Relief for pain and swelling of arthritis
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
Pain and swelling are two of the four cardinal signs of inflammation, the other two being redness and heat.
With arthritis the three main goals of therapy are to reduce pain, improve function, and slow progression of disease.
Inflammation, while the subject of intense investigation, is still poorly understood. And pain- why people feel pain and why people vary so much in their ability to endure pain- is also poorly understood.
This is the reason why there are so many medicines available... but also why everyone will respond differently to what is given to them.
There are multiple drugs available for the pain control of arthritis. While over-the-counter (OTC) medicines help to a certain extent, more severe arthritis pain is best managed using prescription medicines.
Analgesics are drugs that help relieve pain, but not inflammation. They are helpful if you need relief from pain only, are allergic to aspirin, or have had an ulcer. Acetaminophen is one example of an analgesic that gives temporary relief of common arthritis pain, but does not reduce swelling. It is available without a prescription. Tramadol (Ultram) is another analgesic pain medicine. Narcotic pain relievers are sometimes used for patients with severe arthritis pain when all other therapies have failed. Narcotics are available in pill form and also as patches. An example of the latter is the Duragesic patch which dispenses fentanyl.
Narcotics and other strong painkillers have been prescribed mainly for short-term and intense pain. But some physicians believe that with careful monitoring these types of drugs can be effective in treating chronic pain. Narcotics such as morphine and codeine reduce pain by blocking pain signals that are traveling to the brain.
Non-steroidal anti-inflammatory drugs (NSAIDs) help reduce joint pain, stiffness and swelling. NSAIDs cut down on the production of prostaglandins, which are substances in the body that help send pain messages to the brain. Examples of NSAIDs include aspirin, ibuprofen and naproxen sodium. Other NSAIDs are available by prescription only. Examples are Celebrex, Mobic, Voltaren, Daypro, Relafen, and Lodine. NSAIDs can cause the side effect of stomach upset. Concern regarding the potential for cardiovascular side-effects such as heart attack and stroke is also present.
Glucocorticoids are drugs related to the natural hormone in your body called cortisol. Scientists have developed synthetic forms of cortisone that can be taken in pill form or injected directly into joints or other tissues. These drugs help relieve pain by reducing swelling and inflammation in the area. Glucocorticoid injections must be monitored carefully; side effects can occur if injections are administered too frequently.
Disease-modifying antirheumatic drugs (DMARDs) often are used to control inflammatory conditions such as rheumatoid arthritis. While their main function is to slow down and/or suppress the immune system, these drugs also can help relieve pain. The drugs may take several weeks or months to begin working. Examples of DMARDs used for conditions such as rheumatoid arthritis include methotrexate, hydroxychloroquine, azathioprine, azulfidine and lefunomide.
Biologic agents are used to suppress arthritis inflammation. These include: Enbrel, Humira, Kineret, Remicade, Simponi, and Cimiza in the anti-TNF class. Other biologics with different modes of action are Orencia, Actemra, Rituxan, and Xeljanz.
Both DMARDS and biologics are designed to induce remission. These drugs are usually effective for most of the serious forms of arthritis such as rheumatoid arthritis and psoriatic arthritis. Unfortunately, osteoarthritis, the most common form of arthritis, lacks this DMARD and biologic armamentarium.
Antidepressants, in addition to relieving depression, also can help relieve chronic pain. They are typically prescribed for the chronic pain of fibromyalgia rather than for arthritis. These drugs work by blocking pain messengers in the brain. Antidepressants are sometimes used to help people with arthritis break out of the pain and depression cycle. These drugs also can help improve sleep quality, which in turn may help reduce pain. The doses used to treat pain and sleep problems are usually lower than those used for depression. Three major groups are the tricyclics, the selective serotonin reuptake inhibitors, and the selective serotonin and nor-epinephrine reuptake inhibitors. Cymbalta, one of the latter group of medicines, has been approved for use against the pain of osteoarthritis.
GABA stimulators are also being used for chronic pain. These include drugs such as Neurontin and Lyrica.
Topical pain relievers can temporarily relieve the pain of arthritis. They include creams, rubs and sprays that are applied to the skin over a painful muscle or joint. Some topical pain relievers may contain combinations of salicylates, skin irritants and local anesthetics that relieve pain in one area. Most topicals are available without prescription.
Other over-the-counter topical creams containing capsaicin (the chemical that makes chili peppers taste "hot") may be used alone or with other medications to temporarily relieve pain. When applied as directed to joints affected by arthritis, the medication usually begins to work within one to two weeks. It works by decreasing a substance in the nerves called "substance P," which sends pain signals to the brain. Some people may at first feel a burning or stinging sensation where capsaicin is applied, but this usually goes away with repeated applications.
Serious skin burns have been reported with these agents.
Tranquilizers can help reduce painful muscle tension and spasms in some types of arthritis or related conditions. However, these drugs can be addictive if they are used for a long period of time.
Muscle relaxants, such as cyclobenzaprine or carisoprodol, may relieve pain by decreasing muscle spasms that often trigger pain signals. Like tranquilizers, however, they should only be used for brief periods of time. Both tranquilizers and muscle relaxants require prescription.
In addition to medication, physical and occupational therapy may be of benefit in reducing inflammation and pain. The use of different modalities such as ultrasound, diathermy, cold, and electrical stimulation are valuable. Chiropractic and osteopathic manipulation often relieve pain.
Alternative therapies such as herbs, acupuncture, hypnosis, guided visualization, and diet are also helpful.
More aggressive invasive procedures such as arthroscopy (looking inside a joint with a small telescope and removing damaged or diseased tissue) and joint replacement surgery may be required.
Get more information about relief for pain and swelling of arthritis and related conditions as well as...
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Second Opinion Arthritis Treatment Kit
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