Strategies to Deal
with Arthritis Pain

Arthritis afflicts up to 54 million individuals across the United States.  

Many locations of arthritis have excellent surgical treatment options to dramatically reduce pain, improve motion, and dramatically improve overall quality of life and functional use.  For the upper extremity, such surgeries include shoulder replacement, elbow replacement, base of the thumb (CMC joint) reconstruction, and arthroscopic “clean outs” for mild arthritis elbows and shoulders.  

There are also surgical solutions for arthritis for the wrist, finger, and distal thumb and finger joints.  Unfortunately, the surgical options for these joints generally involve reconstruction that ultimately provides stability and pain relief while sacrificing some or all mobility of the joint.  For these joints, surgical treatment is generally a last resort for failed conservative strategies.

Several conservative strategies exist to help cope with the symptoms of arthritis.  Though none of these strategies will prevent the progression of arthritis or cure its presence, they can help to decrease pain and improve quality of life.

The conservative strategies encompass a wide range of treatment modalities from bracing, assistive devices, medications, herbal supplements, homeopathic supplements, creams, and therapeutic modalities.  Any one or a combination of these interventions may be effective in reducing arthritis related pain.

The treatments described in this article discuss some of the more common and effective conservative strategies available to you to help cope with the discomfort associated with arthritis.  

It is strongly recommended that you confer with your primary care provider prior to taking any new medications whether it be over the counter, topical, herbal, homeopathic, or prescription based to verify its safety for your individual health.

Nonsteroidal Anti-inflammatory Drugs (NSAIDS)

This drug is a non-narcotic powerful pain-relieving medication that also acts to reduce swelling and to reduce inflammation in muscles, tendons, and joints. This medicine works best when it is taken regularly or for a continuous but limited duration of time.  Generally, the continuous duration of any course of treatment ranges from 2 weeks up to 4 weeks.

The more common over the counter variations of these medications include Aleve, Naproxen, Ibuprofen, and Motrin.  Though each of these medications works to reduce pain and inflammation through a similar process, your beneficial biologic response to any one of these medications can be variable.  Therefore, there may have to be a process of “trial and error” to determine which medicine best relieves your pain.

Other prescription strength NSAIDS are available if over the counter medications prove to be ineffective at diminishing the symptoms of arthritis.  These medications are best prescribed by your primary care physician due to the concerns for side effects and drug interactions.  Some of these medications require documentation by your primary care physician for insurance coverage purposes.

It is not recommended to take multiple NSAIDS simultaneously; nor is it recommended to take NSAIDS long term (> 1 month) without routine evaluation by your primary care physician to monitor for medical complications such as cardiac, kidney, liver, and stomach lining damage.

Any medicine of this nature can have potential side effects, which are usually not a problem if the medication is taken properly and for a limited duration of time. The common reactions are usually minor, such as indigestion, nausea or diarrhea. The best way to avoid these problems is to take the medication after eating. If problems such as these occur despite taking the medication with food, discontinue the medication and consult with your primary care physician.  While you are taking this medication, you should not take other anti-inflammatory medications, including aspirin. Tylenol or other medications containing acetaminophen are generally safe to take with NSAIDS.

For the reasons of medical safety, our practice does not provide these medications for more than one month’s duration.  If you require these medications as a long-term treatment, it is recommended that you contact your primary care provider to further discuss these medications and their risks/benefits as they pertain to your health.

Steroids

Steroids are very potent anti-inflammatories and can be very useful in the “acute” setting to diminish swelling and inflammation associated with flares of arthritis.  These medications are commonly used as long term management for auto-immune inflammatory arthritis conditions such as rheumatoid arthritis, lupus, and psoriasis. 

Generally, these medications may be taken as a pill or be given as an injection directly into an inflamed arthritic joint.  The injection form is commonly used by orthopedic surgeons as it provides a rapid response and allows for the delivery of the maximum dose of steroid to the affected joint.  Oral steroids tend to have a more systemic effect and a slower response.

Regardless of whether the steroid is provided orally or via injection, there are generally accepted guidelines towards their use.  Oral steroids are not recommended for long term use or repetitive use (dose packs) for arthritis flares.  Long term and repetitive use of steroids can have significant consequences for musculoskeletal health and will affect one’s physiological homeostasis.  In addition, in the aging population, excessive or prolonged steroid use can worsen natural osteopenia changes in bone; making them more fragile and at risk for fracture.

Corticosteroid injections are considered safer than repetitive oral steroid use.  However, injection treatments to a joint have been shown in studies to have deleterious consequences for joint cartilage and adjacent muscle and tendon tissues with repetitive use.  The general rules for safe corticosteroid injection use follow the following principles:

1. An injection lasting 6 months or more is considered a beneficial injection
2. Regardless of how far apart the injections are given, there is a cumulative dose related negative response to a joint and the surrounding tissues over a lifetime
3. Higher doses of steroid do not correlate with better effect
4. The risk of infection rises with each successive injection

A thorough consideration of your circumstances and the respective benefits/risks of steroid use should be considered when using steroids as a recurrent treatment algorithm for arthritis.

Homeopathic/Natural Options

There are several “non-allopathic” options that have been shown promise in helping individuals diminish arthritis pain.  These more naturalistic options come in many forms from liquids and pills to topical ointments.  Below is a list of some of the more well-known natural arthritis treatment remedies available commercially:

1. Glucosamine and Chondroitin Sulfate

These amino acids are the building blocks of joint cartilage and are available in various formulations ranging from oral pills and liquids to sprays and ointments.  This is a non-FDA regulated industry and therefore the various companies have various dosages in their products.  It is unclear what is the correct dose, concentration, or formula of the final product which will provide the best results in arthritis pain relief.  In addition, there are no well conducted scientific studies that verify that this product provides actual joint benefit when taken as a supplement.  By and large, any evidence to support this product is anecdotal.  Use of this product DOES NOT restore cartilage in a joint.  The risk of use is low for the potential benefit.  Allergic reactions are rare.  However, allergic reactions have been reported in individuals with LATEX and SULFA allergies.  Drug interactions when using this product is not clearly understood at this time.

1. Turmeric

Turmeric is a root spice commonly used in Indian Food.  The use of turmeric in homeopathic treatment for medical concerns has been well known and documented in Indian culture and history for thousands of years.  Within the last decade, there has been an enormous interest in turmeric in western medicinal use.  Turmeric has been found to have potent systemic and topical anti-inflammatory and anti-septic properties.  Many formulations of this product are commercially available.  This product is NOT FDA regulated.  There are no guidelines to determine what is the best dose or formulation.  The risk of use is low for the potential benefit.  Many drug interactions have been reported including those that potentiate and decrease the effect of other medications.  Individuals who are on blood thinners should use caution as turmeric naturally thins the blood when taken as a supplement.  Homeopathic literature suggests that the beneficial effects of turmeric are potentiated when taken with black pepper.

Capsaicin Cream

Capsaicin is the extract of chili peppers.  It is the highly purified, heat producing substance in chili peppers.  When applied as a topical cream, capsaicin activates specific nerve receptors causing heat, mild stinging and itching sensations.  Prolonged activation of these receptors causes them to lose their ability to function properly (and process pain signals) for extended periods of time.  Capsaicin must be used regularly to keep the nerve receptors from working properly and processing pain signals.  Capsaicin is considered safe.  Side effects include local skin irritation and burning.  Proper cleansing of hands after use and avoidance of contact with eyes and mouth are important.

More information on treatments options for arthritis can be found at the following website:

www.Arthritis.org