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. It can last a few seconds or longer but 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?
The pain of arthritis may come from different sources, such as inflammation of joint tissue, tendons or ligaments muscle strain and fatigue. A combination of these factors contributes to the intensity of the pain.
Doctors do not yet understand completely why the pain of arthritis varies so widely from person to person. Factors that contribute to pain include swelling within the joint, the severity of inflammation (associated with heat or redness), and the extent of damage within the joint. Activities affect pain differently: Some patients note joint pain after first getting out of bed in the morning, while others develop pain after prolonged use of the joint.
Each individual 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 you 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 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 minimize your specific pain and improve your joint function.
What treatments are used to provide short-term relief for arthritis pain?
Because people with osteoarthritis have little or no inflammation, pain relievers like acetaminophen (e.g., Tylenol®) may be effective. 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®).
- Heat and cold
The effectiveness of either heat or cold for joint pain depends on the type of arthritis; before using these methods for pain relief, discuss them with 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. 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 poor circulation 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.
- Transcutaneous electrical nerve stimulation (TENS)
TENS works by blocking pain messages to the brain and modifying your perception of pain. A small electronic device is used to send mild electric pulses to nerve endings beneath the skin in the painful area. This technique may relieve some arthritis pain. Studies are ongoing to determine the effectiveness of TENS in relieving arthritis pain.
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.
This procedure should only be done under sanitary conditions by a licensed acupuncture therapist. The therapist inserts thin needles at specific points in the body. Scientists think that this stimulates the release of natural, pain-relieving chemicals produced by the brain or nervous system.
What treatments are used to provide long-term relief for arthritis pain?
- Nonsteroidal anti-inflammatory drugs (NSAIDs)
These drugs, which include aspirin and ibuprofen, reduce pain and inflammation and may be used for both short- and long-term pain relief for people with osteoarthritis or rheumatoid arthritis.
- 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.
These drugs 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, while patients with either osteoarthritis or rheumatoid arthritis may receive injections of corticosteroids directly into the affected joint. Since frequent injections may damage the joint cartilage, this procedure should be done only once or twice a year.
- 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 — and even if a person already has osteoarthritis in one knee, weight reduction will reduce the risk of it occurring in the other knee.
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.
Surgery may be necessary in certain patients with arthritis. Surgeons can perform operations 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 not only pain relief but also improved 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 doing any harm, 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. Consider carefully whether the claims of an alternative treatment are reasonable or likely and ask your doctor before taking such a treatment.
How can you 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. Be sure that you and your doctor are working together on this goal and that you have chosen a caring doctor whom you respect.
Maintain a positive attitude. 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 will be lessened and you will 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.