Managing arthritis pain

Created date

July 23rd, 2018
a left hand massaging a right hand

It's possible to manage arthritis pain, with help from your medical professionals.

Experts believe that arthritis and related conditions such as fibromyalgia and gout are likely the main reasons for acute and persistent pain in people 65 years of age and up. According to the Centers for Disease Control and Prevention (CDC), almost 50% of adults age 65-plus have some form of arthritis diagnosed by a doctor. 

“Osteoarthritis is the most common form of arthritis in older individuals,” says Jain Ruchi, M.D., attending physician, department of rheumatology at Montefiore Health System in Bronx, N.Y. “Lumbar stenosis in the back or neck can be caused from narrowing of the spaces in the spine resulting in pressure on the nerves. This can cause nerve-related pain as well as muscular pain in the back and neck.”

The hips and knees are other common sites of pain, according to the Arthritis Foundation.

Many seniors think that arthritis and its symptoms are inevitable; thus, they do little to manage it. But symptoms can affect all aspects of daily life, including appetite, sleep, mood, and social relationships. Few people with arthritis can get to the point of complete pain relief, but research shows that a combination of medications, joint-friendly activity, and other measures can help you improve daily functioning, be more active, and enjoy a better quality of life.

Medication management

The goal with any medication is to take the smallest dose of the safest and most effective drug. “Acetaminophen is often the first line of choice for mild to moderate pain, and it has few side effects,” Ruchi says.

Nonsteroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen, naproxen, and aspirin, usually work well, but the American Geriatric Society lists NSAIDs as a high-risk medication for seniors. “Adverse gastrointestinal, cardiovascular, and kidney effects in older populations usually limit the use of NSAIDs,” Ruchi says. “In certain situations, topical NSAIDs can be used so individuals may experience pain relief in a specific area with less likelihood of systemic side effects.”

Other topical treatments include capsaicin, menthol creams, and hot or cold patches. These work mainly by changing the sensation of pain or counteracting it.

Some people may need stronger medicine. “Duloxetine can be used for patients with arthritis of the knee, chronic low back pain, and other pain conditions such as fibromyalgia,” Ruchi says. “Gabapentin and pregabalin are sometimes used to help, especially for people with nerve-related pain. Depending on the patient’s medical history, opioids may be used for moderate to severe pain.”

Joint-friendly exercise

About half of people with arthritis say they do not participate in exercise or leisure activity because of the functional limitations, the CDC reports. Ultimately, this lack of physical activity can lead to more restricted movement and an increased risk of falls. Inactivity also raises your risk of serious health problems like cardiovascular disease and diabetes.

Studies show, however, that the proper joint-friendly activities can actually reduce pain. “Exercise helps condition and strengthen the muscles and tissues surrounding the joints,” Ruchi says. “In time, muscles become more supportive and can take on some of the ‘load’ of the joints.”

This presents a dilemma for many people because it can be painful to begin exercising in the first place, and some people experience significant joint swelling after any physical activity. “If even simple movements cause pain,” Ruchi says, “the first step would be to tell your doctor.”

One recommendation may be to work with a physical therapist. “A therapist can teach you how to strengthen your muscles and improve flexibility,” says Judith Kahn, M.D., a physiatrist and pain management specialist in New York, N.Y. “Work with your doctor to find a qualified therapist.”

Start slowly, then build up over time. “A therapist can teach you isometric exercises, which are exercises aimed at conditioning the muscles in static positions rather than moving through a range of motion,” Ruchi says. “Other low-impact activities, such as gentle swimming or other pool exercises, may be less painful, and can still condition the muscles well.”

Other modalities

Some complementary (alternative) health practices can relieve pain. “Tai chi, yoga, massage, and acupuncture may help,” Ruchi says. “Using a transcutaneous electrical nerve stimulation unit may help patients with neck or back pain.”

Herbs and supplements such as fish oil, flaxseed oil, ginger, garlic, bromelain, turmeric, and bee venom are available, and some manufacturers claim they may relieve pain and inflammation, but this is not substantiated by the Food and Drug Administration. While these may nevertheless work for some people, drugs you take for other conditions may interfere with their effectiveness or cause harmful interactions. Check with your doctor before considering supplements.

No matter which combination of pain-relieving techniques you try, exercise should be one of them. But getting motivated to begin exercising is a significant problem for people, especially if the pain affects their emotional health. “Individual responses to pain can vary from one person to the other,” Ruchi says. “Finding ways to help patients improve mood and mental health can be useful steps in managing pain and motivating people to engage in activity.”

Be smart to get more active

Experts have found an easy-to-remember acronym for you to exercise:

Start low, go slow.

Modify activity when arthritis symptoms increase; try to stay active.

Activities should be “joint friendly.”

Recognize safe places and ways to be active.

Talk to a health professional or certified exercise specialist.

Source: Centers for Disease Control and Prevention