Gout Pain and Management

Gout is an acutely painful inflammatory arthritic condition. A joint will suddenly become very tender, red, swollen, and warm, typically at night. Some people get gout every few months, and others will have an attack every few years. The attack lasts for can last from two to three days (if treated) to one to two weeks (if untreated).

Gout is caused by the accumulation of needle-like crystals typically within a joint(s). While gout can affect any joint, it more commonly "attacks" the big ("first" or "great") toe. the foot, ankle, knee, fingers, elbows, or wrist. Ultimately, it can cause kidney problems, including kidney stones. When I see a patient with gout, the person (more commonly, males) shows up with excruciating great toe pain, especially tender when something touches the toe. Classically, that person has been out taking a chance, drinking beer. Gout does tend to occur more in men than women.

Gout is caused by high levels of urate/uric acid in the blood.  Uric acid builds up in the blood because the kidneys fail to excrete it in the urine or, rarely, there is an overproduction of uric acid by the body. Heredity plays a big role in the development of this problem. Additionally, purines in various foods break down into uric acid can contribute to (and sometimes trigger) an episode of gout.  Some foods and drinks high in purines include organ meats (liver), some seafood (anchovies, tuna, sardines, some shellfish), red meats (eat in moderation), dried beans and peas, beer and distilled liquors, and foods and drinks that contain a lot of sugar. People with serious gout are advised to watch their intake of these foods carefully. It is also important for a person with gout to stay well-hydrated. Mayo has a very good discussion of a gout diet on their site. A person with gout must learn about dietary restrictions to avoid these very painful and potentially problematic episodes in the future.

How is gout diagnosed? Gout can be diagnosed by doing a joint fluid test: Fluid withdrawn from the joint will contain uric acid crystals. This is one of the best tests. Others include: X-rays, ultrasounds, blood tests (showing high uric acid levels), and a particular CT (Dual-energy CT), which also helps, specifically, to detect crystals.

Gout can often go away on ins own in days to weeks, but sometimes the excruciating pain makes the wait difficult. Moreover, the underlying cause (uric acid buildup) often remains, rearing its ugly head again and again. The following, Gout Pain and Management, explores different options to reduce pain and flare-ups.

Over-the-Counter Approaches to Gout

Treat Early.

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.

Topical anti-inflammatory - Diclofenac/Voltaren as directed over-the-counter

Considered Natural Remedies

• Coffee

• Tart cherry juice - Reportedly helps some people -. more studies

• Ginger

• Magnesium

• Turmeric/Curcumin

• Apple cider vinegar

• Lemon water

Other Approaches to Gout

• Avoid pressure on the area.​

• Ice packs (for 15 minutes every 4-6 hours)

• Drink plenty of water - stay well hydrated.

• Elevate area

Prescriptive Treatment Options (including long-term options to prevent flareups)

Often, gout does not easily respond to conventional, conservative treatment mentioned above. Other, prescriptive options may be available:

• Prescription Anti-inflammatories: Cox-2 inhibitors (common: celecoxib/Celebrex, meloxicam/Mobic. These reportedly cause fewer stomach problems than ibuprofen and other NSAIDs.

• Corticosteroids

• Colchicine (you want to check kidney function before use)

• Interleukin 1 (IL-1) inhibitor, which inhibits inflammation in gout that does not respond to other medications.

• Uric acid-lowering drugs for prevention (common: allopurinol, probenecid)​​ for long term control. It is important that kidney function be optimal for those who are taking probenecid.

• ​High dose (800 mg) ibuprofen (prescription)

• Opioids (short-term) can be used for gout, but rarely are. These are painkillers such as oxycodone or hydrocodone (combo opioids with Tylenol: Lortab, Percocet, and Vicodin) and Tramadol (i.e., Ultram), and can be highly addictive, they are not the drug of choice for long-term pain. There are better options.

Occasionally, surgery may be recommended.

Gout Often Causes Terrible Toe Pain

If you have any questions about your pain, see a healthcare provider.