What
Is Arthritis?
The
word arthritis literally means joint inflammation,
but it is often used to refer to a group of more than 100
rheumatic diseases that can cause pain, stiffness, and swelling
in the joints. These diseases may affect not only the joints
but also other parts of the body, including important supporting
structures such as muscles, bones, tendons, and ligaments,
as well as some internal organs. This booklet focuses on pain
caused by two of the most common forms of arthritis--osteoarthritis
and rheumatoid arthritis.
What Is Pain?
Pain is the body's warning system,
alerting you that something is wrong. The International Association
for the Study of Pain defines it as an unpleasant experience
associated with actual or potential tissue damage to a person's
body. Specialized nervous system cells (neurons) that transmit
pain signals are found throughout the skin and other body
tissues. These cells respond to things such as injury or tissue
damage. For example, when a harmful agent such as a sharp
knife comes in contact with your skin, chemical signals travel
from neurons in the skin through nerves in the spinal cord
to your brain, where they are interpreted as pain.
Most forms of arthritis
are associated with pain that can be divided into two general
categories: acute and chronic. Acute pain is temporary. It
can last a few seconds or longer but wanes as healing occurs.
Some examples of things that cause acute pain include burns,
cuts, and fractures. Chronic pain, such as that seen in people
with osteoarthritis and rheumatoid arthritis,
ranges from mild to severe and can last weeks, months, and
years to a lifetime.
How Many Americans Have Arthritis
Pain?
Chronic pain is a major health problem in the
United States and is one of the most weakening effects of
arthritis. More than 40 million Americans
are affected by some form of arthritis, and
many have chronic pain that limits daily activity. Osteoarthritis
is by far the most common form of arthritis, affecting over
20 million Americans, while rheumatoid arthritis,
which affects about 2.1 million Americans, is the most disabling
form of the disease.
What Causes Arthritis Pain?
Why Is It So Variable?
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 yet understand completely. Factors that contribute 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 note pain in their joints after first
getting out of bed in the morning, whereas others develop
pain after prolonged use of the joint. Each individual has
a different threshold and tolerance for pain, often affected
by both physical and emotional factors. These can include
depression, anxiety, and even hypersensitivity at the affected
sites due to inflammation and tissue injury. This increased
sensitivity appears to affect the amount of pain perceived
by the individual. Social support networks can make an important
contribution to pain management.
How Do Doctors Measure 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 difficulties. 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. You can begin a week or two
before your visit to the doctor. On a daily basis, you can
describe the situations that cause or alter the intensity
of your pain, the sensations and severity of your pain, and
your reactions to the pain. For example: "On Monday night,
sharp pains in my knees produced by housework interfered with
my sleep; on Tuesday 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 the management of 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 been experiencing pain? 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 to determine causes of pain and how
this pain is affecting your ability to function
- Take
blood and/or 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) to see how much joint damage
has been done.
Once
the doctor has done these things and reviewed the results
of any tests or procedures, he or she 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?
A number of different specialists
may be involved in the care of a patient with arthritis--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 the management
of arthritis pain.
How Is Arthritis Pain Treated?
There is no single treatment that applies to
everyone with arthritis, but rather the doctor
will develop a management plan designed to minimize your specific
pain and improve the function of your joints. A number of
treatments can provide short-term pain relief.
Short-Term Relief
- Medications--Because
people with osteoarthritis have very little 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
(Motrin or Advil).
- 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 (or a
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 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 by modifying pain perception.
- Massage--In
this pain-relief approach, a massage therapist will lightly
stroke and/or knead the painful muscle. This may increase
blood flow and bring warmth to a stressed area. However,
arthritis-stressed joints are very sensitive, so the therapist
must be familiar with the problems of the disease.
Osteoarthritis
and rheumatoid arthritis are chronic diseases that may last
a lifetime. Learning how to manage your pain over the long
term is an important factor in controlling the disease and
maintaining a good quality of life. Following are some sources
of long-term pain relief.
*
Brand names included in this booklet are provided as examples
only and their inclusion does not mean that these products
are endorsed by the National Institutes of Health or any other
Government agency. Also, if a particular brand name is not
mentioned, this does not mean or imply that the product is
unsatisfactory.
Long-Term
Relief
- Medications
Biological response modifiers--These
new drugs used for the treatment of rheumatoid arthritis
reduce inflammation in the joints by blocking the reaction
of a substance called tumor necrosis factor, an immune
system protein involved in immune system response. These
drugs include Enbrel and Remicade.
Nonsteroidal anti-inflammatory drugs
(NSAIDs)--These are a class of drugs including aspirin
and ibuprofen that are used to reduce pain and inflammation
and may be used for both short-term and long-term relief
in people with osteoarthritis and rheumatoid arthritis.
NSAIDs also include Celebrex and Vioxx, so-called COX-2
inhibitors that block an enzyme known to cause an inflammatory
response.
Disease-modifying antirheumatic drugs
(DMARDs)--These are drugs used to treat people with
rheumatoid arthritis who have not responded to NSAIDs.
Some of these include the new drug Arava and methotrexate,
hydroxychloroquine, penicillamine, and gold injections.
These drugs are thought to influence and correct abnormalities
of the immune system 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 but cause
many side effects. 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 pain. Because frequent
injections may cause damage to the cartilage, they should
be done only once or twice a year.
Other products--Hyaluronic acid
products like Hyalgan and Synvisc mimic a naturally occurring
body substance that lubricates the knee joint and permits
flexible joint movement without pain. A blood-filtering
device called the Prosorba Column is used in some health
care facilities for filtering out harmful antibodies in
people with severe rheumatoid arthritis.
- Weight
reduction--Excess pounds put extra stress on 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 exercise, 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 give you the most
benefit.*
* The National Institute of Arthritis
and Musculoskeletal and Skin Diseases Information Clearinghouse
has a separate booklet on arthritis and exercise.
- 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 (arthroplasty).
Total joint replacement has provided not only dramatic relief
from pain but also improvement in motion for many people
with arthritis.
What Alternative Therapies
May Relieve Arthritis Pain?
Many people seek other ways of
treating their disease, such as special diets or supplements.
Although these methods may not be harmful in and of themselves,
no research to date shows that they help. Some people have
tried acupuncture, in which thin needles are inserted at specific
points in the body. Others have tried glucosamine and chondroitin
sulfate, two natural substances found in and around cartilage
cells, for osteoarthritis of the knee.
Some alternative or complementary
approaches may help you to cope with or reduce some of the
stress of living with a chronic illness. It is important to
inform your doctor if you are using alternative therapies.
If the doctor feels the approach has value and will not harm
you, it can be incorporated into your treatment plan. However,
it is important not to neglect your regular health care or
treatment of serious symptoms.
How Can You 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 need to be an active participant
with the doctor and other health care professionals in managing
your pain. This may include physical therapy, cognitive-behavioral
therapy, occupational therapy, biofeedback, relaxation techniques
(for example, deep breathing and meditation), and family counseling
therapy.
The Multipurpose Arthritis and Musculoskeletal
Diseases Center at Stanford University, supported by the National
Institute of Arthritis and Musculoskeletal and Skin Diseases
(NIAMS), has developed an Arthritis Self-Help Course that
teaches people with arthritis how to take a more active part
in their arthritis care. The Arthritis Self-Help Course is
taught by the Arthritis Foundation and consists of a 12- to
15-hour program that includes lectures on osteoarthritis and
rheumatoid arthritis, exercise, pain management, nutrition,
medication, doctor-patient relationships, and nontraditional
treatment.
| Things
You Can Do To Manage Arthritis Pain
- Eat
a healthy diet.
- Get
8 to 10 hours of sleep at night.
- Keep
a daily diary of pain and mood changes to share
with your physician.
- Choose
a caring physician.
- Join
a support group.
- Stay
informed about new research on managing arthritis
pain.
|
What Research Is Being Conducted on Arthritis Pain?
The
NIAMS, part of the National Institutes of Health, is sponsoring
research that will increase understanding of the specific
ways to diagnose, treat, and possibly prevent arthritis pain.
As part of its commitment to pain research, the Institute
joined with many other NIH institutes and offices in 1998
in a special announcement to encourage more studies on pain.
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| niams.nih.gov
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