Dr. MJ Bazos MD,
Q & A
About Arthritis Pain
What Is Arthritis?
The word arthritis literally means
joint inflammation, but is often used to refer to a group of more than 100
rheumatic diseases that can cause pain, stiffness, and swelling in the joints.
These diseases may affect not only the joints but also other parts of the body,
including important supporting structures such as muscles, bones, tendons, and
ligaments, as well as some internal organs. This fact sheet focuses on pain
caused by two of the most common forms of arthritis—osteoarthritis and
What Is Pain?
Pain is the body's warning system,
alerting you that something is wrong. The International Association for the
Study of Pain defines it as an unpleasant experience associated with actual or
potential tissue damage to a person's body. Specialized nervous system cells
(neurons) that transmit pain signals are found throughout the skin and other
body tissues. These cells respond to things such as injury or tissue damage. For
example, when a harmful agent such as a sharp knife comes in contact with your
skin, chemical signals travel from neurons in the skin through nerves in the
spinal cord to your brain, where they are interpreted as pain.
Most forms of arthritis are associated
with pain that can be divided into two general categories: acute and chronic.
Acute pain is temporary. It can last a few seconds or longer but wanes as
healing occurs. Some examples of things that cause acute pain include burns,
cuts, and fractures. Chronic pain, such as that seen in people with
osteoarthritis and rheumatoid arthritis, ranges from mild to severe and can last
How Many Americans
Suffer From Arthritis Pain?
pain is a major health problem in the United States and is one of the most
weakening effects of arthritis. More than 40 million Americans suffer from some
form of arthritis, and many have chronic pain that limits daily activity.
Osteoarthritis is by far the most common form of arthritis, affecting about 16
million Americans, while rheumatoid arthritis, which affects about 2.1 million
Americans, is the most crippling form of the disease.
What Causes Arthritis Pain? Why Is
It So Variable?
The pain of arthritis
may come from different sources. These may include inflammation of the synovial
membrane (tissue that lines the joints), the tendons, or the ligaments; muscle
strain; and fatigue. A combination of these factors contributes to the intensity
of the pain.
The pain of arthritis
varies greatly from person to person, for reasons that doctors do not yet
understand completely. Factors that contribute to the pain include swelling
within the joint, the amount of heat or redness present, or damage that has
occurred within the joint. In addition, activities affect pain differently so
that some patients note pain in their joints after first getting out of bed in
the morning whereas others develop pain after prolonged use of the joint. Each
individual has a different threshold and tolerance for pain, often affected by
both physical and emotional factors. These can include depression, anxiety, and
even hypersensitivity at the affected sites due to inflammation and tissue
injury. This increased sensitivity appears to affect the amount of pain
perceived by the individual.
Doctors Measure Arthritis Pain?
is a private, unique experience that cannot be seen. The most common way to
measure pain is for the doctor to ask you, the patient, about your problems. For
example, the doctor may ask you to describe the level of pain you feel on a
scale of 1 to 10. You may use words like aching, burning, stinging, or
throbbing. These words will give the doctor a clearer picture of the pain you
Since doctors rely
on your description of pain to help guide treatment, you may want to keep a pain
diary to record your pain sensations. On a daily basis, you can describe the
situations that cause or alter the intensity of your pain, the sensations and
severity of your pain, and your reactions to the pain. For example: "On Monday
night, sharp pains in my knees produced by housework interfered with my sleep;
on Tuesday morning, because of the pain, I had a hard time getting out bed.
However, I coped with the pain by taking my medication and applying ice to my
knees." The diary will give the doctor some insight into your pain and may play
a critical role in the management of your disease.
What Will Your Doctor Do for Your
The doctor will
usually do the following:
•Take your medical history and ask
questions such as: How long have you had this problem? How intense is the pain?
How often does it occur? What causes it to get worse? What causes it to get
•Review the medications you are using
•Conduct a physical examination
•Take blood and/or urine samples and
request necessary laboratory work
•Ask you to get x rays taken or undergo
other imaging procedures such as a CAT scan (computerized axial tomography) or
MRI (magnetic resonance imaging).
Once the doctor has done these things
and reviewed the results of any tests or procedures, he or she will discuss the
findings with you and design a comprehensive management approach for the pain
caused by your osteoarthritis or rheumatoid arthritis.
Who Can Treat Arthritis Pain?
A number of different specialists may
be involved in the care of an arthritis patient—often a team approach is
used. The team may include doctors who treat people with arthritis
(rheumatologists), surgeons (orthopaedists), and physical and occupational
therapists. Their goal is to treat all aspects of arthritis pain and help you
learn to manage your pain. The physician, other health care professionals, and
you, the patient, all play an active role in the management of arthritis pain.
How Is Arthritis Pain Treated?
There is no single treatment that
applies to all people with arthritis, but rather the doctor will develop a
management plan designed to minimize your specific pain and improve the function
of your joints. A number of treatments can provide short-term pain relief.
Medications: Because people
with osteoarthritis have very little inflammation, pain relievers such as
acetaminophen (Tylenol*) may be effective. Patients with rheumatoid arthritis
generally have pain caused by inflammation and often benefit from aspirin or
other nonsteroidal anti- inflammatory drugs (NSAIDs) such as ibuprofen (Motrin
Heat and Cold: The
decision to use either heat or cold for arthritis pain depends on the type of
arthritis and should be discussed with your doctor or physical therapist. Moist
heat, such as a warm bath or shower, or dry heat, such as a heating pad, placed
on the painful area of the joint for about 15 minutes may relieve the pain. An
ice pack (or a bag of frozen vegetables) wrapped in a towel and placed on the
sore area for about 15 minutes may help to reduce swelling and stop the pain. If
you have poor circulation, do not use cold packs.
Joint Protection: Using a
splint or a brace to allow joints to rest and protect them from injury can be
helpful. Your physician or physical therapist can make recommendations.
Transcutaneous Electrical Nerve
Stimulation (TENS): A small TENS device that directs mild electric pulses to
nerve endings that lie beneath the skin in the painful area may relieve some
arthritis pain. TENS seems to work by blocking pain messages to the brain and by
modifying pain perception.
Massage: In this pain-relief
approach, a massage therapist will lightly stroke and/or knead the painful
muscle. This may increase blood flow and bring warmth to a stressed area.
However, arthritis-stressed joints are very sensitive so the therapist must be
very familiar with the problems of the disease.
Acupuncture: This procedure
should only be done by a licensed acupuncture therapist. In acupuncture, thin
needles are inserted at specific points in the body. Scientists think that this
stimulates the release of natural, pain-relieving chemicals produced by the
brain or the nervous system.
Osteoarthritis and rheumatoid
arthritis are chronic diseases that may last a lifetime. Learning how to manage
your pain over the long term is an important factor in controlling the disease
and maintaining a good quality of life. Following are some sources of long- term
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
anti-rheumatic drugs (DMARDS): These are drugs used to treat people with
rheumatoid arthritis who have not responded to NSAIDs. Some of these include
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. 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 only be done once or twice a
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.
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. 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?
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. Nonetheless, some alternative or complementary
approaches may help you to cope or reduce some of the stress of living with a
chronic illness. 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
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
Another technique is to
substitute distraction for pain. Focus your attention on things that you enjoy.
Imagine a peaceful setting and wonderful physical sensations. Thinking about
something that is enjoyable can help you relax and become less stressed. Find
something that will make you laugh-a cartoon, a funny movie, or even a new joke.
Try to put some joy back into your life. Even a small change in your mental
image may break the pain cycle and provide relief.
Things You Can Do To Manage
•Eat a healthy diet
•Get 8 to 10 hours of sleep at night
•Keep a daily diary of pain and mood
changes to share with your physician
•Choose a caring physician
•Join a support group
•Stay informed about new research on
Institutes of Health: http://www.nih.gov/niams/