flow to the painful area. It's particularly useful for sore muscles arising from stress or overactivity.

Long-Term Relief


Biologics- drugs used for the treatment of inflammatory forms of arthritis that reduce inflammation by blocking different cytokines, protein messengers responsible for perpetuating chronic inflammation.
Non-steroidal anti-inflammatory drugs (NSAIDs)--These are used to reduce pain and inflammation and may be used for both short-term and long-term relief in people with different types of arthritis.

Disease-modifying antirheumatic drugs (DMARDs)--These drugs are slow down the progression of immune-driven forms of arthritis. Treatment with these medications requires careful monitoring by the physician to avoid side effects.

Corticosteroids--These are chemical derivatives that mimic the action of the hormone, cortisol. They are 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 orally to reduce the inflammation of rheumatoid arthritis. In both rheumatoid arthritis and osteoarthritis, the doctor also may inject a corticosteroid into the affected joint to relieve pain. Because frequent injections may cause damage to the cartilage, they should be done only once or twice a year in a given joint.

Other products--Hyaluronic acid products like Hyalgan, Supartz, Euflexxa, Orthovisc, and Synvisc mimic naturally occurring synovial fluid that lubricates and nourishes cartilage. They relieve pain and improve function.

• Weight reduction--Studies have shown that losing as little as five pounds can greatly improve symptoms of knee osteoarthritis (OA). Other studies have demonstrated that weight loss slows OA progression. Recent research has indicated that fat cells produce inflammatory cytokines that perpetuate inflammation.

• Exercise--Swimming, walking, low-impact aerobic exercise, and range-of-motion exercises may reduce joint pain and stiffness. In addition, stretching exercises are helpful. 20

• Surgery--Surgery may be necessary. The surgeon may perform an operation to remove inflamed synovium (synovectomy), realign the joint (osteotomy), or in advanced cases replace the damaged joint with an artificial one (arthroplasty).

Another option is the use of guided autologous stem cell layering. This approach supplemented by the use of platelet-rich plasma (PRP) has helped to restore osteoarthritic cartilage and damaged tendon tissue.In addition to pain relief, the need for surgery is often avoided.

Alternative or complementary therapies have also been used. For example, people have tried acupuncture. Others have tried glucosamine and chondroitin sulfate, two natural substances found in cartilage, for osteoarthritis of the knee.

Get more information about arthritis pain and related conditions as well as...

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Click here Second Opinion Arthritis Treatment Kit

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