Chronic pain

Osteoarthritis and Joint Pain

Our joints take a lot of abuse over the years. That is one of the reasons why up to half of Americans over age 65 have osteoarthritis (OA). Osteoarthritis occurs when the protective cartilage on the end of bones wears down, causing pain and stiffness in areas like hips, knees and hands that make walking and climbing stairs difficult. Even brushing one’s teeth can be challenging for people with arthritis.

Because osteoarthritis doesn’t have a cure, easing the pain you are feeling is key.   There are numerous options which range from pain management therapy and acupuncture, to opioids and pain relievers. Unless absolutely necessary, it is best to leave opioids as a last resort due to the potential long term side effects.

Manage Your Weight

If you are overweight, even losing 5-10 pounds will make a difference and help with your pain and function. In a 2018 study in Arthritis Care and Research, people who lost 10 percent of their body weight saw knee pain drop up to 50% (2018).
What you may eat can make a difference too. A diet rich in fatty fish, healthy fats, fruits, leafy green vegetables and nuts may help relieve some of the inflammation associated with arthritis (Cleveland Clinic 2018).

Stay Physically Active

When you are hurting, the thought of exercise seems overwhelming. However, studies have found that an exercise program was as effective at easing pain and improving function in knee osteoarthritis as a nonsteroidal anti inflammatory drugs (NSAID), such as ibuprofen. (Cochrane 2015).

The Department of Health and Human Services recommends 150 minutes of moderate activity each week. This could be swimming, walking, cycling and says to add muscle-strengthening twice a week. Tai Chi and Yoga has recently been noted as really making a difference in chronic osteoarthritis pain (see last week’s blog post).

If you haven’t exercised in a long time, you might want to start by going first to physical therapy (PT). A physical therapist can help you develop an exercise program you can do at home and make sure you are doing the exercises correctly. Physical therapy can also help you strengthen the muscles around an arthritic joint thus relieving some of the load on that joint. At the end of your session, a physical therapist will often apply ice as you rest.

Home Remedies

When arthritis pain causes a sensation of burning, cool it off with cold — applying an ice pack or even a bag of frozen vegetables (easier to wrap around an area like a knee) can help to numb areas affected by joint pain. Cold therapy can reduce inflammation, a major cause of arthritis joint pain and stiffness (Arthritis Foundation 2020).
While ice is used to reduce inflammation and swelling arthritis pain, heat also can be used to relax muscles and help lubricate joints. A soothing hot shower, using a heating pad for 15 minutes or even drinking a hot beverage can all help your stiff and sore muscles relax and you find relief with a little heat. Not only does heat relax muscles, it also stimulates blood flow and improves circulation, helps increase range of motion, and reduces stiffness in painful joints (Everyday Health 2020).

Use Meds with Caution

If you are experiencing severe painful joints, your doctor may suggest using over-the-counter medication to relieve pain, especially if you are just starting physical therapy or are exercising on your own. Aleve and its generic counterparts were ranked as most effective treatments for knee osteoarthritis (Journal of the American Academy of Orthopaedic Surgeons 2018). However, these types of medications can cause side effects, such as gastrointestinal problems, so you should only be taking them for 2-3 weeks. Dr. Pei Chen from UCSF Center for Geriatric Care suggests, “…if you need longer-term pain relief, consider Tylenol or its generic” (2019).

Be Cautious with Injections

Steroid injections can temporarily ease inflammation and pain, but they may damage the joint and cartilage. James Herrera DO is the chair of rehabilitation medicine at Mount Sinai Health Systems in New York and says “…injections of hyaluronic acid into the knee joint are thought to act like a lubricant, but a study in 2018 found that overall, they weren’t very helpful” (Journal of the American Academy of Orthopaedic Surgeons 2018).
A review of six studies (Arthroscopy 2016) found injections of platelet-rich plasma platelets extracted from your blood and reinjected into an affected joint provide significant pain relief up to 12 months after the injection. While effective, this type of treatment is expensive and often not covered by insurance.

See a Surgeon as a Last Resort

Some surgeons may recommend arthroscopy , but research shows that it isn’t any better than exercise therapy and in 2017 an international panel of experts recommended against it (BMJ 2017).

Who is a good candidate for surgery? Dominic King, DO from the Cleveland Clinic says “the best candidates are people who have already tried several non-operative treatments, are already at a healthy weight and feel their quality of life is suffering because they can no longer do daily activities that they enjoy”. King suggests if this is you, then look for “…for a surgeon who does at least 50 knee or hip replacements a year with a complication rate of 3% or lower and a hospital that does more than 400 joint replacements every year and has an overall infection rate of less than 1%”.

Learn more about Pacific Rehabilitation Centers’ pain management program or contact us to see how we can help.

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