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Arthritic Treatment and Management Options Today
There are many ways to effectively manage arthritic arthritis pain today to find relief. Available are arthritic diets, exercise programs, over-the-counter and prescription medications, relaxation and positive emotion coping techniques. Also available are surgeries, supplements, home remedies, natural and other alternative therapies. When arthritis is first suspected, it would be wise to seek a medical opinion first. Then as time and resources allow, check out the other options. The basics of each option follows.
Pain Management in Arthritis
Rheumatologists are increasingly required to address pain as a specific symptom,” notes leading author Mary-Ann Fitzcharles, M.D., of Montreal General Hospital, McGill University. “Pain management is no longer simply a quick fix with a single pill, but rather an approach to the patient as a whole biopsychosocial being.”
What is rheumatic pain? How is it affected by inflammation? How is it linked to a patient’s psychological state? Drawing on the latest research into this complex factor, Dr. Fitzcharles and her collaborators demystify both the process and the experience of pain for patients with rheumatoid arthritis (RA) and related diseases. Pain mechanisms are not hard wired, but constantly in a state of change. But neurotransmitters and inflammatory molecules make rheumatic pain feel chronic. Rheumatic pain, as the authors explain, is transmitted by not only the central nervous system, but also receptors in the joint tissue and cartilage. Because rheumatic pain travels through small, slow-conducting fibers, it is perceived as a pervasive aching rather than as acute, localized stabs. Inflammation also plays a role in activating pain pathways that usually lie dormant – comprising as many as one-third of the total number of pain-transmitting nerves. What’s more, molecular evidence suggests that stress and depression may increase a rheumatic patient’s production of pain-provoking inflammatory agents.
How can a rheumatologist accurately assess a patient’s pain? As Dr. Fitzcharles acknowledges, clinical evaluation of pain is difficult and subjective. In addition to using time-honored tools – namely, the visual analogue scale of pain severity and patient questionnaires – in real-life practice, the rheumatologist must take cues from the patient during the interview and examination, heeding spontaneous movement, musculoskeletal structure, and verbal complaints, as well as consider the patient’s psychosocial history and coping strategies.
Beyond the prescription of a pill, what works to relieve rheumatic pain? “There is no gold standard regarding the ideal management of chronic pain in rheumatic diseases,” observes Dr. Fitzcharles. “Ideal pain management should encompass a wide range of both pharmacological and nonpharmacological interventions.” The authors culminate with a comprehensive review of complementary treatment approaches, including:
Exercise. According to studies, regular physical activity not only maintains muscle tone and helps to improve function, but also induces the production of endogenous opioids – endorphins and other natural painkillers.
Herbal and dietary supplements. For example, decreased pain has been recorded among RA patients receiving supplementation with an omega-3 enriched diet for 12 months. This dietary change reduced the need for antirheumatic medication.
Topical applications. Used for centuries as home remedies, healing ointments have shown clinical promise for the care of rheumatic conditions. In one recent study, topical diclofenac performed as well as ingested diclofenac in relieving knee joint pain.
Opioid analgesics. The cornerstone of pain management in cancer, opioids are increasingly prescribed for patients with musculoskeletal pain. However, only limited data support the long-term use of opioids in patients with rheumatic pain. It is not clear, as yet, if opioids provide sufficient benefit to counterbalance the possible harmful effects.
“Rheumatologists will need to become familiar and comfortable with the use of newly developed strategies for pain management to ensure optimal treatment,” Dr. Fitzcharles concludes. “Improved function and rehabilitation, and not simply palliation, should be the main goal of pain management in rheumatologic practice.”
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ARTHRITIC DIETS & NUTRITIONAL HEALING
There is a great deal of debate in the medical world about the effects of overall diet on arthritis and using diet toward alleviating the condition. Doctors have known for a long time that diet affects gout, a specific type of arthritic condition, however the jury remained out for a long time on other common types of arthritis such as rheumatoid and osteoarthritis.
The majority of opinions has clearly shifted to the view that diet and nutritional health plays a role in the onset and progression of many forms of arthritis. Being overweight can affect certain arthritic conditions, forcing some joints to excessive loads. This added weight stresses the joints, causing overuse or more wear to components, and arthritis pain, especially in the knees. So making sure arthritic sufferers eat good foods, manage their weight and get help from healthcare providers to create and follow a well-balanced dietary plan is an important part of treating most forms of arthritis.
The Arthritis Foundation published a list of their top 10 supplements for use in management of arthritis
- Chondroitin Sulfate
- Glucosamine Sulfate
- GLA: (Gamma linoleic acid)
- Fish Oil
- Flaxseed Oil
- Vitamin D
- Vitamin E
- Folic Acid
- Green Tea: Camellia sinensis
- DHEA:
Dehydroepiandrosterone
Treatment of Osteoarthritis
The concept that diet can, in any way, affect osteoarthritis (degenerative arthritis) is an area of a lot of ongoing research. We have complied summaries of much of the current research.
- Obesity increases the risk for developing osteoarthritis. Overweight persons might reduce their chances for developing or aggravating their osteoarthritis by losing weight. Furthermore, if a person already has substantial osteoarthritis in a weight-bearing joint, such as a knee or hip, weight reduction can significantly improve their ability to rehabilitate after joint surgery as well as decrease their risk of surgical complications.
- Vitamin C is important in the development of normal cartilage. A deficiency of Vitamin C might lead to the development of weak cartilage. Vitamin C is commonly available in citrus fruits. Supplementation with a Vitamin C tablet may be advised if dietary fruits are unavailable. Care should be taken not to exceed recommended dosages, in the case of Osteoarthritis there is some evidence that excessive levels of Vitamin C may make the condition worse.
- Persons with low bone mineral density, such as in osteoporosis, may be at increased risk for osteoarthritis. Exercise and adequate calcium and magnesium intake, as recommended for age and gender, can help to maintain bone density.
- Vitamin D deficiency has been shown to increase the risk of joint space narrowing and progression of disease in osteoarthritis. Many doctors are recommending Vitamin D supplementation of 400IU daily. This can also help to prevent osteoporosis.
- In recent years, there have been studies originally conducted in Europe and more recently in the United States that have verified that the food supplements glucosamine and chondroitin can help to relieve osteoarthritis symptoms, including arthritis pain and stiffness. Each of these supplements can be taken alone or in combination formulations. Keep in mind that glucosamine has been marketed as a "cartilage re-builder." This is in part under the assumption that, because glucosamine is a component of normal cartilage, consuming it will assist in the rebuilding of damaged cartilage.
Nutrition for Rheumatoid Arthritis
We do know that the most commonly observed vitamin and mineral deficiencies in patients with Rheumatoid Arthritis, are folic acid, vitamin C, vitamin D, vitamin B6, vitamin B12, vitamin E, folic acid, calcium, magnesium, zinc and selenium (ref1). Although nutritionists agree that food is always the preferred source for vitamins and minerals, it may be essential to use a supplement to help in replacing the outlined deficiencies to improve the nutritional status for patients with Rheumatoid Arthritis. Research has also shown that antioxidants such as selenium and vitamin E may decrease free-radical damage to the joint linings, helping to decease swelling and arthritis pain.
To begin, here is a look at some vitamins, minerals, nutrients / foods and some herbal applications to consider in the management and prevention of arthritis.
Read on for both medical and natural treatment approaches
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