Questions
and Answers About
ARTHRITIS PAIN
National Institute of
Arthritis and Musculoskeletal and Skin Diseases
Arthritis News and
Information
What Is Arthritis?
What Is Pain?
How Many Americans Have
Arthritis Pain?
What Causes Arthritis
Pain? Why Is It So Variable?
How Do Doctors Measure
Arthritis Pain?
What Will Happen When You
First Visit a Doctor for Your Arthritis Pain?
Who Can Treat Arthritis
Pain?
How Is Arthritis Pain
Treated?
What Alternative Therapies
May Relieve Arthritis Pain?
How Can You Cope With
Arthritis Pain?
What Research Is Being
Conducted On Arthritis Pain?
Where Can You Find More
Information on Arthritis Pain?
Things You Can Do To
Manage 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 rheumatoid arthritis.
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 a lifetime.
How Many Americans
Suffer From Arthritis Pain?
Chronic 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 20 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. Social support networks can make an important contribution to
pain management.
How Do Doctors
Measure Arthritis Pain?
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 difficulties. 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 are experiencing.
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. You can begin a week or two before your
visit to the doctor. 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 Happen
When You First Visit a Doctor for Your Arthritis Pain?
The doctor will usually do the following:
- Take your medical history and ask questions such as: How long have you been experiencing
pain? How intense is the pain? How often does it occur? What causes it to get worse? What
causes it to get better?
- Review the medications you are using
- Conduct a physical examination to determine causes of the pain and how this pain is
affecting your ability to function
- 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) to see how much joint
damage has been done.
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.
Short-Term 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 or Advil).
- 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.
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 pain relief.
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
response system. 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 and Vioxx, so-called COX-2 inhibitors that block
and enzyme known to cause an inflammatory response.
Disease-modifying anti-rheumatic 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 only be done 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 Arthritis and Musculoskeletal and Skin Diseases Information
Clearinghouse has a separate fact sheet on arthritis and exercise. See the end of this
booklet for contact information.)
- 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 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 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 organizations listed at the end of this fact sheet
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.
Things You Can Do To Manage
Arthritis Pain
- 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 managing arthritis pain.
|
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 a 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 of 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 in 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 their quality of life. At the
Indiana University School of Medicine in Indianapolis, health care professionals are
looking at the causes of pain adn 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 Indiannapolis,
Institute-supported scientists are determining whether strength training can diminish the
risk of sever 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 Muscuskeletal and Skin Diseases Information
Clearinghouse (NAMSIC)
National Institutes of Health
1 AMS Circle
Bethesda, MD 20892-3675
301/495-4484 or 877/22-NIAMS (226-4267) (free of charge)
TTY: 301/565-2966
Fax: 301/718-6366
www.nih.gov/niams/
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.
- American Academy of Orthopaedic Surgeons
P.O. Box 2058
Des Plains, IL 60017
Phone: 800/824-BONE (2663) (free of charge)
www.aaos.org
This academy publishes brochures on arthritis and other subjects. Single copies of a
brochure are available free of charge by sending a self-addressed, stamped (business size)
envelope to (name of brochure) at the address above.
- American College of Rheumatology
1800 Century Place, Suite 250
Atlanta, GA 30345
Phone: 404/633-3777
Fax: 404/633-1870
www.rheumatology.org
This association provides referrals to doctors and health professionals who work on
arthritis, rheumatic diseases, and related conditions. It also provides educational
materials and guidelines.
- American Physical Therapy Association
1111 North Fairfax Street
Alexandria, VA 22314-1488
Phone: 703/684-2782 or 800/999-2782, ext.3395 (free of charge)
This association is a national professional organization representing physical therapists,
allied personnel, and students. Its objectives are to improve research, public
understanding, and education in the physical therapies.
- Arthritis Foundation
1330 West Peachtree Street
Atlanta, GA 30309
404/872-7100 or 800/283-7800 (free of charge) or call your local chapter, (listed in the
telephone directory)
www.arthritis.org
This is the major voluntary organization devoted to arthritis. The foundation publishes a
free brochure, Coping With Pain, and a monthly magazine for members that provides
up-to-date information on all forms of arthritis. The foundation also can provide
addresses and phone numbers for their local chapters and physician and clinic referrals.
- American Chronic Pain Association
P.O. Box 850
Rocklin, CA 95677
916/632-0922
www.theacpa.org
The Association provides information on positive ways to deal with chronic pain, and can
provide guidelines on selecting a pain management center.
- American Pain Society
4700 West Lake Avenue
Glenview, IL 60025-1485
847/375-4715
www.ampainsoc.org
The Society provides general information to the public and maintains a directory of
resources, including referrals to pain centers.
- National Chronic Pain Outreach Association, Inc.
7979 Old Georgetown Road, Suite 100
Bethesda, MD 20814-2429
Phone: 301/652-4948
Fax: 301/907-0745
http://www.theacpa.org
The Association operates an information clearinghouse offering publications and cassette
tapes for people with pain. They also publish a newsletter that includes information on
pain management techniques, coping strategies, book reviews, and support groups.
Acknowledgments
The NIAMS gratefully acknowledges the assistance of Susana Serrate-Sztein, M.D., and
Barbara Mittleman, M.D., of the NIAMS; John H. Klippel, M.D., Medical Director, Arthritis
Foundation; Brian M. Berman, M.D., Director of the Complementary Medicine Program,
University of Maryland, School of Medicine; and Laurence A. Bradley, Ph.D., Professor of
Medicine/Rheumatology, University of Alabama at Birmingham in the preparation and review
of this booklet. |
