How to Manage Arthritis Pain Without Surgery

How to Manage Arthritis Pain Without Surgery

Many types of arthritis can be managed effectively without surgery. Try these six at-home methods first.

Arthritis symptoms range from an occasional mild ache to debilitating pain. Osteoarthritis, the most common type of arthritis, develops when the cushion of cartilage between the bones in a joint wears away, leading to pain (particularly after exercise), stiffness, a cracking noise during movement, and decreased mobility.

A degenerative disease, osteoarthritis usually occurs later in life. However, injuries such as a dislocation or fracture can make a joint more susceptible to arthritis. Fortunately, managing arthritis pain doesn’t always mean surgery. You can reduce the pain and stiffness of arthritis with several proven at-home, non-surgical therapies.

6 Ways to Manage Arthritis Pain Without Surgery

Whether it’s your hip, knee, or shoulder, first-line treatment for arthritis typically entails non-surgical methods to alleviate pain and increase range of motion. Try these at-home remedies for arthritis pain:

ExerciseLow-impact aerobic exercises such as walking, swimming, biking, and using an elliptical strengthen the muscles surrounding your joints. These activities also get your heart rate up without putting too much stress on your body. However, strenuous exercises that involve jumping, twisting, or deep bending should be avoided. A physical therapist can model effective ways to exercise or perform routine daily tasks like walking up and down stairs so you don’t strain your joints.

Lose Weight. Extra weight increases pressure on your joints, particularly your knees. For example, when you walk, your knees bear nearly two times your body weight. The more you weigh, the more stress you put on your knees. Exercise is one way to lose weight and reduce joint pain, but your diet plays a role, too. A plant-based diet of fruits and vegetables is helpful in fighting arthritis-related inflammation. On the other hand, processed foods, red meat, saturated fats, sugar, and salt contribute to inflammation and weight gain.

Hot & Cold Therapy. To ease stiffness, take a warm shower or bath or wrap yourself in a heated blanket. To reduce pain and swelling, apply a cold compress of ice covered by a towel or a gel ice pack to the aching joint. Just make sure the ice doesn’t directly touch your skin.

Anti-inflammatories. NSAIDs (non-steroidal anti-inflammatory drugs) are available either over-the-counter (ibuprofen and naproxen) or by prescription (celecoxib and meloxicam). Each one is an effective pain reliever and can be taken before you start an activity that causes discomfort. NSAIDs are generally safe, especially if used for a short period of time. But check with your doctor before taking an NSAID to make sure the medication doesn’t interfere with other drugs you may be prescribed.

Assistive Devices. Supportive devices, such as a walker or brace, alleviate pain by lifting the pressure off the affected joints. Assistive devices can also help you more easily accomplish everyday activities. If the pain is centered in your hands, for example, toothbrushes and brushes with larger handles are easier to maneuver.

Reduce Stress. Dealing with a painful chronic condition like arthritis can cause stress and anxiety, which only increases the intensity of your pain. Meditation, yoga, and other relaxation techniques calm the mind and help you cope with stress and pain.

If these at-home remedies or physical therapy fail to relieve your pain, your arthritis may have progressed to a point where surgery or joint replacement is advisable. Fortunately, today’s minimally invasive arthroscopic procedures allow you to regain use of your joint after a brief recovery period.

Let Us Heal You

The physicians at Comprehensive Orthopaedics treat arthritis with a combination of surgical and non-surgical methods. Our goal is to relieve your pain and get you moving freely again. Contact us today for a consultation.

What Shoes Work Best With Arthritic Knees?

What Shoes Work Best With Arthritic Knees?

WEDNESDAY, Jan. 13, 2021 (HealthDay News) — Lots of Americans suffer from painful arthritic knees, but a new study finds that wearing the right type of shoe may help ease discomfort.

Patients with knee arthritis will achieve greater pain relief by opting for sturdy and supportive shoes rather than flat flexible footwear, researchers in Australia found.

“A ‘sturdy supportive shoe’ is a shoe that gives stability to the foot, via motion control features such as arch support,” explained study author Rana Hinman, a professor of physiotherapy at the University of Melbourne. “It also has a thick, cushioned heel and a rigid sole that does not bend easily.”

In contrast, Hinman noted, “a ‘flat flexible shoe’ is more lightweight, contains no arch support or motion control features, has a low heel (i.e., flat) with minimal/no cushioning and has a flexible sole that bends easily.”

Roughly 1 in 4 adults over the age of 45 has arthritic knees, Hinman noted.

One U.S. expert unconnected to the study agreed that “bum knees” will probably feel better with special footwear.

“I think it’s pretty intuitive that a structured shoe will be more stable and better for arthritis patients,” said Dr. Jeffrey Schildhorn, an orthopedic surgeon at Lenox Hill Hospital in New York City. “I’ve found that to be true in my practice and in my life. But this study is the first to really look at this in a rigorous way, and to show with good science that this isn’t just anecdotal.”

Foot support matters

As the Australian team noted, people with creaky, painful knees are often advised to wear shoes with support. But there’s also a school of thought that flat flexible shoes may deliver greater benefit because they provide more of a “barefoot” experience.

The latter theory didn’t win out in the new study. After working with 164 knee arthritis patients in the Melbourne area, Hinman’s team found that “58% of people who wore sturdy supportive shoes experienced a meaningful reduction in knee pain on walking, compared to only 40% of the people who wore flat flexible shoes.”

Study participants were 50 years old and older. Prior to the study’s launch, all had experienced near constant knee pain in the prior month (rated at a 4 or greater on a pain scale of 11), and most had worn shoes that featured a mix of sturdy and flat characteristics.

Between 2017 and 2019, half were randomly assigned to wear a flat flexible shoe for at least six hours a day over six months, while the other half was assigned stable supportive footwear. (The team did not compare shoes distributed in the study with the ones patients regularly wore.)

All footwear was commercially available. For the flat variety, the brands included: Merrell Bare Access (for men and women); Vivobarefoot Primus Lite (men and women); Vivobarefoot Mata Canvas (men); Converse Dainty Low (women); and Lacoste Marice.

Stable variety brands included ASICS Kayano (for men and women); Merrell Jungle Moc (men); Nike Air Max 90 Ultra (women); Rockport Edge Hill (men); and New Balance 624 (women).

Each patient was able to switch between two brands throughout the trial. Investigators kept track of reported knee pain levels while walking, functional ability, overall quality of life indicators and overall physical activity levels.

In the end, the team determined that while stable supportive shoes did not restore greater mobility to patients than flat flexible shoes, they did offer a leg up on knee and hip pain reduction and improved quality of life.

‘A Rolls-Royce over potholes’

As well, Hinman noted that “sturdy supportive shoes were much less likely to cause adverse effects at the knee and other joints, such as ankle/foot pain [or] knee swelling.” Moreover, people who wore flat flexible shoes reported twice as many adverse effects as people who wore sturdy supportive shoes, she said.

The upshot: “Shoes are an easy option that can help people self-manage their knee osteoarthritis pain,” Hinman said. “Patients with knee osteoarthritis should think carefully about their footwear and choose shoes that are most likely to reduce their knee pain.”

Schildhorn agreed.

“For someone with knee arthritis,” he said, “a structured shoe is almost like a Rolls-Royce going over potholes. Because the problem with an arthritic knee is that the joints aren’t aligned correctly, and aren’t nearly as supple anymore. And it has cartilage with gaps, like cobblestones, which wear away.”

A structured shoe can absorb those issues, said Schildhorn. But an unstructured shoe or a bare foot “relies on all of the joints of the body to work just as they were designed. They all have to be aligned correctly, the ligaments have to be functional, and the joints have to be supple in order to absorb loads when walking in uneven areas. Because you need your body to be able to adjust to variances.”

The U.S.-based Arthritis Foundation agrees that patients should pay attention to the style and fit of the shoes they wear. But it cites mixed findings as to best practices.

For example, foundation experts acknowledge that stable shoes and boots (without heels) can indeed be helpful for some.

However, they also highlight prior knee research indicating that some flat shoes — such as flip-flops — may trigger less knee stress than more stable shoes. Others, however, such as loosely strapped sandals and so-called “foot gloves,” may prove problematic.

But the foundation has one piece of overriding advice: Never favor style over function and comfort.

The results were published Jan. 11 in the Annals of Internal Medicine.

More information

There’s more on shoe wear and arthritis at the Arthritis Foundation.

SOURCES: Jeffrey Schildhorn, MD, orthopedic surgeon, Lenox Hill Hospital, Northwell Health, New York City; Rana Hinman, PhD, professor, department of physiotherapy, University of Melbourne, Australia; Annals of Internal Medicine, Jan. 11, 2021

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How to Talk to Your Doctor About Arthritis Pain

How to Talk to Your Doctor About Arthritis Pain

SUNDAY, Dec. 20, 2020 (HealthDay News) – Chronic pain can be excruciating, debilitating and hard to describe.

Yet the best way to get the right treatment for the exact pain you’re experiencing is to put those symptoms into words, so your doctor can pinpoint a diagnosis and help you find relief.

The Arthritis Foundation created a guide with suggestions for communicating your discomfort. Included are questions ranging from, “What does the pain feel like?” to “How does the pain affect your life?” and specific details to share.

When describing what the pain feels like, be as specific as possible. If you describe it as aching or dull, that may point to muscle strains or arthritis. A description of shooting, tingling or burning might point to nerve pain as the cause. Sharp or stabbing pain might suggest injuries to a bone, muscle or ligament. Throbbing could be a headache, abscess or gout. Tightness may be a muscle spasm.

Where does it hurt? Is it in one location or does it travel? Is it steady or does it come and go? Try to be precise about location. For example, someone might describe a shoulder pain as deep in the joint or on the muscle surface.

Rate the intensity of your pain on a scale of 0 to 10, with 0 being pain-free and 10 being unimaginable. This can help a doctor determine the type or dosage of pain medicine you may need.

“Some patients come in the door with an eight on the pain scale, and they’re functional. Other patients walk in with a three and they’re disabled,” said Dr. Thelma Wright, medical director of the Pain Management Center at the University of Maryland Rehabilitation and Orthopedics Institute. “Function is huge.”

Keep a journal tracking when you hurt and if it’s worse at certain times of day.

“If I notice that a patient has higher pain scores in the morning versus in the evening, I may tailor my medication management to that,” Wright said.

Does anything ease your pain? In your journal, make note of what you’ve tried and what helped or hurt. Options could include heat or ice, rest or over-the-counter pain medicine.

Be aware that it could take a while to find relief. Being able to communicate your pain will help get you closer to a solution.

“It’s a trial-and-error process,” Wright said. “You might go through several medications before you get the best combination.”

More information

Johns Hopkins Medicine offers more information on chronic pain.

SOURCE: Arthritis Foundation, news release, Dec. 14, 2020

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A ‘Stunning’ Alternative Rx for Arthritic Joints?

A ‘Stunning’ Alternative Rx for Arthritic Joints?

THURSDAY, Nov. 19, 2020 (HealthDay News) — A procedure that “stuns” pain-sensing nerves might offer relief to people with severe arthritis of the hip or shoulder, a small, preliminary study suggests.

The procedure is a form of radiofrequency ablation, where doctors use needles to send a low-grade electrical current to nerves that are transmitting pain signals from the arthritic joint to the brain. The current heats and damages the nerve fibers, rendering them unable to deliver those pain messages.

In the United States, a number of ablation devices are cleared for treating low back pain and knee osteoarthritis.

At this point, the procedure is slowly becoming a more established treatment, said Dr. Felix Gonzalez, a radiologist at Emory University School of Medicine in Atlanta.

But whether ablation can help patients with severe hip or shoulder arthritis is unclear.

To find out, Gonzalez and his colleagues treated 23 patients whose hip or shoulder pain had become so bad that anti-inflammatory painkillers and cortisone injections — two standard treatments — were no longer helping.

Before undergoing ablation, and again three months later, patients answered standard questionnaires gauging their pain and daily function.

In the end, the study found, patients with shoulder arthritis reported an 85% drop in their pain ratings, on average. Among hip arthritis patients, pain declined by an average of 70%.

Gonzalez called the results “promising” and said, in his experience, there have been no major complications from the procedure, such as bleeding or infections — though those are potential risks.

And before the ablation is done, Gonzalez explained, patients go through what is basically a trial run. They are given an injection of numbing medication near the nerves believed to be generating the pain signals. If the pain abates, that means targeting the same nerves with ablation will likely work, too — longer term.

It’s too soon, however, to judge the effectiveness of the approach for shoulder and hip pain, according to Dr. Rajat Bhatt, a rheumatologist who was not involved in the study.

None of the study patients received a placebo (inactive treatment) to serve as a comparison, said Bhatt, of Prime Rheumatology in Katy, Texas. So it’s possible at least some of the pain relief came from the fact that patients received a novel therapy.

“With pain, there’s generally a large placebo effect,” Bhatt pointed out.

Larger studies, with a comparison group, are still needed, he said.

Gonzalez is scheduled to present the findings at the annual meeting of the Radiological Society of North America, being held online Nov. 29 to Dec. 5. Studies reported at meetings are generally considered preliminary until they are published in a peer-reviewed journal.

Osteoarthritis is exceedingly common, affecting more than 32.5 million Americans, according to the U.S. Centers for Disease Control and Prevention.

The condition arises when the cartilage cushioning the joint breaks down over time, leading to pain, stiffness and decreased range of motion.

People with osteoarthritis often take over-the-counter painkillers, such as ibuprofen (Advil, Motrin) and naproxen (Aleve). But besides being only moderately effective, the drugs are not without risks: Prolonged use is linked to increased risks of heart disease and kidney damage.

Corticosteroid injections, which reduce inflammation, are the next option. But their effectiveness wanes over time, Bhatt said, and there are long-term safety issues, including a risk of cartilage damage.

Beyond that, Gonzalez said, there are essentially two options for more severe pain: joint replacement surgery or opioid painkillers.

“But not everyone is a candidate for surgery, because of health reasons,” Gonzalez said. “And some patients don’t want it.”

Opioids, meanwhile, carry their own well-documented problems, including the potential for addiction.

“So we need something to fill the gap,” Gonzalez said.

Ablation stands as an additional therapy, he said, but it’s not a “cure.” For one, it addresses pain — not the underlying joint damage of arthritis. And the pain is not banished forever: The nerve fibers eventually grow back.

When ablation is used for knee osteoarthritis, Gonzalez said, the pain relief typically lasts 6 months or more — and up to two years in some patients. The procedure can be repeated.

In this early study, patients were only followed for three months. So it’s not clear how long the pain relief will last, Gonzalez said.

And while ablation is coming into wider use for certain pain conditions, people may not be able to find it locally. Gonzalez said some of his patients come from hours away to get the treatment.

More information

The Arthritis Foundation has more on osteoarthritis.

SOURCES: Felix Gonzalez, MD, assistant professor, department of radiology and imaging sciences, Emory University School of Medicine, Atlanta; Rajat Bhatt, MD, Prime Rheumatology, Katy, Texas; presentation, Radiological Society of North America virtual annual meeting, Nov. 29 to Dec. 5, 2020

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Knee or Hip Replacements Cut People’s Risk for Falls: Study

Knee or Hip Replacements Cut People’s Risk for Falls: Study

MONDAY, Oct. 26, 2020 (HealthDay News) — People who have total joint replacement, or total joint arthroplasty (TJA), experience fewer falls than those who don’t undergo the surgery, a new study finds.

“Osteoarthritis (OA) is the degeneration of the cartilage in our joints over the years,” said lead author Dr. Ran Schwarzkopf, an orthopedic surgeon at NYU Langone Health in New York City. “As the wear and tear increases, patients lose their range of motion. They cannot turn their toes as easily, flex their hips or lift their legs high enough to avoid obstacles due to physical limitations as well as pain, resulting in falls and fragility fractures.”

TJA is surgery to restore function — typically by replacing a damaged joint with an artificial one.

For the study, recently published in the Journal of the American Academy of Orthopaedic Surgeons, Schwarzkopf and his team used a New York database on nearly 500,000 OA patients. Patients had either total hip or total knee replacements, and their fall rates were compared to those who didn’t have the surgeries.

“Those who had TJA fell far less than those who did not,” Schwarzkopf said in a journal news release. “From that, we concluded that TJA for patients that have OA is protective against future falls.”

TJA decreases pain, increases range of motion and agility and leads to more successful physical therapy. Mentally, patients also have less fear of falling, leading to more stability and confidence, according to the researchers.

“TJA will allow patients to go back to the daily activities they may have avoided due to pain and restricted range of motion,” Schwarzkopf said. “They are able to go back to the point in their lives when they can do activities, such as hiking, riding a bicycle or even walking their dog, without having to think about whether it will cause them physical pain or rely as heavily on ambulatory aids and caregivers.”

Not everyone needs joint replacement surgery, however. OA can be treated with anti-inflammatory drugs, walking aids and exercises to increase strength, Schwarzkopf said. Only if patients are unable to live with the symptoms is surgery recommended.

Schwarzkopf offered these safety tips to help prevent falls:

  • Cover sharp corners of tables or counters.
  • Remove loose rugs.
  • Install handrails in bathrooms and near staircases.
  • Install motion-activated night lights.
  • Encourage use of wearable or portable communication devices.

More information

For more tips on avoiding falls, visit the National Council on Aging.

SOURCE: American Academy of Orthopaedic Surgeons, news release, Oct. 16, 2020

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1 in 3 Americans With Arthritis Say Pain, Symptoms Persist

1 in 3 Americans With Arthritis Say Pain, Symptoms Persist

TUESDAY, Oct. 20, 2020 (HealthDay News) — About 30 million U.S. adults live with osteoarthritis and the pain and stiffness it causes, a new survey finds.

And nearly one-third of these people said their symptoms are not well-managed, according to the Arthritis Foundation survey of almost 2,000 adults. In osteoarthritis, the cartilage cushioning the joints gradually wears down, leading to swelling, and limiting a person’s abilities to do the activities they want and need to do every day.

“Pain is debilitating. My back and hip pain are so bad that I have trouble getting out of bed,” wrote one survey respondent. “Each step is excruciating, and I wonder how much longer I can deal with the pain.”

The results of the recently released survey are clear, according to a news release from the foundation. Patients want to see more treatment and care options to reduce the impact of arthritis pain on their daily lives.

Respondents said that pain was difficult to manage with few options, including anti-inflammatory medications (NSAIDs), diet, exercise, opioids, braces and canes. Some reported using meditation and prayer. Surgery was considered a last resort.

About 65% said they use NSAIDs or topical medications to manage their pain, about 29% rely on therapies like physical therapy or massage, and another 29% said total joint replacement helped. Research shows that staying physically active can improve arthritis pain, according to the foundation.

More than one-third said COVID-19 concerns had caused them to cancel or skip health care appointments. Some also reported that pain levels had increased because of COVID-19 restrictions impacting their ability to access treatment and activity.

The primary change patients want to see is for health insurance to increase coverage of new arthritis treatments, though more than half said they were only interested in a treatment for pain if it didn’t also increase their joint damage, according to the foundation.

“You spend a lot of time & effort trying not to think about it because what you focus on magnifies,” wrote one survey respondent. “You hate pain scales because how do you rate something that is always there? Oftentimes it’s not the pain’s intensity but rather the duration.”

About 82% want to invest in research to explore new ways to treat or cure osteoarthritis, the survey found. About 65% want to advocate for better access to treatments and 61% want to support the development of new products to help with daily tasks.

More information

Individuals with osteoarthritis can share experiences by taking the Live Yes! INSIGHTS assessment and learn more at the Arthritis Foundation.

SOURCE: Arthritis Foundation, news release, August 2020

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