Arthritis Pain and Management
- Victoria Wermers, RN,MSN,FNP, PMHNP
- Oct 26, 2024
- 7 min read
Updated: Sep 14
arth=joint itis=inflammation
Arthritis Pain and Management
Osteoarthritis (OA)
Osteoarthritis affects millions of people in the United States. Osteoarthritis is the breakdown of joint structures, including the bone, cartilage, tendons, ligaments, muscles, and the synovium, or lining of the joint which provides lubrication and protection of the joint. An increase in the proinflammatory cytokines and chemokines in the joint seems to start the biological cascade of destruction in the joint. OA most commonly occurs in the knees but also occurs in the hands, hips, shoulders, and, quite often, the lower back (spine).
There are two major types of osteoarthritis: Primary and secondary. Primary Osteoarthritis has no known direct cause. In some cases, genes (heredity) appear to be a factor, female gender by birth, and loss of estrogen may come into play (it is more common in females); obesity and older age also play a role. The latter would stand to reason because, as you get older, you have put a LOT of miles on those joints: they see a LOT of wear and tear. This is especially true of the knees. Think about this: According to WebMd "They [knees] bear 80% of your body weight when you stand still and 150% or more when you walk across the room. In a 160-pound person, that’s 240 pounds of force!"
Secondary arthritis is triggered by things like infection, disease, misalignment, trauma/injury, and deformity. The biological process is similar to that of primary osteoarthritis.
Symptoms of osteoarthritis include one or (often) more of the following: Pain, tenderness to touch, burning, swelling (made worse during activity), stiffness and difficulty moving the joint (often worsened by activity), occasionally "grating", bumps on joints of fingers or visible bone spurs under the skin, and sometimes cysts on fingers.
Advancing osteoarthritis is typically diagnosed by exam and history along with X-rays that show joint space narrowing and osteophytes (small bone growths), and, in later stages deformity at the ends of bones. MRIs, CT scans, ultrasounds, and labs*(see below) can be done to help diagnose osteoarthritis. For example, an increased erythrocyte sedimentation rate (ESR) – while not specific for OA - occurs if there is significant inflammation within the body.
There is no treatment for osteoarthritis, but worsening can often be stalled, and symptoms can be made significantly better.
General Approaches to Osteoarthritis
The following addresses osteoarthritis arthritis pain, and management
Exercise (especially for the knee and hip)
Physical therapy
Supportive devices
Tai Chi (especially for the knee and hip)
Yoga (especially for the knee)
Guided imagery - A meditation-type exercise - Relax and concentrate on a beautiful, calm place anywhere and stay there in your mind for a few minutes. If your mind wanders off, bring it back.
Hydrotherapy
Acupressure
Acupuncture (especially for osteoarthritis)
Weight Loss for those with higher BMI (NOT due to muscle)
Biofeedback
Surgery
Over-the-Counter
Anti-inflammatory topical treatments (Diclofenac, Icy Hot)
NSAIDS - These include Ibuprofen (Motrin, Advil), Naproxen (Aleve), and Aspirin and are quite effective in decreasing pain in many cases. They are always good medications to start with if you are having pain - especially pain from inflammation (almost all pain has some element of inflammation). BUT on a long-term basis, these medicines can cause gastric ulcers and bleeding as well as kidney and blood pressure issues, so beware - alternate your pain medications (NSAIDS) if possible - ibuprofen to Tylenol or a prescription medicine. Speak to your PCP about this, and also, consider taking a stomach acid-reducing medicine (common: omeprazole/Prilosec or famotidine/Pepcid and others) while taking NSAIDs. Remember: Aspirin thins your blood and can make you bleed more easily.
Acetaminophen (common: Tylenol), on the other hand, is not an anti-inflammatory but a pain reliever instead. This is also a good medication, but used long-term, can cause liver problems. Again, consider alternating this with ibuprofen every few weeks or speak to your PCP about getting another prescription pain medication.
Considered Natural and Herbal Remedies
Capsaicin (topical)
Glucosamine combined with chondroitin (commonly reported as helpful). Some products are also over-the-counter
Prescriptive Treatment
High-dose ibuprofen
Intra-articular steroid injections
Cox 2 inhibitors (common: Celebrex)
Meloxicam (NSAID)
Opioids - Opioids (short-term) - These are painkillers such as oxycodone or hydrocodone (combo opioids with Tylenol: Lortab, Percocet and Vicodin) and Tramadol (i.e., Ultram). Because these are highly addictive, they are not the drug of choice for long-term pain
Hyaluronic acid injections (mixed reviews)
Duloxetine/Cymbalta - Antidepressant and analgesic (pain killer)
For more on General pain management with over-the-counter oral treatment, remedies, and prescriptive treatments.
Arthritis Pain and Management
Rheumatoid Arthritis (RA)
Rheumatoid arthritis is caused when a person’s immune system (antibodies) travels to a person’s joint and, erroneously sensing that the tissue is foreign, attacks that tissue, ultimately destroying the cartilage, tendons, ligaments, and bones. RA typically occurs in those 40-60 years old, and more frequently, in females
Symptoms: Pain and inflammation with swelling, morning stiffness, heat, loss of function, and often joint deformity – Usually starts in small joints and then progresses to others. Sometimes deformity, fever and fatigue, and loss of appetite.
Where: RA can affect many different parts of the body - usually the joints of the hands, and feet but can affect many other joints: wrists, elbows, shoulders, hips/groin-thigh and buttock pain, feet, spine, knees, and even the jaw.
Complications of severe RA can also occur in the heart (chest pain, pericarditis), lungs (fibrosis/scarring, pleurisy, chronic cough, chest pain, shortness of breath, nodules), kidneys, nerve tissues, blood vessels, bone marrow, nerves, eyes (scleritis and/or uveitis), and possibly the skin.
How does a person get rheumatoid arthritis? No one knows. Genetics, hormones, environment, smoking (can cause specific rheumatoid changes), and illness. Sometimes, vitamin D deficiency or diet can trigger RA. The following foods are considered risks for inflammation:
Processed foods. High in salt, sugar, and unhealthy fats, processed foods (foods with additives and preservatives, many sliced breads on the shelf of a store, and boxed cereals ) can cause inflammation
Red meat and processed meats (lunch meats, hot dogs, bacon, sausage-type foods)
Fried foods.
Refined sugars and carbohydrates.
Diagnosis is done by an exam (history and physical), radiology-- helpful to determine the degree of destruction, Ultrasounds, and some labs. Sedimentation rate (ESR) – Similar to using the ESR for OA, this is not specific for RA but is increased if there is significant inflammation. Rheumatoid factor and anti-CCP antibody levels can also be helpful in diagnosis.
There is no cure for rheumatoid arthritis, but symptoms can become significantly better, especially if treated early.
Approaches to rheumatoid arthritis
The following addresses rheumatoid arthritis pain and management
Low-impact exercise: Gentle workouts like cycling, swimming, or water aerobics can help reduce inflammation and ease pain.
Heat and cold therapy: Heat can help reduce stiffness, while cold can help with pain.
Stretching: Stretching can improve the range of motion and flexibility in the hip joint.
Treatments may include medications
Physical therapy
Splints
Surgery
Routine use of the disease activity scoring tool
A healthy diet (an anti-inflammatory diet that particularly recommends that you eliminate processed foods)
A healthy diet (an anti-inflammatory diet that particularly recommends that you eliminate processed foods)
TENS (transcutaneous electrical nerve stimulation)
Over-the-Counter Medications
NSAIDS. These include Ibuprofen (Motrin, Advil), Naproxen (Aleve), and Aspirin, and are quite effective in decreasing pain in many cases. They are always good medications to start with if you are having pain, especially pain from inflammation (almost all pain has some element of inflammation). BUT on a long-term basis, these medicines can cause gastric ulcers and bleeding as well as kidney and blood pressure issues, so beware - alternate your pain medications (NSAIDS) if possible - ibuprofen to Tylenol or a prescription medicine. Speak to your PCP about this, and also, consider taking a stomach acid-reducing medicine (common: omeprazole/Prilosec or famotidine/Pepcid and others) while taking NSAIDs. Remember: Aspirin thins your blood and can make you bleed more easily.
Acetaminophen (common: Tylenol), on the other hand, is not an anti-inflammatory but a pain reliever instead. This is also a good medication but used long term, can cause liver problems. Again, consider alternating this with ibuprofen every few weeks or speak to your PCP about getting another prescription pain medication.
Considered Herbal and Natural Remedies
Prescriptive treatment:
DMARDS (disease-modifying antirheumatic drugs) which help decrease autoimmune reactions leading to inflammation (common: methotrexate, hydroxychloroquine, sulfasalazine) and biologic DMARDS $$$ (common: Humira, Enbrel, Remicade)
Cytokine inhibitor - Rinvoq$$$
Diclofenac oral (NSAID)
Meloxicam (NSAID)
Ibuprofen- high dose (800 mg dose)
Methotrexate (immunosuppressant)
Biologics$$$ - A newer form of treatment that slows the immune system down when it is attacking itself in autoimmune disease. These can also lower your overall immunity.
Interleukin 1 inhibitor (decreases inflammation)
Intraarticular corticosteroid injections
Corticosteroids have lots of potential side effects from ulcers to diabetes, to hypertension to insomnia and sometimes downright psychosis, but they are great anti-inflammatories. Sometimes healthcare providers prescribe a low dose to use over the long term but because of the potential side effects, it is good to look at some of the alternatives.
Cox-2 inhibitors (common: celecoxib/Celebrex, meloxicam (Mobic), an anti- inflammatory. This is less likely to cause stomach problems than ibuprofen and other NSAIDS.
Opioids (short course) - painkillers such as oxycodone, and acetaminophen. Percocet,
hydrocodone, Lortab, Vicodin, Tramadol and others.
Consider a pain clinic to help with your pain. They take a holistic approach to treatment and care. They have providers who help diagnose painful conditions, prescribe medications, give injections, provide physical therapy, occupational therapy, and provide other approaches to pain, like cognitive behavioral therapy (psych) to help alter the perception of and tolerance to pain. This is an ideal approach to hard-to-control chronic pain.
If you are wondering if you have arthritis, testing is available that you can do at home and send in to the lab with a 2-3 day turnaround time. Many of these test for inflammation and for autoimmune diseases. HealthLabs is a site to explore and order for these tests.
If you have any questions about your pain, see a healthcare provider. Treat early.
