Arthritis: How to ease the pain

Zoomer | January 29th, 2010

It’s more than just pain relief. Today’s options for preventing and managing the effects of arthritis.

BY: ELIZABETH ROGERS

Your body hurts. Take a pill and you’re good to go!

If you live with arthritis, you know it’s not usually that simple. The Public Health Agency of Canada says that people with arthritis experience more pain and restrictions than patients with any other chronic disease, report more disrupted sleep and depression, and are more likely to need help with daily activities.

Immediate pain relief is only part of the solution: controlling inflammation, improving mobility, dealing with secondary symptoms (like fatigue and depression) and preventing permanent damage need to be part of the plan. However, today’s patients have more options for treating the more than 100 related conditions that can cause pain and swelling in the joints and fall under the heading of arthritis.

Here are some of the steps that might be included in a comprehensive treatment plan.

Deal with the symptoms
The first concern: dealing with the pain, inflammation and stiffness. Not only does it affect your quality of life, but left untreated can lead to a downward spiral. For example, pain can rob you of a good night’s sleep and make you skip your exercise routine — but a lack of physical activity and insufficient rest can make the condition worse.

Some of the choices to deal with symptoms include:

– Acetaminophen. While not an anti-inflammatory, it’s often used to treat osteoarthritis (the most common type).

– Ibuprofen and acetylsalicylic acid (ASA), which offer relief from both pain and inflammation.

– Combination preparations, which include one of the pain relievers listed above combined with codeine and/or muscle relaxants.

– Creams and gels. These topical treatments “trick” your brain into numbing the area, or provide soothing heat or cold. Many products contain ASA, capsaicin or menthol.

– Non-steroidal anti-inflammatory drugs (NSAIDs), a class of drugs which don’t contain cortisone. (ASA and ibuprofen also fall under this heading). In addition to treating pain, their job is to minimize persistent inflammation by targeting the enzymes and hormones (like prostaglandin) that can cause it. Coxibs, the latest NSAID class, are designed to be gentler on the stomach.

Of course, following the doctor’s and pharmacist’s advice or the instructions on the package is essential to avoid dangerous combinations or overdose. For instance, you can take acetaminophen when you are taking an NSAID, but stay clear of ASA or ibuprofen (i.e. don’t take more than one NSAID). The regular use of an ASA cream can put you over the limit if you’re taking ASA tablets too.

Control the disease
Sometimes NSAIDs aren’t enough so a doctor will prescribe an additional medication to help with the body’s allergic and inflammatory responses. Some options include:

– Disease-modifying anti-rheumatic drugs (DMARDs) which slow down the processes in the body that lead to persistent inflammation. (Examples include chloroquine, gold therapy and methotrexate.) DMARDs are slow-acting, but they can help control conditions like lupus, rheumatoid arthritis and psoriatic arthritis — which are autoimmune disorders than can cause permanent disfigurement.

— Corticosteroids (synthetic versions of the adrenal hormone cortisol) are used to treat a variety of conditions. They work by acting on the immune system to prevent allergic reactions and inflammatory response. Once thought to be a miracle cure for arthritis, the side effects have made doctors more cautious using this treatment.

— Biological response modifiers (BRMs), the latest class of drugs on the market, target cytokines (a part of the immune system that can contribute to the disease process). BRMs are faster acting than (and may be used in conjunction with) DMARDs.

Finding the right combinations and dosages might take some time and trial, so it’s important to take medications as directed.

Countering side effects
Unfortunately, the medications used to treat arthritis can have some unpleasant side effects. Most NSAIDs are acidic and therefore stimulate acid production, especially if they aren’t taken with food and a full glass of water. Some patients experience heartburn, cramps and upset stomachs as a result. Other foods that irritate the stomach — like alcohol, coffee and chocolate — can make things worse.

In addition, because NSAIDs go to work on the prostaglandins that cause inflammation, they can also decrease the level of the prostaglandins that help keep the stomach lining healthy, and cause bleeding and ulcers. Though not common, these dangers can go unnoticed because the pain is masked by the medication.

Doctors may therefore recommend over-the-counter antacids or stomach-protecting prescription medication like a proton pump inhibitor (which decreases the amount of acid the stomach produces). Sustained-release doses or coxibs may be a better fit for some people.

Physical and occupational therapy
Restoring and maintaining movement and range of motion are important, especially when there’s the danger of permanent damage. That’s where regular sessions with a physiotherapist or occupational therapist can help. Physiotherapy aims to strengthen muscles, improve mobility and flexibility, help with balance and coordination and reduce pain and stiffness. (For more information, see Physiotherapy: What to expect.)

Occupational therapy focuses on activities — particularly how patients can remain active, independent and engaged in their daily activities (like work and family life) and favourite activities. For example, a few easy-to-hold or “arthritis-friendly” gadgets can help make cooking and gardening much easier and more enjoyable. Some modifications at work can improve satisfaction and productivity.

Occupational therapy deals with mental health as well as physical health, and can therefore help patients cope with the impact of arthritis like frustration, depression and withdrawal. (For more information, visit the Canadian Occupational Therapy Foundation website.)

Complimentary therapies
Science is just starting to understand and incorporate alternative therapies and treatments, but some can offer relief, such as:

– Massage.

– Acupuncture.

– Guided imagery or self-hypnosis.

– Laughter.

– Relaxation techniques.

– Supplements.

– Transcutaneous Electrical Nerve Stimulation (TENS).

To read more about these therapies, see Managing arthritis pain and the Arthritis Society’s Types of Complementary Therapies section.

Healthy habits
We’re often told that eating a healthy diet, maintaining a healthy weight and regular physical activity are essential for managing many chronic diseases, and arthritis is no exception. For instance, losing weight can relieve a lot of the stress and wear-and-tear on joints, muscles and organs. Regular exercise promotes mobility, maintains range of motion and strengthens the muscles and tissue that support and cushion joints.

What about diet? Over the years, you may have heard that a specific food (like honey or pineapple) can reduce inflammation, or you’ve seen ads for so-called “arthritis diets” that promise a cure. However, experts warn that there’s no conclusive proof that a single food or supplement can improve or “cure” arthritis. There isn’t a lot of clinical research in this area, and it’s hard to tell if the food in question actually relieved symptoms or if other factors — like food intolerances or remission — were responsible.

Currently, the Arthritis Society recommends enjoying a balanced diet that includes a variety of healthy foods like fruits and vegetables, lean meats, whole grains and healthy fats.

Surgery
For people with advanced arthritis, surgery can offer a new lease on life. The type of surgery will depend on the affected area, the type of arthritis and the amount of damage.

For instance, synovectomy removes part or all of the diseased joint lining, while resection removes part or all of the bone in a joint that’s become damaged or diseased. Then there’s arthroplasty — more commonly known as a joint replacement — which can do wonders for restoring range of motion in the knees and hips. (For more information, see Types of Surgery.)

So how can you tell which treatment options are best for you? You can’t on your own — that’s a job for the medical professionals. However, being informed can help you be a more effective team player when it comes to finding relief from arthritis, both in the short and long run.

ON THE WEB
The Arthritis Society
The Arthritis Foundation (U.S.)

Additional sources: The Mayo Clinic, Public Health Agency of Canada: Arthritis in Canada