Great Pains

Great Pains

The key to living with arthritis is good pain management

Each year, 27 million Americans suffer from the chronic disease, osteoarthritis (OA). The cause of OA is still not completely understood, and there is no known cure. What is known is that arthritis hurts.

Osteoarthritis can be either primary or secondary. Primary OA is a degenerative disease, and although it usually appears in old age, it is not a normal part of the aging process. It results from the wearing out of a joint; the breakdown of cartilage that helps facilitate and lubricate joint movement.

Secondary OA often appears in younger people. It can be the result of an injury; that bone-crunching hit you sustained in a high school football game or the increased daily stress caused by certain activities. Laborers might experience it in a shoulder or knee that was repeatedly compromised by their work. Typists and musicians can get OA in their fingers.

One of the most understood and most preventable causes of secondary osteoarthritis is obesity. For an overweight person, everyday activities put extra stress on the joints. For every pound of weight gain, four pounds of pressure is added to your knees, while an extra six pounds of pressure is added to your hips. It’s easy to see how this can quickly add up to an unhealthy situation.

In some cases, “you’re asking a joint to carry 50–100 percent more weight than it is designed to carry,” says Dr. Timothy R. Lubenow, director of the Section of Pain Management at Rush University Medical Center.

“Smoking increases the incidence of degenerative disc disease, which is one element of the arthritic changes that go on in the spine,” says Lubenow. In fact, smokers are twice as likely to have a chronic pain condition as those who do not smoke.

Both smoking and obesity increase the incidence of complications after surgery. “[Obesity] makes everything more challenging technically,” explains Lubenow. “[And obese patients] have a poor end result because they can’t push themselves with the physical exercise level that’s necessary following surgery in order to rehabilitate themselves successfully.”

Even when leading a healthy lifestyle, arthritis pain cannot always be avoided and must be managed. Nonsteroidal anti-inflammatory drugs (NSAIDs) can be very effective with a low risk of side effects. Aspirin, ibuprofen and naproxen all work well for most people. Thanks to advertising, they’re more familiarly known by names such as Bayer, Advil and Aleve, respectively.

Glucosamine has become a popular and widely used supplemental treatment for arthritis pain. However, there is some debate regarding its effectiveness. “I guess the best way to describe it is that it’s controversial,” says Lubenow.

Dr. Leslie Mendoza Temple is director of the Integrative Medicine Program at NorthShore University HealthSystem and a clinical assistant professor in Family Medicine at University of Chicago. “Clinically, I’ve seen that [glucosamine has] been helpful. If you’re not sure whether it’s working, go off of it and see how your arthritis pain does. If it starts coming back and you’re not doing anything else differently, then go back on it.”

Mendoza Temple’s approach to treating mild to moderate arthritis utilizes other supplements as well. “I’ll use supplements like turmeric and ginger or Chinese golden thread. I’ll use turmeric on the outside of the joint made into a paste with sea-salt and water,” she explains.

“I’ll recommend different brands of herbs and supplements that have as many of those components in them as possible so you can reduce the number of pills you’re taking,” says Mendoza Temple. Many of these supplements can be added to your diet without the use of pills by incorporating Indian, Asian and Thai food into your meals.

Mendoza Temple also recommends Omega-3 fatty acids (fish oil) and Vitamin D. “Vitamin D is very important for bone density, but I have also found that it can help with pain,” she says.

“When people have low Vitamin D levels, as they often do in Chicago and most places north of Atlanta, if you fix those levels, some folks feel a global reduction in pain,” explains Mendoza Temple. Vitamin D levels can be checked by a physician through a simple blood test. It is possible to overdose on Vitamin D, so you should consult your physician before taking it.

“The mind-body connection with pain is important,” says Mendoza Temple. “If you’re really stressed out and sleep deprived, your knees hurt more. Even if you have the same amount of arthritis in your knees compared to a person who is managing their stress really well, sleeping and eating well.”

Angie Ng is an acupuncturist at Acupuncture for Balanced Wellness. She explains her take on the mind-body connection. “From a Chinese perspective, we believe that the body is made up of a network of energy channels, called meridians, and that in order for the body to be healthy, this energy, or qi, must flow freely,” she says. The purpose of acupuncture is to “unblock obstructions in the energy channels.”

“When we insert needles into specific acupuncture points, we are opening up those energy channels and helping the energy to flow,” Ng says. She acknowledges that this idea sounds strange to many Westerners, but explains that “acupuncture has been shown to cause the brain and the nervous system to release biochemicals, like endorphins and serotonin, that act as natural painkillers and help the body to relax and heal itself.”

“By placing needles throughout the body, particularly in areas of pain, we’re causing a signal to be sent to the brain, telling it that it needs to send a healing response to that area,” says Ng.

When NSAIDs and alternative measures fail to control a person’s arthritis pain, steroids may become necessary. Your physician can refer you to an orthopedic surgeon or a physiatrist (a physical medicine rehabilitation specialist). These specialists can provide corticosteroid injections into the joint and guide you through physical therapy.

At Rush University Medical Center, “I work in a multi-disciplinary pain center,” explains Lubenow. “So we tend to see people who have not responded to the first-, second- or third-tier type of treatment.

“If it’s arthritis of the back or the spine, then they often get referred to a doctor like me to do a steroid injection in different parts of the spine.”

In some cases, a doctor may use a hyaluronate gel-like substance, such as Synvisc, Supartz and Hyalgan, instead of steroids. Unlike steroids, which combat the inflammation caused by arthritis, a substance like Synvisc mimics your body’s natural fluids. These substances are used as a substitute for the fluid and cartilage that have been lost and damaged by arthritis.

If all else fails, surgery may be necessary. There are several surgical procedures that can relieve pain. In extreme cases, when a major joint has lost all function, surgery can be performed to replace a damaged joint with an artificial one. Most people want to do whatever they can to avoid this last resort, but it can be very effective when more conservative measures have failed. Artificial joints can relieve the pain caused by a severely arthritic joint, while also restoring a great deal of mobility to a disabled person.

There are a multitude of options, traditional and alternative, to help you deal with your arthritis pain. It doesn’t have to be something you just have to live with. With a little guidance, it can be effectively managed for many years.

Published in Chicago Health Summer 2011