Non-invasive treatment for joint pain
There is an immense variety of noninvasive non-drug pain management techniques available for treating joint pain. A few of the most widely accepted in comprehensive pain management programs are the following: • Exercise—physical exertion with the aim of training or improvement. Includes water therapy, flexion exercises, aerobic routines, and many others. May involve active, passive, and resistive elements. Exercise is necessary for proper cardiovascular health, disc nutrition, and musculoskeletal health. • Manual techniques—manipulation of affected areas by means of chiropractic adjustments, osteopathy, massage therapy and other techniques. Some evidence for the effectiveness of certain techniques is available. • Behavioral modification—use of behavioral methods to optimize patient responses to joint pain and painful stimuli. Cognitive therapy involves teaching the patient to alleviate pain by means of relaxation techniques, coping techniques, and other methods. Biofeedback involves the gradual alteration of neuromuscular signals for symptomatic improvement. • Cutaneous stimulation —superficial heating or cooling of skin. These pain management methods include cold packs and hot packs, and should be used in conjunction with exercise. Cold and heat are used for different situations, more specifically, cold is used for acute stages of RA while heat is used during chronic stages. Heat, therefore, is more commonly used before generally activities such as exercise. Applications of heat are recommended for 10-20 minutes once or twice a day. Caution is necessary in all patients due to the obvious burn risk. Cold application is preferred for more specific areas where heat is not desired. There are also efforts underway to determine the effect of longer-range heat/cold treatment for the musculoskeletal system. • Hydrotherapy is also known as balneotherapy. Balneotherapy has long been a practice of RA sufferers searching for something to alleviate the pain. Initially, the term "balneotherapy" was used to discriminate thermal and mineral water therapy from hydrotherapy, but today these terms are often used interchangeably. In recent years, balneotherapy has served as one of the therapeutic alternatives in other rheumatoid diseases, particularly in chronic degenerative diseases. Objectives of balneotherapy are to increase the patient's range of motion, to strengthen muscles, to relieve painful muscle spasms, and to improve the patient's well-being. • Electrotherapy —the most commonly known form of electrotherapy is transcutaneous electrical nerve stimulation (TENS). TENS therapy attempts to reduce pain by means of a low-voltage electric stimulation that interacts with the sensory nervous system. Randomized controlled trials have yielded either positive or neutral results regarding the efficacy of TENS as a treatment for joint pain. Electrical stimulation therapy is also being studied. Electrostimulation is used in RA patients to relieve pain
Pain relievers and related drugs are used at every stage of the medical treatment of joint pain, from the initial onset of acute pain to facilitation of rehabilitation, treatment of chronic joint pain. The most common noninvasive pharmacologic treatments for chronic joint pain are: • Analgesics—includes acetaminophen. Long-term use involves risk of renal damage. • Nonsteroidal anti-inflammatory agents (NSAIDs)—includes aspirin, ibuprofen, naproxen, and the new COX-2 inhibitors. • Muscle relaxants—used to treat muscle spasms due to pain and protective mechanisms. • Narcotic medications—most appropriate for acute or post-operative pain. Since use of narcotics entails risk of habituation or addiction if not properly supervised, they are not often used for chronic conditions. • Antidepressants and anticonvulsants—used to treat neuropathic (“nerve”) pain. • GABA stimulators- Neurontin or Gabatril are oral medicines that often are very effective. They act on central GABA stimulators in the brain. • Patches- Lidoderm patch is an anesthetic patch that is useful for superficial joint pain. The PATCH is a device used to deliver a low dose of glucocorticoid to an area of pain. This is often effective for tendonitis and bursitis. Duragesic is a narcotic patch that delivers a low dose of fentanyl over a 3 day period.
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