What is pain?
Pain is the body's warning system, an unpleasant sensation alerting you that something is wrong. Specialized nerve cells transmit pain signals in response to tissue damage or injury.
Most forms of arthritis are associated with two types of pain: acute and chronic. Acute pain is temporary and lasts a limited amount of time. It is related to an injury or tissue damage and goes away as healing occurs. Chronic pain ranges from mild to severe and may last for months, years or a lifetime.
What is the impact of arthritis pain?
Chronic pain is a major health problem in the United States and is one of the most debilitating effects of arthritis. More than 40 million American suffer from some form of arthritis, and many have chronic pain that limits daily activity.
What causes arthritis pain and why is it so variable?
Rheumatoid arthritis. This type of arthritis causes pain, stiffness, and swelling in the joints, especially in the joints of the wrist, hands, feet, and knees. Over time, it can also cause pain and stiffness in the shoulders, elbows, hips, and neck. It usually affects several joints at a time and both sides of the body at the same time. It is caused by inflammation.
Osteoarthritis. Osteoarthritis happens when the cartilage in the joints wears down. This causes often pain and stiffness in a joint during or after your use it. Or, you may get pain and stiffness after being inactive. Sometimes, a joint is painful when the weather changes. Over time, the joints can become inflexible. Arthritis often affects weight-bearing joints like the hips, knees and feet. Other joints can also be affected like your spine and hands.
Doctors do not yet understand completely why the pain of arthritis varies so widely from person to person.
Everyone has a different threshold and tolerance for pain. A person's subjective experience of pain is affected by both physical and emotional factors. These can include depression, anxiety and even hypersensitivity at the affected joints due to inflammation and tissue injury.
How do doctors measure arthritis pain?
Pain is a private, unique experience that cannot be seen. The most common way for a doctor to measure pain is to ask about your symptoms. The doctor may ask you to describe the intensity of your pain on a scale from one to 10. If you use terms like aching, burning, stinging, throbbing or others as appropriate, you will give the doctor a clearer idea of what type of pain you're feeling.
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. Describe factors that cause or alter your pain, the type of pain you're feeling and any steps that help alleviate it. This information will give your doctor some insight into the course of your arthritis.
Who can treat arthritis pain?
Both you and your physician should be involved in treating and managing your arthritis pain. Other health care professionals, including other medical specialists, may also play an active role but should communicate well with you and your primary physician as part of a team-based approach.
No specific pain treatment works for all people with arthritis. However, your doctor or medical team should develop a pain management plan designed to lessen your pain and improve your joint function.
What are the key points in arthritis treatment?
- Treatment depends on type of arthritis you have.
- Treatment depends on joints affected (for example, some joints may respond to splinting) and severity of symptoms (for example, sometimes surgery may be warranted-such as joint replacement).
- Treatments can include medications and non-medical treatments, for example physical therapy and exercises.
What treatments are used to provide relief for arthritis pain?
Osteoarthritis
Medications:
- Acetaminophen (e.g., Tylenol®) works well for mild pain and has fewer risks than other pain pills. Do not take more acetaminophen than recommended and do not drink alcohol when taking acetaminophen.
- NSAIDs, like ibuprofen (Motrin®, Advil®), naproxen (Aleve®) or aspirin, can help with pain. Because they can cause stomach bleeding and other problems, you should take the lowest dose you can for the shortest time you can.
- Prescription pain pills like Celebrex® may work well to relieve pain but they also have a higher chance of serious problems like heart attacks.
- Capsaicin skin cream, such as Theragen or Zostrix, can help with mild pain. Capsaicin cream also has fewer risks than pain pills.
- Corticosteroids. These drugs reduce inflammation and can be very effective in treating arthritis, although they also may have significant side effects. If needed, people with osteoarthritis usually get injections of corticosteroids directly into the affected joint. Since frequent injections may damage the joint cartilage, this procedure typically is not done more than only once or twice a year.
- Hyaluronic acid for knee osteoarthritis. This procedure involves injecting a thick fluid (hyaluronic acid-based fluid) into the knee. This is thought to improve the lubricating qualities of the knee joint.
Other therapies for osteoarthritis:
-
Heat and cold - Before using these methods, talk to your doctor or physical therapist. Moist heat, such as a warm bath or shower, or dry heat, such as a heating pad, may relieve pain if placed on the painful area of the joint for about 15 minutes. It may be especially helpful to apply heat before exercise. An ice pack or bag of frozen vegetables wrapped in a towel and placed on the sore area for about 15 minutes may help to reduce swelling and stop pain. If you have diabetes, poor circulation, nerve problems or suffer from Reynaud's phenomenon, do not use cold for pain.
-
Joint protection - Using a splint or brace to allow joints to rest and protect them from injury can be helpful. Ask your doctor or physical therapist for recommendations.
-
Massage - A therapist lightly strokes and/or kneads the painful muscle, to increase blood flow and bring warmth to a stressed body area. However, arthritis-stressed joints are very sensitive. So the therapist must be knowledgeable about arthritis.
-
Acupuncture - A landmark study has shown that acupuncture provides pain relief and improves function for people with osteoarthritis of the knee and works well when used with traditional medical care. The large study was funded by the National Institutes of Health.
Rheumatoid arthritis
-
Pain relievers - People with rheumatoid arthritis generally have pain caused by inflammation and often benefit from aspirin or other nonsteroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen (e.g., Motrin® or Advil®) or naproxen (e.g., Aleve®). Some NSAIDs are also available by prescription. Taking NSAIDs can cause upset stomach and stomach bleeding. Prescription pain pills like Celebrex may work well to relieve pain but they also have a higher chance of serious problems like heart attacks.
-
Corticosteroids - These medications reduce inflammation and can be very effective in treating arthritis, although they also may have significant side effects. Patients with rheumatoid arthritis may take prednisone by mouth.
-
Disease-modifying anti-rheumatic drugs (DMARDs) - These drugs are thought to influence and correct the abnormalities of the immune system that are responsible for diseases like rheumatoid arthritis. They include methotrexate, hydroxychloroquine, penicillamine, gold injections and newer, recently approved drugs. Treatment with these medications requires careful monitoring by a physician because of possible side effects.
-
Immunosuppressants - These medications work by suppressing your immune system, which is overactive in rheumatoid arthritis. In addition, some of these drugs attack and eliminate cells that are associated with the disease. Some of the commonly used immunosuppressants include leflunomide (Arava), azathioprine (Imuran), cyclosporine (Neoral, Sandimmune) and cyclophosphamide (Cytoxan). These medications can have potentially serious side effects such as increased susceptibility to infection.
-
Tumor necrosis factor inhibitors (etanercept, infliximab and adalimumab) or TNF blockers - These drugs selectively block parts of the immune system called cytokines, which play a role in inflammation. Within one or two weeks, most people notice less swelling, stiffness and pain. These medications work well for people who don't have much luck with DMARDs. Your doctor may give you them along with some DMARDs, particularly methotrexate. Etanercept requires injections two times per week. Infliximab is injected into a vein during a two-hour procedure. Adalimumab requires injections every two weeks.
-
Interleukin-1 inhibitor (anakrina) - This medication requires daily shots for people with moderate to severe disease who haven't responded to other therapy. It may be combined with methotrexate or used alone.
-
Rituximab - This is used with methotrexate. It targets B cells to reduce inflammation. Rituximab is intended for patients who have not improved with TNF blockers.
-
Abatacept - This medication blocks T cells, a type of white cell that plays a role in inflammation. It is to be used for patients that are not helped by other RA drugs.
- Some antidepressants can be helpful for arthritis pain. The most commonly used ones are Elavil, Pamelor and Desyrel.
Other therapies for rheumatoid arthritis
-
Prosorba column - Prosorba column is a blood-filtering device that certain antibodies that contribute to painful inflammation. It is mostly used for people who have severe rheumatoid arthritis and have not responded to other therapy. This specialized treatment is usually done in 12 weekly treatments as an outpatient procedure. This treatment isn't recommended if you heart problems, high blood pressure or blood-clotting problems.
-
Heat - Warm baths or showers, warm compresses and the careful use of heat lamps can relax your muscles and relieve pain and stiffness. Use heat for no longer than 20 minutes at a time. Be careful not to burn your skin, especially if you're an older adult or have poor circulation. Don't use heat on any red, warm joint. Notify your doctor.
-
Orthotics - Your doctor may suggest orthotic devices for your shoes. These inserts can help redistribute your weight and relieve pain.
 A word about NSAIDs
NSAIDs (nonsteroidal anti-inflammatory drugs) are commonly taken to reduce pain and swelling, although they are not for everyone. Ibuprofen, naproxen and aspirin are all NSAIDs. Talk to your doctor about whether taking NSAIDs is safe for you, especially if you:
COX-2 inhibitors
Recent information suggests that the COX-2 inhibitor celecoxib (Celebrex®) may increase the risk of heart attack and stroke. Related drugs, rofecoxib (Vioxx®) and valdecoxib (Bextra®), were removed from the market because of the risks of heart, stomach and skin problems. Ask your doctor if celecoxib is safe for you.
DO NOT STOP TAKING YOUR MEDICATIONS WITHOUT FIRST TALKING TO YOUR DOCTOR.
What things can I do to help with rheumatoid arthritis or osteoarthritis?
Weight reduction. Being overweight puts extra stress on weight-bearing joints such as the knees and hips. Studies show that losing only 11 pounds can substantially reduce the risk of developing osteoarthritis in the knees. Even if a person already has osteoarthritis in one knee, weight reduction will reduce the risk of it occurring in the other knee.
Exercise. Swimming, walking, low-impact aerobic exercise and range-of-motion exercises may reduce joint pain and stiffness. In addition, stretching exercises are helpful. Your doctor or your physical therapist can help plan an exercise program that will give you the most benefit.
People with rheumatoid arthritis should rest during flare ups to reduce damage, protect and rest the affected joints -- especially during periods of inflammation.
Surgery. Surgery may be necessary for some people with arthritis. Surgeons can operate to remove inflamed joint tissue, realign the joint or replace severely damaged joints with artificial ones. These joint replacements have disadvantages, but in appropriate cases, they can provide pain relief and improvements in motion in the involved joint.
What alternative therapies may relieve arthritis pain?
Many people look for other ways of treating their arthritis, such as special diets or supplements. Although these methods are not necessarily harmful, there also is no real proof that they help. Because the pain of arthritis may come and go, a person taking an alternative treatment may mistakenly think that the remedy worked.
It's also true that pain is a very subjective experience, and people with pain sometimes feel better simply because of their strong faith in a particular treatment. This is why researchers rely on clinical trials involving hundreds or thousands of people. In such trials, patients and doctors are not told what medications are being taken until the end of the trial, before they claim that a new method for relieving pain works.
If your doctor agrees that an alternative treatment helps you to cope without harming you, it can be incorporated into your treatment plan. However, don't let yourself be taken advantage of by unscrupulous people who promise quick and easy answers to the pain of arthritis, then sell you "remedies" that may be ineffective or even harmful. Ask your doctor before taking such a treatment.
How can I cope with arthritis pain?
Osteoarthritis and rheumatoid arthritis are chronic diseases that may last a lifetime. Learning how to manage your pain is important in controlling the disease and maintaining a good quality of life. Work with your doctor on this goal and be sure you have chosen a caring doctor whom you respect.
Stay positive. Don't dwell on negative thoughts, and use distraction or relaxation techniques to reduce your stress and focus your thoughts outside of your body on the things you enjoy. Studies show that depression, stress and anxiety increase your perception of pain. If you can improve your sense of control and mental well-being, your perception of pain may be lessened and you may feel better even if the physical causes of your pain don't change.
Try to eat a healthy diet and get enough sleep at night, again to lessen your perception of pain and increase your ability to cope with it. Join a support group with people in the same situation as yours, and stay informed about research on new methods for managing arthritis pain.
This article was reviewed and updated June 2007.
|
