Pain Relief: The L.A. Pain Clinic Guideby Sota Omoigui


Arthritis means inflammation of the joints. People of all ages including children and young adults can develop arthritis. The symptoms are intermittent pain, swelling, redness and stiffness in the joints. There are many different types of arthritis, some of which are rheumatoid arthritis, osteoarthritis, infectious arthritis and spondylitis. In rheumatoid arthritis, and other autoimmune diseases like systemic lupus erythematosus (SLE), the joints are destroyed by the immune system. Other parts of the body such as skin and internal organs may also be affected.Rheumatoid arthritis begins between the ages of 25 50 years and develops suddenly (within weeks to months). It usually affects the same joint on both sides of the body especially the end joints of the hands (except the thumb), wrists, ankles, feet and neck. The joints are red, warm and swollen. There may be nodules (lumps) under the skin on the pressure points of the body such as the elbows, arms, knees and feet. Rheumatoid arthritis causes a general feeling of sickness, fatigue, weight loss and fever.Osteoarthritis (also called degenerative arthritis) is caused by breakdown of joint tissue from injury, overuse or aging. Osteoarthritis usually begins after the age of 40 years and develops slowly over many years. It often affects joints on one side of the body first. Osteoarthritis involves the end joints closest to the fingernails more often than any other joints in the hands. Bony growths in those end joints are called heberden’s nodes. Osteoarthritis affects only certain joints including the spine and rarely affects elbows or shoulders. Unlike rheumatoid arthritis, the joints are usually not inflamed and there is no feeling of sickness.
Spondylitis usually begins under the age of 40 years, develops slowly over a few months and often affects mainly the joints of the spine. Like rheumatoid arthritis, other parts of the body may be affected. Symptoms are pain and stiffness in the low back or buttocks. The inflamed joints may put pressure on the nerves and cause shooting pain in the buttocks and down the back of the leg. Infectious arthritis is due to infection of the joints by a virus such as influenza or bacteria such as gonorrhea.
Practice good joint protection. Use a cane for a bad knee or hip. Keep common items at counter level in the kitchen or bathroom. Use lightweight items made from/of plastic rather than metal. Push, pull or roll instead of carrying. Use wide or large grip handles on doors, cabinets or kitchen utensils. You may take aspirin or other over the counter pain relievers such as Tylenol. These medications decrease the production of prostaglandins that cause pain, and should be taken daily even if you have few symptoms. Take the medicines with food to prevent stomach upset. Natural anti-inflammatory plant derived supplements such as Quercetin, Rutin, Curcumin, Red Wine tablets, Cinnamon and Ground Clove Extracts may be taken to reduce pain and joint inflammation. If you are overweight, you need to lose weight to reduce the stress on your joints. For every ten pounds you lose, you save 200 pounds of stress on your joints. Correct posture is important. Use a firm mattress or bed board while you sleep or rest in bed. Whenever possible sit in straight back chairs that have armrests and try not to slump. If you have infectious arthritis, the pain disappears when the virus runs its course or when the infection is treated. For the other types of arthritis, a hot shower coupled with daily exercises such as yoga or water exercises can relieve soreness due to stiff unused muscles. Warm water aerobics in a swimming pool enable you to exercise your joints with less discomfort because in water, you weigh only 10% of your body weight. Do not overdo any exercises or activities. Follow the 2 hour pain rule. If exercise induced pain lasts longer than 2 hours, cut back on exercises but do not stop. Do not exercise a joint that is inflamed or “hot”. However you should gently move the joint through the full range of motion twice a day. Pace yourself throughout the day so you do not get too tired. Learn to relax. Books and audiotapes teaching relaxation techniques are available at many bookstores. Some people find copper bracelets helpful. The dissolved copper enters the body through the skin and may help decrease joint inflammation. Maintaining a healthy diet with adequate protein and calcium is important. Vitamin C may be helpful. Fish oils from tuna, salmon, and mackerel e.t.c. help arthritis pain by reducing levels of leukotriene B4, a substance produced by the immune system that inflames joint tissues. Diet supplements may be obtained from fish oil capsules or liquids such as cod liver oil. Do not take more than 1 teaspoon of cod liver oil a day to avoid a build up of excess vitamin A that may cause liver damage. A herbal medication that may be helpful is pycnogenol, which is an extract of the pine bark. The active ingredients are also found in grape seed extract. Pycnogenol is 50 times more potent as a free radical remover (scavenger) than Vitamin E and 20 times more powerful than Vitamin C. Inflammation is the origin of all pain and is responsible for the breakdown of our bodies, including the joints, skin and organs. Aging, joint, muscle and tissue inflammation, plus poor functioning of the circulatory system, nervous system and immune system are a result of inflammation. Keep your weight down by reducing fats, cholesterol and sugar. Eat a diet rich in plants, fruits and vegetables flavored with herbal spices and extracts. They contain polyphenols which are the best anti-inflammatory agents that nature has provided to us. Cut back on vegetable oils and oil containing products like salad dressings, fried food and margarine. These contain omega 6 fatty acids that have been shown to worsen inflammation. You may use canola or olive oil that are low in omega 6 fatty acids. Occasional fasting for a day on just vegetable juice e.g. carrot juice, has been shown to reduce pain. Let your doctor know if you wish to fast. Limit your alcohol intake. It may worsen stomach upset from aspirin, Advil and other arthritis drugs. If you have rheumatoid arthritis, avoid foods from the nightshade plant family such as white potatoes, tomatoes, eggplant, tobacco and all peppers with the exception of black pepper.
Take pain relievers, such as Tylenol. When you have a flare up, use common sense and do not fight the pain. Put ice on ‘hot joints’, and wear your brace if you have one. If the painful joint is not hot, you may apply wet or dry heat or you may rub over the counter ointments, rubs and sprays such as Eucalypta Mint, Ben Gay or Flex all 454. Take herbal supplements such as Quercetin, Rutin, Curcumin, Red Wine tablets, Cinnamon and Ground Clove Extracts. These contain polyphenols which are the best anti-inflammatory agents that nature has provided to us. A new ointment called Zostrix (Capsaicin) may also help painful joints by decreasing the amount of substance P, which sends pain signals to the brain. Zostrix is the burning ingredient in red-hot chili peppers. The ointment itself may give you a funny burning sensation that lasts the initial couple of days. Wear rubber gloves when you apply it and keep it out of your eyes. A number of people have had relief using Certo which is an ingredient used to thicken home made jams and jellies and is found in the canning section of the supermarket. Certo contains pectin, which is derived from the cell wall of plants. It also contains citric acid and potassium citrate, which may help arthritis by neutralizing some of the inflammatory agents that cause some form of arthritis. Add 2 teaspoons of Certo, in 3 oz of grape juice. Do this three times a day. Cut back to one teaspoon Certo in grape juice twice a day after the joints quit aching. You should see results within a month. Rest is important because fatigue can make the pain worse. Your doctor may need to examine you and perform laboratory tests e.g. for antibodies such as rheumatoid factor. If you have a bacterial infection of the joints, you will need antibiotics. Get treatment quickly to prevent damage to your joints. For the other types of arthritis, your doctor may prescribe stronger anti inflammatory drugs such as Tolmetin or Diclofenac or may recommend injections of cortisone into the painful joints. If your arthritis is difficult to control, you may have to take low dose steroids by mouth. Steroids should be used cautiously because of the side effects such as thinning of the bones, high blood pressure and weight gain. Your doctor should discuss this with you. Strong pain medications such as Vicodin or Percocet may be given for short periods. The drugs should be used carefully so that they do not produce drug dependency. Other drugs that help control chronic rheumatoid arthritis include biologics such as Enbrel, Kineret or Remicade injections or oral medications such as sulfasalazine, d penicillinamine, antimalarials such as hydroxychloroquine, or anti cancer drugs such as methotrexate, cyclophosphamide. These drugs may provide long lasting relief but are expensive and may have serious side effects that your doctor will discuss with you. If your joints are very painful you may need splints or walking aids. Surgery may sometimes be necessary to replace or correct damaged joints. Your doctor may use biofeedback or meditation to help you learn to relax. If you are depressed you may need antidepressant medication and counseling.

Call your Doctor : If your pain is not relieved by over-the-counter pain killers, if you have fever, unusual redness, swelling, stiffness in the joints or if you do not feel well.

National Organization: The Arthritis Foundation (1 800 283 7800). You may request educational brochures and information on classes, clubs, support groups, exercise and water programs.