Arthritis Pain

What Is Osteoarthritis?

Osteoarthritis is the most common type of arthritis, and is seen especially among older people. Sometimes it is called degenerative joint disease.

Osteoarthritis mostly affects cartilage, the hard but slippery tissue that covers the ends of bones where they meet to form a joint. Healthy cartilage allows bones to glide over one another. It also absorbs energy from the shock of physical movement. In osteoarthritis, the surface layer of cartilage breaks down and wears away. This allows bones under the cartilage to rub together, causing pain, swelling, and loss of motion of the joint. Over time, the joint may lose its normal shape. Also, small deposits of bone - called osteophytes or bone spurs - may grow on the edges of the joint. Bits of bone or cartilage can break off and float inside the joint space. This causes more pain and damage.

People with osteoarthritis usually have joint pain and some movement limitations. Unlike some other forms of arthritis, such as rheumatoid arthritis, osteoarthritis affects only joint function and does not affect skin tissue, the lungs, the eyes, or the blood vessels.

Who Has Osteoarthritis?

Osteoarthritis is by far the most common type of arthritis, and the percentage of people who have it grows higher with age. An estimated 12.1 percent of the U.S. population (nearly 21 million Americans) age 25 and older have osteoarthritis.

Both men and women have the disease. Before age 45, more men than women have osteoarthritis; after age 45, it is more common in women. It is also more likely to occur in people who are overweight and in those with jobs that stress particular joints.

As the population ages, the number of people with osteoarthritis will grow. By 2030, 20 percent of Americans - about 72 million people - will have passed their 65th birthday and will be at high risk for the disease.

Which areas does osteoarthritis effect?

Osteoarthritis most often occurs in the hands (at the ends of the fingers and thumbs), spine (neck and lower back), knees, and hips.

How Does Osteoarthritis Affect People?

Osteoarthritis affects different people differently. Although in some people it progresses quickly, in most individuals joint damage develops gradually over years. In some people, osteoarthritis is relatively mild and interferes little with day-to-day-life; in others, it causes significant pain and disability.

While osteoarthritis is a disease of the joints, it can effect a person’s lifestyle.

Signs of Osteoarthritis

• stiffness in a joint after getting out of bed or sitting for a long time

• swelling in one or more joints

• a crunching feeling or the sound of bone rubbing on bone

• Only about a third of people whose x rays demonstrate osteoarthritis report pain or stiffness. If you feel hot or your skin turns red, you probably do not have osteoarthritis. Check with your doctor about other causes.

Four Goals of Osteoarthritis Treatment

• to control pain

• to improve joint function

• to maintain normal body weight

• to achieve a healthy lifestyle

Treatment Approaches to Osteoarthritis

• exercise

• weight control

• rest and relief from stress on joints

• non-drug pain relief techniques

• medications to control pain

• surgery

• complementary and alternative therapies

Exercise

Research shows that exercise is one of the best treatments for osteoarthritis. Exercise can decrease pain, increase flexibility, strengthen the heart, improve blood flow, improve mood and outlook, maintain weight and promote general physical fitness. Exercise is inexpensive and, if done correctly, has few negative side effects. The amount and form of exercise prescribed will depend on which joints are involved, how stable the joints are, and whether a joint replacement has already been done. Walking, swimming, and water aerobics are a few popular types of exercise for people with osteoarthritis.

On the Move: Fighting Osteoarthritis with Exercise

You can use exercises to keep strong and limber, improve cardiovascular fitness, extend your joints' range of motion, and reduce your weight. The following types of exercise are part of a well-rounded arthritis treatment plan.

• strengthening exercises: These exercises strengthen muscles that support joints affected by arthritis. They can be performed with weights or with exercise bands, inexpensive devices that add resistance.

• aerobic activities: These are exercises, such as walking or low-impact aerobics, that get your heart pumping and can keep your lungs and circulatory system in shape.

• range-of-motion activities: These keep your joints limber.

• agility exercises: These can help you maintain daily living skills.

Ask your doctor or physical therapist what exercises are best for you.

Weight control

Osteoarthritis patients who are overweight or obese should try to lose weight. Weight loss can reduce stress on weight-bearing joints, limit further injury, and increase mobility. A dietitian can help you develop healthy eating habits.

Non-medication pain relief

People with osteoarthritis may find many non-drug ways to relieve pain. Below are some examples:

• Heat and cold

• Transcutaneous electrical nerve stimulation (TENS)

• Acupuncture

• Medications to control pain

Because some medications can interact with one another and certain health conditions put you at increased risk of drug side effects, it's important to discuss your medication, and health history with your doctor before you start taking any new medication, and to see your doctor regularly while you are taking medication. By working together, you and your doctor can find the medication that best relieves your pain with the least risk of side effects.

The following types of medicines are commonly used in treating osteoarthritis:

Acetaminophen: Ask your doctor if acetaminophen is a safe and effective choice for you.

NSAIDs (non-steroidal anti-inflammatory drugs): Many people should not take NSAIDs check with your doctor to see if this class of medications is safe for you.

Other medications: Doctors may prescribe several other medicines for osteoarthritis. They include the following:

Topical pain-relieving creams, rubs, and sprays: These products, which are applied directly to the skin over painful joints, contain ingredients that work by stimulating the nerve endings to distract the brain's attention from the joint pain; depleting the amount of a substance P that sends pain messages to the brain; or by blocking chemicals that cause pain and inflammation.

Tramadol, mild narcotic painkillers, corticosteroids, hyaluronic acid substitutes: Because most medicines used to treat osteoarthritis have side effects, it's important to learn as much as possible about the medications you take, even the ones available without a prescription.

Surgery

For many people, surgery helps relieve the pain and disability of osteoarthritis. Surgery may be performed to achieve one or more of the following:

• removal of loose pieces of bone and cartilage from the joint if they are causing symptoms of buckling or locking

• repositioning of bones

• resurfacing (smoothing out) of bones.

The decision to use surgery depends on several factors, including the patient's age, occupation, level of disability, pain intensity, and the degree to which arthritis interferes with his or her lifestyle..

Complementary and alternative therapies

Along side conventional medical treatments, several complementary medical treatments have been scientifically proven to be helpful.

Acupuncture: Many people have found pain relief using acupuncture, a practice in which hair-thin needles are inserted by an acupuncturist at specific points on the skin. Scientists believe the needles stimulate the release of natural, pain-relieving chemicals produced by the nervous system.

Nutritional supplements: Nutrients such as glucosamine and chondroitin sulfate have been reported to improve the symptoms of people with osteoarthritis. Additional studies have been carried out to further evaluate these claims.

What You Can Do: The Importance of Self-Care and a Good-Health Attitude

While health care professionals can prescribe or recommend treatments to help you manage your arthritis, the real key to living well with the disease is you. Research shows that people with osteoarthritis who take part in their own care report less pain and make fewer doctor visits. They also enjoy a better quality of life.

Self-Management Programs Do Help

People with osteoarthritis find that self-management programs help them:

• understand the disease

• reduce pain while remaining active

• cope physically, emotionally, and mentally

• have greater control over the disease

• build confidence in their ability to live an active, independent life.

Stay active: Regular physical activity plays a key role in self-care and wellness. Three types of exercise are important in osteoarthritis management. The first type, strengthening exercises, help keep or increase muscle strength. Strong muscles help support and protect joints affected by arthritis. The second type, aerobic conditioning exercises, improve cardiovascular fitness, help control weight, and improve overall function. The third type, range-of-motion exercises, help reduce stiffness and maintain or increase proper joint movement and flexibility.

Most people with osteoarthritis exercise best when their pain is least severe. Start with an adequate warm-up and begin exercising slowly. Resting frequently ensures a good workout and reduces the risk of injury.

Before beginning any type of exercise program, consult your doctor to learn which exercises are appropriate for you and how to do them correctly, because doing the wrong exercise or exercising improperly can cause problems. Your doctor can also advise you on how to warm up safely and when to avoid exercising a joint affected by arthritis.

Eat well: Though no specific diet will necessarily make your arthritis better, eating right and controlling your weight can help by minimizing stress on the weight-bearing joints such as the knees and the joints of the feet. It can also minimize your risk of developing other health problems.

Get plenty of sleep: Getting a good night's sleep on a regular basis can minimize pain and help you cope better with the effects of your disease.

Have fun: having osteoarthritis doesn't mean you have to stop having fun. Activities such as sports, hobbies, socializing and work can distract your mind from your pain and make you a happier person.

Keep a positive attitude: Perhaps the best thing you can do for your health is to keep a positive attitude. People must decide to make the most of things when faced with the challenges of osteoarthritis. This attitude - a good health mindset - doesn't just happen. It takes work, every day. And with the right attitude, you will achieve it.

Enjoy a "Good-Health Attitude"

• Focus on your abilities instead of disabilities.

• Focus on your strengths instead of weaknesses.

• Break down activities into small tasks that you can manage.

• Incorporate fitness and nutrition into daily routines.

• Develop methods to minimize and manage stress.

• Balance rest with activity.

• Develop a support system of family, friends, and health professionals.

Exercise and weight reduction

Exercise plays a key part in a comprehensive treatment plan. Researchers are studying exercise in greater detail and finding out just how to use it in treating or preventing osteoarthritis. For example, several scientists have studied knee osteoarthritis and exercise. Their results included the following:

• Walking can result in better functioning, and the more you walk, the farther you will be able to walk.

• People with knee osteoarthritis who are active in an exercise program feel less pain. They also function better.

Research has shown that losing extra weight can help people who already have osteoarthritis. Moreover, overweight or obese people who do not have osteoarthritis may reduce their risk of developing the disease by losing weight.

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Other Complementary and alternative therapies:

• Acupuncture: One of the most popular alternative pain-relief methods is acupuncture, an ancient Chinese practice in which fine needles are inserted at specific points in the body. Acupuncture reduces pain and improve function for individuals with knee osteoarthritis.

One study underway compares the benefits of acupuncture with physical therapy to the benefits of physical therapy alone. The hope is that acupuncture will help relieve pain that makes exercise difficult and, therefore, will improve the effectiveness of traditional exercise physical therapy.

• Glucosamine and chondroitin sulfate: In recent years, the nutritional supplement pair glucosamine and chondroitin has shown some potential for reducing the pain of osteoarthritis. Both of these nutrients are found in small quantities in food and are components of normal cartilage.

A recent NIH trial found that the combination of glucosamine and chondroitin sulfate did not provide significant relief from osteoarthritis pain among all participants. However, a smaller subgroup of study participants with moderate-to-severe pain showed significant relief with the combined supplements.

• Green tea: Many studies have shown that green tea possesses anti-inflammatory properties. Studies are looking at the effects of green tea compounds on human cartilage. It is too soon to recommend green tea for the treatment of arthritis.

• Prolotherapy: This is a popular, growing, and unregulated therapy for chronic musculoskeletal pain in which an irritant solution is injected into painful ligaments and adjacent joint spaces. However, no rigorous, scientifically valid clinical trials have proven the therapy's action or usefulness. A clinical trial sponsored by the NIH is studying prolotherapy's effectiveness for the pain of knee osteoarthritis.

Courtesy: NIH