Arthritis Pain

Long-Term Relief

• Medications
  

  Biological response modifiers--These new drugs used for the treatment of rheumatoid arthritis reduce inflammation in the joints by blocking the reaction of a substance called tumor necrosis factor, an immune system protein involved in immune system response. These drugs include Enbrel and Remicade.

  Nonsteroidal anti-inflammatory drugs (NSAIDs)--These are a class of drugs including aspirin and ibuprofen that are used to reduce pain and inflammation and may be used for both short-term and long-term relief in people with osteoarthritis and rheumatoid arthritis. NSAIDs also include Celebrex, one of the so-called COX-2 inhibitors that block an enzyme known to cause an inflammatory response.

  Disease-modifying antirheumatic drugs (DMARDs)--These are drugs used to treat people with rheumatoid arthritis who have not responded to NSAIDs. Some of these include the new drug Arava and methotrexate, hydroxychloroquine, penicillamine, and gold injections. These drugs are thought to influence and correct abnormalities of the immune system responsible for a disease like rheumatoid arthritis. Treatment with these medications requires careful monitoring by the physician to avoid side effects.

  Corticosteroids--These are hormones that are very effective in treating arthritis but cause many side effects. Corticosteroids can be taken by mouth or given by injection. Prednisone is the corticosteroid most often given by mouth to reduce the inflammation of rheumatoid arthritis. In both rheumatoid arthritis and osteoarthritis, the doctor also may inject a corticosteroid into the affected joint to stop pain. Because frequent injections may cause damage to the cartilage, they should be done only once or twice a year.

  Other products--Hyaluronic acid products like Hyalgan and Synvisc mimic a naturally occurring body substance that lubricates the knee joint and permits flexible joint movement without pain. A blood-filtering device called the Prosorba Column is used in some health care facilities for filtering out harmful antibodies in people with severe rheumatoid arthritis.

• Weight reduction--Excess pounds put extra stress on weight-bearing joints such as the knees or hips. Studies have shown that overweight women who lost an average of 11 pounds substantially reduced the development of osteoarthritis in their knees. In addition, if osteoarthritis has already affected one knee, weight reduction will reduce the chance of it occurring in the other knee.
  
  
• Exercise--Swimming, walking, low-impact aerobic exercise, and range-of-motion exercises may reduce joint pain and stiffness. In addition, stretching exercises are helpful. A physical therapist can help plan an exercise program that will give you the most benefit.*
  
  

  * The National Institute of Arthritis and Musculoskeletal and Skin Diseases Information Clearinghouse has a separate booklet on arthritis and exercise.

• Surgery--In select patients with arthritis, surgery may be necessary. The surgeon may perform an operation to remove the synovium (synovectomy), realign the joint (osteotomy), or in advanced cases replace the damaged joint with an artificial one (arthroplasty). Total joint replacement has provided not only dramatic relief from pain but also improvement in motion for many people with arthritis.
  
  

What Alternative Therapies May Relieve Arthritis Pain?

Many people seek other ways of treating their disease, such as special diets or supplements. Although these methods may not be harmful in and of themselves, no research to date shows that they help. Some people have tried acupuncture, in which thin needles are inserted at specific points in the body. Others have tried glucosamine and chondroitin sulfate, two natural substances found in and around cartilage cells, for osteoarthritis of the knee.

Some alternative or complementary approaches may help you to cope with or reduce some of the stress of living with a chronic illness. It is important to inform your doctor if you are using alternative therapies. If the doctor feels the approach has value and will not harm you, it can be incorporated into your treatment plan. However, it is important not to neglect your regular health care or treatment of serious symptoms.

How Can You Cope With Arthritis Pain?

The long-term goal of pain management is to help you cope with a chronic, often disabling disease. You may be caught in a cycle of pain, depression, and stress. To break out of this cycle, you need to be an active participant with the doctor and other health care professionals in managing your pain. This may include physical therapy, cognitive-behavioral therapy, occupational therapy, biofeedback, relaxation techniques (for example, deep breathing and meditation), and family counseling therapy.

The Multipurpose Arthritis and Musculoskeletal Diseases Center at Stanford University, supported by the National Institute of Arthritis and Musculoskeletal and Skin Diseases (NIAMS), has developed an Arthritis Self-Help Course that teaches people with arthritis how to take a more active part in their arthritis care. The Arthritis Self-Help Course is taught by the Arthritis Foundation and consists of a 12- to 15-hour program that includes lectures on osteoarthritis and rheumatoid arthritis, exercise, pain management, nutrition, medication, doctor-patient relationships, and nontraditional treatment.

You may want to contact some of the listed at the end for additional information on the Arthritis Self-Help Course and on coping with pain, as well as for information on support groups in your area.

What Research Is Being Conducted on Arthritis Pain?

The NIAMS, part of the National Institutes of Health, is sponsoring research that will increase understanding of the specific ways to diagnose, treat, and possibly prevent arthritis pain. As part of its commitment to pain research, the Institute joined with many other NIH institutes and offices in 1998 in a special announcement to encourage more studies on pain.

At the Specialized Center of Research in Osteoarthritis at Rush-Presbyterian-St. Luke's Medical Center in Chicago, Illinois, researchers are studying the human knee and analyzing how injury in one joint may affect other joints. In addition, they are analyzing the effect of pain and analgesics on gait (walking) and comparing pain and gait before and after surgical treatment for knee osteoarthritis.

At the University of Maryland Pain Center in Baltimore, NIAMS researchers are evaluating the use of acupuncture on patients with osteoarthritis of the knee. Preliminary findings suggest that traditional Chinese acupuncture is both safe and effective as an additional therapy for osteoarthritis, and it significantly reduces pain and improves physical function.

At Duke University in Durham, North Carolina, NIAMS researchers have developed cognitive-behavioral therapy (CBT) involving both patients and their spouses. The goal of CBT for arthritis pain is to help patients cope more effectively with the long-term demands of a chronic and potentially disabling disease. Researchers are studying whether aerobic fitness, coping abilities, and spousal responses to pain behaviors diminish the patient's pain and disability.

NIAMS-supported research on arthritis pain also includes projects in the Institute's Multipurpose Arthritis and Musculoskeletal Diseases Centers. At the University of California at San Francisco, researchers are studying stress factors, including pain, that are associated with rheumatoid arthritis. Findings from this study will be used to develop patient education programs that will improve a person's ability to deal with rheumatoid arthritis and enhance quality of life. At the Indiana University School of Medicine in Indianapolis, health care professionals are looking at the causes of pain and joint disability in patients with osteoarthritis. The goal of the project is to improve doctor-patient communication about pain management and increase patient satisfaction.

The list of pain studies continues. A NIAMS-funded project at Stanford University in California is evaluating the effects of a patient education program that uses a book and videotape to control chronic pain. At Indiana University in Indianapolis, Institute-supported scientists are determining whether strength training can diminish the risk of severe pain from knee osteoarthritis. And a multicenter study funded by the National Center for Complementary and Alternative Medicine and NIAMS, and coordinated by the University of Utah School of Medicine, is investigating the effects of the dietary supplements glucosamine and chondroitin sulfate for knee osteoarthritis.

Where Can You Find More Information on Arthritis Pain?

National Institute of Arthritis and Musculoskeletal and Skin Diseases Information Clearinghouse
National Institutes of Health
1 AMS Circle
Bethesda, MD 20892-3675
Phone: 301-495-4484 or 877-22-NIAMS (226-4267) (free of charge)
TTY: 301-565-2966
Fax: 301-718-6366

The clearinghouse provides information about various forms of arthritis and rheumatic disease and bone, muscle, and skin diseases. It distributes patient and professional education materials and refers people to other sources of information. Additional information and updates can also be found on the NIAMS Web site.

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