Muscular skeletal inflammation
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.
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Joint inflammation is a key sign of arthritis. The cardinal signs of inflammation are swelling, redness, heat, and pain. Inflammation is due to the action of inflammatory cells that kill their targets by either ingesting them directly, releasing proteolytic enzymes that digest cell membranes, or by the production of toxic oxygen species that penetrate into target tissues. The process of inflammation is complex and consists of multiple types of cells, cytokines, and enzymes.
Inflammation can be generalized and due to an autoimmune process as in rheumatoid arthritis… or it can occur locally as a result of bruising, infection, burns, headaches, and sprains and strains. Caution should be taken when treating inflammation without understanding its cause—this may delay or confuse diagnosis.
Over the counter nonsteroidal anti-inflammatory drugs (NSAIDs), including aspirin , ibuprofen , and naproxen , are commonly used for mild inflammation.
Prescription strength NSAIDs, including ibuprofen, naproxen , etodolac , and indomethacin , are prescribed when over the counter products are ineffective. Oral corticosteroids such as prednisone and methylprednisolone are often prescribed to reduce severe inflammation.
More recently, biologic agents have been developed to treat more serious inflammatory conditions. These drugs are very effective for inducing remission.
Since pain and inflammation go together, there has been much interest in the use of herbal remedies for inflammation.
Capsaicin is an extract of cayenne pepper that may ease many types of chronic pain when applied regularly to the skin. In animal studies, capsaicin was consistently effective at reducing
pain when given by mouth, by injection, or when applied topically. A controlled trial in humans found that application of a solution of capsaicin (0.075%) decreased sensitivity of skin to all noxious stimuli. In several uncontrolled and at least five controlled clinical trials, capsaicin has been consistently shown to decrease the pain of many disorders, including trigeminal neuralgia, shingles, diabetic neuropathy, osteoarthritis, and cluster headaches. For treatment of chronic pain, capsaicin ointment or cream (standardized to 0.025 to 0.075% capsaicin) is typically applied to the painful area four times per day. It is common to experience stinging and burning at the site of application, especially for the first week of treatment; avoid getting it in the eyes, mouth, or open sores.
As early as 1763, use of willow bark to decrease pain and inflammation was reported. Its constituents are chemically related to aspirin.
In animal research, alcohol/water extracts of plants from the genus phyllanthus (25 to 200 mg per 2.2 pounds body weight) have shown a marked ability to decrease pain. This family includes the plants Phyllanthus urinaria, P. caroliniensis, P. amarus, and P. niruri. Like aspirin, phyllanthus extracts appear to reduce pain by decreasing inflammation.
Other herbs that have been historically used to relieve musculoskeletal pain include valerian, passion flower, American scullcap, Piscidia erythrina, and crampbark (Viburnum opulus).
Transcutaneous electrical nerve stimulation (TENS) is a form of electrical physical therapy that has been used in the treatment of musculoskeletal pain since the early 1970s. A review of the first ten years of research on TENS described success rates in treating chronic pain varying from 12.5% to 92% after one year of treatment. Variations in success rates were attributed to differences in the type of pain the TENS was treating.
Acupuncture has been shown to decrease pain by acting on the enkephalin-based, pain-killing pathways. In 1997, the National Institutes of Health (NIH) stated that acupuncture is useful for muscular, skeletal, and generalized pain, as well as for anesthesia and post-operative pain.
Practitioners of manipulation report that it often produces immediate pain relief either in the area manipulated or elsewhere. Controlled trials have found that people given spinal manipulation may experience reduction in pain sensitivity of the skin in related areas, a reduction in joint and muscle tenderness in the area manipulated, and a decrease in elbow tenderness when the neck was manipulated. Some researchers have speculated that joint manipulation affects pain by enhancing the effects of endorphins. However, only one of three controlled studies has shown an effect of manipulation on endorphin levels.
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