ARTHRITIS PAIN AND RELIEF
The pain of arthritis may come from different sources. These may include inflammation of the synovial membrane (tissue that lines the joints), the tendons, or the ligaments; muscle strain; and fatigue. A combination of these factors contributes to the intensity of the pain.
The pain of arthritis varies greatly from person to person for reasons that doctors do not understand completely. Factors contributing to the pain include swelling within the joint, the amount of heat or redness present, or damage that has occurred within the joint. In addition, activities affect pain differently so that some patients do not have pain in their joints after first getting out of bed in the morning, whereas others develop pain after prolonged joint use. Each individual has a different threshold and tolerance for pain, often affected by physical and emotional factors. These can include depression, anxiety, and hypersensitivity at the affected sites due to inflammation and tissue injury. This increased sensitivity appears to affect the amount of pain the individual perceives.
MEASURING ARTHRITIS PAIN
Pain is a private, unique experience that cannot be seen. The most common way to measure pain is for the doctor to ask you, the patient, about your problems. For example, the doctor may ask you to describe the level of pain you feel on a scale of 1 to 10. You may use words like aching, burning, stinging, or throbbing. These words will give the doctor a clearer picture of the pain you are experiencing. Since doctors rely on your description of pain to help guide treatment, you may want to keep a pain diary to record your pain sensations. Daily, you can describe the situations that cause or alter the intensity of your pain, the feelings and severity of your pain, and your reactions to the pain. For example:
“On Sunday night, sharp pains in my knees produced by housework interfered with my sleep; on Monday morning, because of the pain, I had a hard time getting out bed. However, I coped with the pain by taking my medication and applying ice to my knees.”
The diary will give the doctor some insight into your pain and may play a critical role in managing your disease.
What will happen when you first visit a Doctor for your Arthritis Pain?
The doctor will usually do the following:
• Take your medical history and ask questions such as: How long have you had this problem? 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 you are using.
• Conduct a physical examination.
• Take blood and urine samples and request necessary laboratory work.
• Ask you to get X-rays taken or undergo other imaging procedures such as a CAT scan (Computerized Axial Tomography) or MRI (Magnetic Resonance Imaging).
Once the doctor has done these things and reviewed the results of any tests or procedures, they will discuss the findings with you and design a comprehensive management approach for the pain caused by your osteoarthritis or rheumatoid arthritis.
WHO CAN TREAT ARTHRITIS PAIN?
Several specialists may be involved in the care of an arthritis patient—often, a team approach is used. The team may include doctors who treat people with arthritis (rheumatologists), surgeons (orthopaedists), and physical and occupational therapists. Their goal is to treat all aspects of arthritis pain and help you learn to manage your pain. The physician, other health care professionals, and you, the patient, all play an active role in managing arthritis pain.
TREATMENT
There is no single treatment that applies to all people with arthritis, but rather the doctor will develop a management plan designed to minimize your specific pain and improve the function of your joints. Several treatments can provide short-term pain relief.
SHORT-TERM RELIEF
Medications: Because people with osteoarthritis have minor inflammation, pain relievers such as acetaminophen (Tylenol) may be effective. Patients with rheumatoid arthritis generally have pain caused by inflammation and often benefit from aspirin or other nonsteroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen.
Heat and Cold: The decision to use either heat or cold for arthritis pain depends on the type of arthritis and should be discussed with your doctor or physical therapist. Moist heat, such as a warm bath or shower, or dry heat, such as a heating pad, placed on the painful area of the joint for about 15 minutes may relieve the pain. An ice pack wrapped in a towel and placed on the sore spot for about 15 minutes may help to reduce swelling and stop the pain. If you have poor circulation, do not use cold packs.
Joint Protection: Using a splint or a brace to allow joints to rest and protect them from injury can be helpful. Your physician or physical therapist can make recommendations.
Transcutaneous Electrical Nerve Stimulation (TENS): A small TENS device that directs mild electric pulses to nerve endings that lie beneath the skin in the painful area may relieve some arthritis pain. TENS seems to work by blocking pain messages to the brain and modifying pain perception.
Massage: In this pain-relief approach, a massage therapist lightly strokes and kneads the painful muscle. This may increase blood flow and bring warmth to a stressed area. However, arthritis-stressed joints are susceptible, so the therapist must be very familiar with the problems of the disease.
Acupuncture: This procedure should only be done by a licensed acupuncture therapist. In acupuncture, thin needles are inserted at specific points in the body. Scientists think this stimulates the release of natural, pain-relieving chemicals produced by the brain or the nervous system.
Osteoarthritis and rheumatoid arthritis are chronic diseases that may last a lifetime. Learning to manage your pain over the long term is an essential factor in controlling the disease and maintaining a good quality of life. Following are some sources of long-term pain relief.
LONG-TERM RELIEF
Medications: Nonsteroidal anti-inflammatory drugs (NSAIDs)—These are a class of drugs, including aspirin and ibuprofen, used to reduce pain and inflammation and may be used for short-term and long-term relief in people with osteoarthritis and rheumatoid arthritis.
Disease-modifying anti-rheumatic drugs (DMARDs) are used to treat people with rheumatoid arthritis who have not responded to NSAIDs. Some of these include methotrexate, hydroxychloroquine. Penicillamine and gold injections. These drugs are thought to influence and correct immune system abnormalities responsible for a disease like rheumatoid arthritis. Treatment with these medications requires careful monitoring by the physician to avoid side effects.
Corticosteroids: These are hormones that are very effective in treating arthritis. 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, the doctor also may inject a corticosteroid into the affected joint to stop the pain. Because frequent injections may cause damage to the cartilage, they should only be done once or twice a year.
Weight reduction: Excess pounds stress weight-bearing joints such as the knees or hips. Studies have shown that overweight women who lost an average of 11 pounds substantially reduced the development of osteoarthritis in their knees. In addition, if osteoarthritis has already affected one knee, weight reduction will reduce the chance of it occurring in the other knee.
Exercise: Swimming, walking, low-impact aerobic, and range-of-motion exercises may reduce joint pain and stiffness. In addition, stretching exercises are helpful. A physical therapist can help plan an exercise program that will benefit you most.
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. Total joint replacement has provided dramatic relief from pain and motion improvement for many people with arthritis.
TO COPE WITH ARTHRITIS PAIN
The long-term goal of pain management is to help you cope with a chronic, often disabling disease. You may be caught in a cycle of pain, depression and stress. To break out of this cycle, you must actively participate with the doctor and other healthcare professionals in managing your pain. This may include physical therapy, cognitive-behavioural therapy, occupational therapy, biofeedback, relaxation techniques (for example, deep breathing and meditation), and family counseling therapy.
Another technique is to substitute distraction for pain. Focus your attention on things that you enjoy. Imagine a peaceful setting and incredible physical sensations. Thinking about something enjoyable can help you relax and become less stressed. Find something that will make you laugh—a cartoon, a funny movie, or even a new joke. Try to put some joy back into your life. Even a tiny change in your mental image may break the pain cycle and provide relief.
RESEARCH ON ARTHRITIS PAIN
Recent NIAMS studies show that levels of several neuropeptides (compounds produced by nervous system cells), such as substance P, are increased in arthritic joints. Substance P is involved in transmitting pain signals via the nervous system. At the University of Missouri, researchers study the effects of P on the spines of animals with chronic arthritis. Findings from this study may be used to develop specific drugs for chronic pain, such as that associated with arthritis.
Researchers are also studying the human knee and analyzing how injury in one joint may affect other joints. In addition, they are investigating the effect of pain and analgesics on gait (walking) and comparing pain and rate before and after surgical treatment of knee osteoarthritis.