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

Copyright ©2020 HealthDay. All rights reserved.
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

Copyright ©2020 HealthDay. All rights reserved.

Contact Our Health Professionals

Follow Us

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

Copyright ©2020 HealthDay. All rights reserved.
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

Copyright ©2020 HealthDay. All rights reserved.
What Jobs Are Toughest on the Knees?

What Jobs Are Toughest on the Knees?

Joint replacements for knee osteoarthritis are becoming more common, and now researchers have identified jobs that may lead to one.

Based on a review of 71 studies that included nearly one million workers, the riskiest occupations include agriculture, construction, mining, service jobs and housekeeping. And jobs that demand excessive kneeling, squatting, standing, lifting and climbing stairs all increase your odds.

A team of researchers from the University of Sydney in Australia, and the Universities of Oxford and Southampton in the United Kingdom found that:

  • Carpenters, bricklayers and floor installers have roughly three times the risk for knee osteoarthritis, compared with sedentary workers.
  • Farm workers have 64% higher odds for the condition, slightly higher than the 63% for builders and construction workers.
  • Housekeeping also carries a risk — with unpaid houseworkers facing up to 93% increased odds for knee osteoarthritis.
  • Some jobs were kinder to the knees, however. Workers in commerce, forestry, fishing, machinists, plumbers, electricians, technicians and postal workers did not have a statistically significant risk for knee osteoarthritis, the study found.

“Knee osteoarthritis is a leading cause of loss of work and disability worldwide and can necessitate invasive surgery including total knee replacement, so preventing occupational hazards is critical,” senior study author Dr. David Hunter said in a news release from the University of Sydney, where he leads the Institute of Bone and Joint Research.

Osteoarthritis develops as cartilage deteriorates and bone comes into contact with bone, causing pain and swelling, and limiting function, which affects lifestyle. It can follow an injury, but most of the time the cause is unknown, according to a New York orthopedic surgeon.

“There is a genetic component, but there’s also a lifestyle component,” said Dr. Jeffrey Schildhorn of Lenox Hill Hospital in New York City, who reviewed the findings. One of the biggest risk factors is being overweight or obese.

“I’ve seen arthritis in every walk of life,” he said.

Osteoarthritis is a disease of aging, so it’s not surprising that more people are suffering from it and that the number of joint replacements is soaring, because people are living longer, Schildhorn said. But, he added, there is no miracle cure.

“The thing with arthritis that makes it difficult to deal with is that cartilage has no true regenerative ability,” he said, suggesting that the best way to prevent it is to eat well and watch your weight. Stretching and exercises like yoga will also help keep joints limber, Schildhorn added.

Treatment can include pain medications, and physical or behavioral therapy. But when these don’t work, a knee replacement may be in order.

“Osteoarthritis is mechanical wear and tear,” Schildhorn said. “Some people have more resilient cartilage than others.” If it is very soft and flaky, no treatment is going to work and it has nothing to do with a person’s lifestyle — or their job, he said.

But employers can help by providing physical therapy and teaching workers how to do their jobs with less stress on their knees, Schildhorn said.

The report was recently published in the journal Arthritis Care and Research.

More information

Learn more about knee osteoarthritis from the American Academy of Orthopaedic Surgeons.

SOURCES: Jeffrey Schildhorn, MD, orthopedic surgeon, Lenox Hill Hospital, New York City; University of Sydney, news release, July 8, 2020; Arthritis Care and Research, July 8, 2020

Copyright ©2020 HealthDay. All rights reserved.
Contact Our Health Professionals
Do I Have Arthritis?

Do I Have Arthritis?

How do you know if your joint symptoms mean you have arthritis? Only a health care professional can tell you for sure, but certain signs usually point to arthritis. There are four important warning signs that should prompt you to talk to a health care provider.

Warning Signs

1. Pain

Pain from arthritis can be constant or it may come and go. It may occur when at rest or while moving. Pain may be in one part of the body or in many different parts.

2. Swelling

Some types of arthritis cause the skin over the affected joint to become red and swollen, feeling warm to the touch. Swelling that lasts for three days or longer or occurs more than three times a month should prompt a visit to the doctor.

3. Stiffness

This is a classic arthritis symptom, especially when waking up in the morning or after sitting at a desk or riding in a car for a long time. Morning stiffness that lasts longer than an hour is good reason to suspect arthritis.

4. Difficulty moving a joint.

It shouldn’t be that hard or painful to get up from your favorite chair.

What To Do:

 

Your experience with these symptoms will help your doctor pin down the type and extent of arthritis. Before visiting the doctor, keep track of your symptoms for a few weeks, noting what is swollen and stiff, when, for how long and what helps ease the symptoms. Be sure to note other types of symptoms, even if they seem unrelated, such as fatigue or rash.   If you have a fever along with these symptoms you  may need to seek immediate medical care.

If the doctor suspects arthritis, they will perform physical tests to check the range of motion in your joints, asking you to move the joint back and forth. The doctor may also check passive range of motion by moving the joint for you. Any pain during a range of motion test is a possible symptom of arthritis. Your doctor will ask you about your medical history and may order lab tests as needed.

Most people start with their primary care physician, but it’s possible to be referred to doctors who specialize in treating arthritis and related conditions. Getting an accurate diagnosis is an important step to getting timely medical care for your condition.

Call Now Button