managing pain caused by arthritis and related conditionszgreatlakes.com/literature/osp...

Ouch!Managing pain caused

by arthritis and related conditions

For people with arthritis, pain management is more complex than justtaking aspirin. Arthritis is a chronic disease that can cause significant painand discomfort. It requires a carefulapproach to pain management, including a combined effort involvingyou and your doctor.

In this pamphlet, you will find a general overview of medications andother approaches to pain management. It will help you gain additional insightinto pain management, but remember, itis very important you discuss this subjectwith your doctor to determine what specific pain management course is right for you.

MANAGING ARTHRITIS PAIN

Getting the most out of treatment

The subject of pain medications for arthritis is extremely broad because thereare more than 100 types of arthritis andequally as many medications. Here are a few basic considerations about the use of pain medications:

• Not every drug is right for every patient

• Most drugs have some type of side effect

• A combination of drugs may be appropriate for some conditions if recommended by your doctor

• There’s a great deal of information and misinformation available about medications. That’s why it’s important to talk with your doctor about using, changing, or discontinuing medications

Several categories of drugs are used totreat various types of arthritis.

MEDICATIONS: THE MAINAPPROACH TO PAIN MANAGEMENT

The primary purpose of an analgesic is to relieve pain. Some patients useaspirin, an analgesic that also reducesjoint inflammation. The most commonlyused analgesic, acetaminophen, is relatively effective and has few sideeffects. Acetaminophen does not containaspirin, however, so it doesn’t relieve joint inflammation. For this reason, acetaminophen is less likely to be usedwith rheumatoid arthritis and other typesof arthritis that cause inflammation, and more likely to be used to treatosteoarthritis and fibromyalgia.

The main side effect of analgesics is aslight risk of dependency that can occur if the drugs are used for long periods of time.

ANALGESICS


NSAIDs are the most frequently usedmedications for arthritis. They are oftenused to treat osteoarthritis, rheumatoidarthritis, gout, juvenile arthritis, and bursitis. Some are available by prescrip-tion only, while others (such as aspirin,ibuprofen, and naproxen) can be purchased over the counter.

NSAIDs help reduce redness and swellingand relieve pain. The type of NSAID thatyour doctor recommends for you willdepend on several factors:

• The type of arthritis you have

• The degree of pain and inflammation

• How your body reacts to the NSAID

• Other medications you are taking

As with all medications, there are sideeffects that can occur with NSAIDs. The most common side effects include constipation and stomach irritation

NONSTEROIDALANTI-INFLAMMATORY DRUGS(NSAIDS)

(ranging from indigestion and heartburn todevelopment of ulcers if symptoms are leftuntreated). For this reason, your doctorwill monitor you carefully, and you shouldreport any symptoms immediately.

Corticosteroids are similar to the hormone, cortisol, which occurs naturallyin the body. Corticosteroids reducepainful inflammation in joints, butbecause of potentially serious side effects,they are rarely used as a first choice forlong-term treatment.

Corticosteroids are almost never used totreat osteoarthritis, and when they areprescribed for rheumatoid arthritis, it isgenerally to relieve severe symptomswhile waiting for another drug, such as anNSAID, to reach an effective level. If theyare used for a longer period of time, theyare generally used in lower doses.

CORTICOSTEROIDS


Corticosteroids can be administered orallyor intravenously for pain relief throughoutthe body, or injected directly into anarthritic joint for quick, local pain relief.

If taken orally, corticosteroids may produce such side effects as:

• Lowered resistance to infection (since they temporarily suppress the body’s normal immune system)

• Weight gain

• Bone loss

• Muscle weakness

• Blurred vision

• Elevated blood pressure (occasionally)

If injected into the knee joint, they do notproduce side effects throughout the body,but if used repeatedly, corticosteroids canlead to joint damage.


DMARDs, used to treat rheumatoid arthritis, are usually prescribed in conjunction with NSAIDs for additionalrelief. DMARDs tend to work slowly and are thought to slow down or perhapshalt the progression of the disease.

Because DMARDs are slow acting, theirside effects may take several weeks to benoticed. Some potential side effects areflu-like symptoms (such as diarrhea andnausea) as well as mouth sores. The sideeffects can often be reduced by adjustingthe dose.

Now let’s look at several specific arthriticconditions and how they are treated.

DISEASE-MODIFYINGANTIRHEUMATIC DRUGS (DMARDS)

Drugs used to treat gout break up thecrystals of uric acid deposited in thejoints, which cause inflammation, pain,and swelling.

Side effects may include:

• An initial increased recurrence of gout as the body reacts to the drug (this can be managed by the use of an anti-inflammatory drug until the gout attacks gradually decrease)

• Hives

• Itching

• Nausea and other gastrointestinal symptoms

• Skin rash

• Headaches

TREATING SPECIFICCONDITIONS: GOUT

Although osteoporosis is a disease of the bones, it also affects the joints.Osteo-porosis is treated with drugs such as:

• Oral estrogen

• The hormone calcitonin (injected or taken via nasal spray)

• Alendronate, the first non-hormonal drug approved by the FDA

Side effects vary according to the drugtaken, but may include:

• Gastrointestinal problems

• Skin inflammation

• Weight gain

• Swelling and bloating

OSTEOPOROSIS


Fibromyalgia is often mistaken for chronic fatigue syndrome because thepatients never feel fully rested. Fibromy-algia, affecting deep muscle tissues andtheir attachments to bone, is extremelypainful. A number of drugs that are notgenerally used to treat other types ofarthritis may be prescribed for fibromyalgia, including antidepres- sants and antianxiety drugs.

Taken in smaller doses than for depression, these drugs can give patientsthe type of deep sleep they need, whichcontributes to pain relief and increasedenergy. Muscle relaxants can also promote sleep and ease painful muscles.Possible side effects vary depending onwhich type of medication is taken. Youshould discuss with your doctor the sideeffects of the drug prescribed for you.

FIBROMYALGIA

Arthritis patients have found that theymay benefit from a number of other painmanagement techniques that do notinvolve medication. The most popular aredescribed in the following sections.

PAIN MANAGEMENT WITHOUTMEDICATION

Source: The Arthritis Foundation

Woman With Fibromyalgia:Fibromyalgia is a puzzling condition characterized by persistent pain throughoutthe body or specific pain in the musclesand soft tissues.


It’s important to remember that arthritisshouldn’t be used as an excuse for asedentary lifestyle. Inactivity can weakenand stiffen the muscles surrounding thejoints and impair your joints permanently.

There are many psychological benefitsfrom exercise. Arthritis patients report that even a limited program of exercisewill contribute to an overall sense of well-being and vigor.

If you have arthritis, you will need todetermine what types of exercise willbenefit your condition. Your doctorshould be your first source of information.Physical therapists, nurses, and otherhealth professionals who are experiencedin working with arthritis patients can alsoassist you in developing an exercise program that is most beneficial.

EXERCISE

Not getting a good night’s sleep is a problem for many people with arthritis. If your pain continually awakens you, youmay never reach Stage 3 sleep - the deepsleep that’s needed for true rest. And yourfatigue can worsen your pain. There aremany sources of information about get-ting a better night’s sleep - magazine articles, books, Web sites, etc., and youshould consult with your doctor, nurse, or therapist.

Stress can have a physical and psychological impact on the mind andbody. Stress can lead to tense muscles,headache, nervousness, anxiety, and indigestion. It’s important to learn how to react to stressful situations and avoidthese effects that could worsen the physical symptoms of arthritis.

SLEEP

STRESS MANAGEMENT


Here are some techniques to help youcontrol or reduce stress in your life:

• Identify the Cause of Stress: If it’s something that can be changed, make the change (avoiding people who always irritate you, for instance) and work on being calmer about things that can’t be changed (such as when the person who irritates you is a relative).

• Share Your Thoughts and Feelings: Discussing them with a spouse, friend, physician, or counselor can help “work out” the stress and provide an opportunity to identify ways to better manage the situation.

Source: The Arthritis Foundation

• Manage Your Time andConserve Energy:Rest is important for everyone, but it’s particularly important for arthritis patients. Being overtired worsens arthritis pain. Try to anticipate fatigue and rest before you get really tired.

• Make Time for Relaxation and Fun:Research has found that laughter can have a positive physiological effect on the body - the release of chemicals called endorphins cause a feeling of happiness, and the actual process of laughing can be similar to an aerobic workout.

Massages can provide temporary relief for sore muscles by increasing blood flow. However, arthritis patients shouldavoid massage therapy if joints are tenderor inflamed since the tenderness couldworsen.

If you have a massage, it is best to notifythe therapist of your condition and clarify

MASSAGE THERAPY


that you want a gentle approach. Yourdoctor, physical therapist, or other healthprofessional may be able to recommendmassage therapists who specialize inworking with arthritis patients.

Relaxation therapy involves more than sitting down and being inactive. It is alearned technique to help you relieve tension by entering a deeper state ofrelaxation that, for many people, lowersblood pressure, respiratory rate, andadrenaline flow.

As your muscles relax, your body releasespain-relieving hormones called endor-phins. The release of muscle tension is arelief from an unconscious source of painand discomfort.

Although there are many variations andtechniques, following are some generalguidelines. Your doctor, nurse, or therapistmay be able to recommend other specifictechniques that work best for your situation, such as imagery, relaxation, or progressive muscle relaxation.

RELAXATION THERAPY

• Establish a Suitable Environment:Find a quiet area where you will have as few distractions as possible. Get in a comfortable position, sitting or lying down.

• Breathe Slowly and Deeply:Concentrate on feeling the air move in and out of your body. Really fill your lungs with air, so it feels as if your rib cage is moving out. Hold your breath for just a second, and then very slowly let the air out. Don’t actively exhale or push it out; just drop your jaw (whichalso is a relaxing motion) and let the air slowly flow out. Ideally, you will begin to associate deep breathing with feeling relaxed.

• Focus Your Attention on Your Body:Begin with the tips of your toes. Imagine each part of your body becoming lighter, calmer, and floating. Work up from your toes to feet, ankles, calves, etc. Take it very slowly so that by the time you’ve reached your head, you almost feel as if your body is lighter than air. Concentrate on relieving the tension in each part of your body as you breathe deeply. Imagine the soothing feeling of your muscles relaxing.


Biofeedback therapy uses electronicinstruments to monitor and measure yourbody’s reaction to stress. You learn whenand how you react to stress, and then youmonitor the results of stress managementand relaxation techniques. The “feed-back” allows you to actually see or hearthe effect of various stress managementtechniques on your own body and compare the results.

There are many methods for measuringthe body’s response to stress. The following are some examples.

• Skin Temperature Method:This method measures the skin’s temperature in response to the effects of adrenaline. During times of danger or stress, the adrenaline in your system diverts blood from the body surface to critical organs, which causes the skin temperature to drop.

BIOFEEDBACK

• Skin Electrical Resistance:Under stress, the body sweats more. Moist skin conducts electricity more effectively than dry skin. Biofeedback measures how easily electricity is conducted between two electrodes on the skin.

• Muscle Electrical Activity Method:This system measures the electrical activity of muscles under the surface of the skin. When an individual is tense, muscles “tighten up,” which can be measured as increased electrical activity.

After you have learned and practicedstress management and relaxation techniques, you should repeat the measurements so you can literally seehow your stress responses have changed.Many individuals find that biofeedbacktherapy is useful because it providesmeasurable results (seen or heard) inreaction to their stress management. Theresults, however, can vary according toeach person’s ability to follow through on managing stress.


The use of hot and cold treatments toreduce pain and stiffness due to arthritiscan be very effective, especially inconjunction with other pain managementtechniques. For tense muscles and joints,heat can stimulate blood flow and relaxmuscles. For inflammation, cold treatments can reduce swelling, by reducing blood flow. Check with yourdoctor to find the most effective methodof treatment for your condition, gain themost from your therapy, and feel the best you can every day.

Another therapy for the relief of the painof osteoarthritis specifically in the knee is called viscosupplementation. This is a way to relieve arthritis pain without drugs or surgery.

HOT / COLD TREATMENT

The treatment takes place in your doctor’soffice. It involves a series of injectionsinto the knee, using a clear fluid madefrom a natural substance called sodiumhyaluronate. This biological, nondrugproduct reduces the stiffness in the kneejoint, relieves the pain, and allows you to move easier.

VISCOSUPPLEMENTATION


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