Ouch! Managing pain caused by arthritis and related conditions

Ouch! Managing pain caused by arthritis and related conditions

MANAGING ARTHRITIS PAIN For people with arthritis, pain management is more complex than just taking aspirin. Arthritis is a chronic disease that can cause significant pain and discomfort. It requires a careful approach to pain management, including a combined effort involving you and your doctor. In this pamphlet, you will find a general overview of medications and other approaches to pain management. It will help you gain additional insight into pain management, but remember, it is very important you discuss this subject with your doctor to determine what specific pain management course is right for you. Getting the most out of treatment

MEDICATIONS: THE MAIN APPROACH TO PAIN MANAGEMENT The subject of pain medications for arthritis is extremely broad because there are more than 100 types of arthritis and equally as many medications. Here are a few basic considerations about the use of pain medications: Not every drug is right for every patient Most drugs have some type of side effect A combination of drugs may be appropriate for some conditions if recommended by your doctor There s a great deal of information and misinformation available about medications. That s why it s important to talk with your doctor about using, changing, or discontinuing medications Several categories of drugs are used to treat various types of arthritis.

ANALGESICS The primary purpose of an analgesic is to relieve pain. Some patients use aspirin, an analgesic that also reduces joint inflammation. The most commonly used analgesic, acetaminophen, is relatively effective and has few side effects. Acetaminophen does not contain aspirin, however, so it doesn t relieve joint inflammation. For this reason, acetaminophen is less likely to be used with rheumatoid arthritis and other types of arthritis that cause inflammation, and more likely to be used to treat osteoarthritis and fibromyalgia. The main side effect of analgesics is a slight risk of dependency that can occur if the drugs are used for long periods of time. Getting the most out of treatment

NONSTEROIDAL ANTI-INFLAMMATORY DRUGS (NSAIDS) NSAIDs are the most frequently used medications for arthritis. They are often used to treat osteoarthritis, rheumatoid arthritis, gout, juvenile arthritis, and bursitis. Some are available by prescription only, while others (such as aspirin, ibuprofen, and naproxen) can be purchased over the counter. NSAIDs help reduce redness and swelling and relieve pain. The type of NSAID that your doctor recommends for you will depend on several factors: The type of arthritis you have The degree of pain and inflammation How your body reacts to the NSAID Other medications you are taking As with all medications, there are side effects that can occur with NSAIDs. The most common side effects include constipation and stomach irritation

(ranging from indigestion and heartburn to development of ulcers if symptoms are left untreated). For this reason, your doctor will monitor you carefully, and you should report any symptoms immediately. CORTICOSTEROIDS Corticosteroids are similar to the hormone, cortisol, which occurs naturally in the body. Corticosteroids reduce painful inflammation in joints, but because of potentially serious side effects, they are rarely used as a first choice for long-term treatment. Corticosteroids are almost never used to treat osteoarthritis, and when they are prescribed for rheumatoid arthritis, it is generally to relieve severe symptoms while waiting for another drug, such as an NSAID, to reach an effective level. If they are used for a longer period of time, they are generally used in lower doses. Getting the most out of treatment

Corticosteroids can be administered orally or intravenously for pain relief throughout the body, or injected directly into an arthritic joint for quick, local pain relief. If taken orally, corticosteroids may produce such side effects as: Lowered resistance to infection (since they temporarily suppress the body s normal immune system) Weight gain Bone loss Muscle weakness Blurred vision Elevated blood pressure (occasionally) If injected into the knee joint, they do not produce side effects throughout the body, but if used repeatedly, corticosteroids can lead to joint damage.

DISEASE-MODIFYING ANTIRHEUMATIC DRUGS (DMARDS) DMARDs, used to treat rheumatoid arthritis, are usually prescribed in conjunction with NSAIDs for additional relief. DMARDs tend to work slowly and are thought to slow down or perhaps halt the progression of the disease. Because DMARDs are slow acting, their side effects may take several weeks to be noticed. Some potential side effects are flu-like symptoms (such as diarrhea and nausea) as well as mouth sores. The side effects can often be reduced by adjusting the dose. Now let s look at several specific arthritic conditions and how they are treated. Getting the most out of treatment

TREATING SPECIFIC CONDITIONS: GOUT Drugs used to treat gout break up the crystals of uric acid deposited in the joints, which cause inflammation, pain, and swelling. Side effects may include: An initial increased recurrence of gout as the body reacts to the drug (this can be managed by the use of an anti-inflammatory drug until the gout attacks gradually decrease) Hives Itching Nausea and other gastrointestinal symptoms Skin rash Headaches

OSTEOPOROSIS Although osteoporosis is a disease of the bones, it also affects the joints. Osteo-porosis is treated with drugs such as: Oral estrogen The hormone calcitonin (injected or taken via nasal spray) Alendronate, the first non-hormonal drug approved by the FDA Side effects vary according to the drug taken, but may include: Gastrointestinal problems Skin inflammation Weight gain Swelling and bloating Getting the most out of treatment

FIBROMYALGIA Fibromyalgia is often mistaken for chronic fatigue syndrome because the patients never feel fully rested. Fibromyalgia, affecting deep muscle tissues and their attachments to bone, is extremely painful. A number of drugs that are not generally used to treat other types of arthritis may be prescribed for fibromyalgia, including antidepressants and antianxiety drugs. Taken in smaller doses than for depression, these drugs can give patients the type of deep sleep they need, which contributes to pain relief and increased energy. Muscle relaxants can also promote sleep and ease painful muscles. Possible side effects vary depending on which type of medication is taken. You should discuss with your doctor the side effects of the drug prescribed for you.

Source: The Arthritis Foundation Woman With Fibromyalgia: Fibromyalgia is a puzzling condition characterized by persistent pain throughout the body or specific pain in the muscles and soft tissues. PAIN MANAGEMENT WITHOUT MEDICATION Arthritis patients have found that they may benefit from a number of other pain management techniques that do not involve medication. The most popular are described in the following sections. Getting the most out of treatment

EXERCISE It s important to remember that arthritis shouldn t be used as an excuse for a sedentary lifestyle. Inactivity can weaken and stiffen the muscles surrounding the joints and impair your joints permanently. There are many psychological benefits from exercise. Arthritis patients report that even a limited program of exercise will contribute to an overall sense of well-being and vigor. If you have arthritis, you will need to determine what types of exercise will benefit your condition. Your doctor should be your first source of information. Physical therapists, nurses, and other health professionals who are experienced in working with arthritis patients can also assist you in developing an exercise program that is most beneficial.

SLEEP Not getting a good night s sleep is a problem for many people with arthritis. If your pain continually awakens you, you may never reach Stage 3 sleep - the deep sleep that s needed for true rest. And your fatigue can worsen your pain. There are many sources of information about getting a better night s sleep - magazine articles, books, Web sites, etc., and you should consult with your doctor, nurse, or therapist. STRESS MANAGEMENT Stress can have a physical and psychological impact on the mind and body. Stress can lead to tense muscles, headache, nervousness, anxiety, and indigestion. It s important to learn how to react to stressful situations and avoid these effects that could worsen the physical symptoms of arthritis. Getting the most out of treatment

Source: The Arthritis Foundation Here are some techniques to help you control or reduce stress in your life: Identify the Cause of Stress: If it s something that can be changed, make the change (avoiding people who always irritate you, for instance) and work on being calmer about things that can t be changed (such as when the person who irritates you is a relative). Share Your Thoughts and Feelings: Discussing them with a spouse, friend, physician, or counselor can help work out the stress and provide an opportunity to identify ways to better manage the situation.

Manage Your Time and Conserve Energy: Rest is important for everyone, but it s particularly important for arthritis patients. Being overtired worsens arthritis pain. Try to anticipate fatigue and rest before you get really tired. Make Time for Relaxation and Fun: Research has found that laughter can have a positive physiological effect on the body - the release of chemicals called endorphins cause a feeling of happiness, and the actual process of laughing can be similar to an aerobic workout. MASSAGE THERAPY Massages can provide temporary relief for sore muscles by increasing blood flow. However, arthritis patients should avoid massage therapy if joints are tender or inflamed since the tenderness could worsen. If you have a massage, it is best to notify the therapist of your condition and clarify Getting the most out of treatment

that you want a gentle approach. Your doctor, physical therapist, or other health professional may be able to recommend massage therapists who specialize in working with arthritis patients. RELAXATION THERAPY Relaxation therapy involves more than sitting down and being inactive. It is a learned technique to help you relieve tension by entering a deeper state of relaxation that, for many people, lowers blood pressure, respiratory rate, and adrenaline flow. As your muscles relax, your body releases pain-relieving hormones called endorphins. The release of muscle tension is a relief from an unconscious source of pain and discomfort. Although there are many variations and techniques, following are some general guidelines. Your doctor, nurse, or therapist may be able to recommend other specific techniques that work best for your situation, such as imagery, relaxation, or progressive muscle relaxation.

Establish a Suitable Environment: Find a quiet area where you will have as few distractions as possible. Get in a comfortable position, sitting or lying down. Breathe Slowly and Deeply: Concentrate on feeling the air move in and out of your body. Really fill your lungs with air, so it feels as if your rib cage is moving out. Hold your breath for just a second, and then very slowly let the air out. Don t actively exhale or push it out; just drop your jaw (which also is a relaxing motion) and let the air slowly flow out. Ideally, you will begin to associate deep breathing with feeling relaxed. Focus Your Attention on Your Body: Begin with the tips of your toes. Imagine each part of your body becoming lighter, calmer, and floating. Work up from your toes to feet, ankles, calves, etc. Take it very slowly so that by the time you ve reached your head, you almost feel as if your body is lighter than air. Concentrate on relieving the tension in each part of your body as you breathe deeply. Imagine the soothing feeling of your muscles relaxing. Getting the most out of treatment

BIOFEEDBACK Biofeedback therapy uses electronic instruments to monitor and measure your body s reaction to stress. You learn when and how you react to stress, and then you monitor the results of stress management and relaxation techniques. The feedback allows you to actually see or hear the effect of various stress management techniques on your own body and compare the results. There are many methods for measuring the body s response to stress. The following are some examples. Skin Temperature Method: This method measures the skin s temperature in response to the effects of adrenaline. During times of danger or stress, the adrenaline in your system diverts blood from the body surface to critical organs, which causes the skin temperature to drop.

Skin Electrical Resistance: Under stress, the body sweats more. Moist skin conducts electricity more effectively than dry skin. Biofeedback measures how easily electricity is conducted between two electrodes on the skin. Muscle Electrical Activity Method: This system measures the electrical activity of muscles under the surface of the skin. When an individual is tense, muscles tighten up, which can be measured as increased electrical activity. After you have learned and practiced stress management and relaxation techniques, you should repeat the measurements so you can literally see how your stress responses have changed. Many individuals find that biofeedback therapy is useful because it provides measurable results (seen or heard) in reaction to their stress management. The results, however, can vary according to each person s ability to follow through on managing stress. Getting the most out of treatment

HOT / COLD TREATMENT The use of hot and cold treatments to reduce pain and stiffness due to arthritis can be very effective, especially in conjunction with other pain management techniques. For tense muscles and joints, heat can stimulate blood flow and relax muscles. For inflammation, cold treatments can reduce swelling, by reducing blood flow. Check with your doctor to find the most effective method of treatment for your condition, gain the most from your therapy, and feel the best you can every day. Another therapy for the relief of the pain of osteoarthritis specifically in the knee is called viscosupplementation. This is a way to relieve arthritis pain without drugs or surgery.

VISCOSUPPLEMENTATION The treatment takes place in your doctor s office. It involves a series of injections into the knee, using a clear fluid made from a natural substance called sodium hyaluronate. This biological, nondrug product reduces the stiffness in the knee joint, relieves the pain, and allows you to move easier. Getting the most out of treatment

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