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National Institute of Arthritis and
Musculoskeletal and Skin Diseases
Questions and Answers About ARTHRITIS PAIN

What Is Arthritis? 

The word arthritis literally means joint inflammation, but is often used to refer to a group of more than 100 rheumatic diseases that can cause pain, stiffness, and swelling in the joints. These diseases may affect not only the joints but also other parts of the body, including important supporting structures such as muscles, bones, tendons, and ligaments, as well as some internal organs. This fact sheet focuses on pain caused by two of the most common forms of arthritis-osteoarthritis and rheumatoid arthritis. 

What Is Pain? 

Pain is the body's warning system, alerting you that something is wrong. The International Association for the Study of Pain defines it as an unpleasant experience associated with actual or potential tissue damage to a person's body. Specialized nervous system cells (neurons) that transmit pain signals are found throughout the skin and other body tissues. These cells respond to things such as injury or tissue damage. For example, when a harmful agent such as a sharp knife comes in contact with your skin, chemical signals travel from neurons in the skin through nerves in the spinal cord to your brain, where they are interpreted as pain. 

Most forms of arthritis are associated with pain that can be divided into two general categories: acute and chronic. Acute pain is temporary. It can last a few seconds or longer but wanes as healing occurs. Some examples of things that cause acute pain include burns, cuts, and fractures. Chronic pain, such as that seen in people with osteoarthritis and rheumatoid arthritis, ranges from mild to severe and can last a lifetime. 

How Many Americans Suffer From Arthritis Pain?

Chronic pain is a major health problem in the United States and is one of the most weakening effects of arthritis. More than 40 million Americans suffer from some form of arthritis, and many have chronic pain that limits daily activity. Osteoarthritis is by far the most common form of arthritis, affecting about 16 million Americans, while rheumatoid arthritis, which affects about 2.1 million Americans, is the most crippling form of the disease. 

What Causes Arthritis Pain? Why Is It So Variable? 

The pain of arthritis may come from different sources. These may include inflammation of the synovial membrane (tissue that lines the joints), the tendons, or the ligaments; muscle strain; and fatigue. A combination of these factors contributes to the intensity of the pain. 

The pain of arthritis varies greatly from person to person, for reasons that doctors do not yet understand completely. Factors that contribute to the pain include swelling within the joint, the amount of heat or redness present, or damage that has occurred within the joint. In addition, activities affect pain differently so that some patients note pain in their joints after first getting out of bed in the morning whereas others develop pain after prolonged use of the joint. Each individual has a different threshold and tolerance for pain, often affected by both physical and emotional factors. These can include depression, anxiety, and even hypersensitivity at the affected sites due to inflammation and tissue injury. This increased sensitivity appears to affect the amount of pain perceived by the individual. 

How Do Doctors Measure Arthritis Pain? 

Pain is a private, unique experience that cannot be seen. The most common way to measure pain is for the doctor to ask you, the patient, about your problems. For example, the doctor may ask you to describe the level of pain you feel on a scale of 1 to 10. You may use words like aching, burning, stinging, or throbbing. These words will give the doctor a clearer picture of the pain you are experiencing. 

Since doctors rely on your description of pain to help guide treatment, you may want to keep a pain diary to record your pain sensations. On a daily basis, you can describe the situations that cause or alter the intensity of your pain, the sensations and severity of your pain, and your reactions to the pain. For example: "On Monday night, sharp pains in my knees produced by housework interfered with my sleep; on Tuesday morning, because of the pain, I had a hard time getting out bed. However, I coped with the pain by taking my medication and applying ice to my knees." The diary will give the doctor some insight into your pain and may play a critical role in the management of your disease. 

What Will Happen When You First Visit a Doctor for Your Arthritis Pain? 

The doctor will usually do the following: 

Take your medical history and ask questions such as: How long have you had this problem? How intense is the pain? How often does it occur? What causes it to get worse? What causes it to get better? 

Review the medications you are using 

Conduct a physical examination 

Take blood and/or urine samples and request necessary laboratory work 

Ask you to get x rays taken or undergo other imaging procedures such as a CAT scan (computerized axial tomography) or MRI (magnetic resonance imaging). 
Once the doctor has done these things and reviewed the results of any tests or procedures, he or she will discuss the findings with you and design a comprehensive management approach for the pain caused by your osteoarthritis or rheumatoid arthritis. 

Who Can Treat Arthritis Pain? 

A number of different specialists may be involved in the care of an arthritis patient-often a team approach is used. The team may include doctors who treat people with arthritis (rheumatologists), surgeons (orthopaedists), and physical and occupational therapists. Their goal is to treat all aspects of arthritis pain and help you learn to manage your pain. The physician, other health care professionals, and you, the patient, all play an active role in the management of arthritis pain. 

How Is Arthritis Pain Treated? 

There is no single treatment that applies to all people with arthritis, but rather the doctor will develop a management plan designed to minimize your specific pain and improve the function of your joints. A number of treatments can provide short-term pain relief. 

Short-Term Relief 

Medications-Because people with osteoarthritis have very little inflammation, pain relievers such as acetaminophen (Tylenol*) may be effective. Patients with rheumatoid arthritis generally have pain caused by inflammation and often benefit from aspirin or other nonsteroidal anti- inflammatory drugs (NSAIDs) such as ibuprofen (Motrin or Advil).

Heat and cold-The decision to use either heat or cold for arthritis pain depends on the type of arthritis and should be discussed with your doctor or physical therapist. Moist heat, such as a warm bath or shower, or dry heat, such as a heating pad, placed on the painful area of the joint for about 15 minutes may relieve the pain. An ice pack (or a bag of frozen vegetables) wrapped in a towel and placed on the sore area for about 15 minutes may help to reduce swelling and stop the pain. If you have poor circulation, do not use cold packs.

Joint Protection-Using a splint or a brace to allow joints to rest and protect them from injury can be helpful. Your physician or physical therapist can make recommendations.

Transcutaneous electrical nerve stimulation (TENS)-A small TENS device that directs mild electric pulses to nerve endings that lie beneath the skin in the painful area may relieve some arthritis pain. TENS seems to work by blocking pain messages to the brain and by modifying pain perception. 

Massage-In this pain-relief approach, a massage therapist will lightly stroke and/or knead the painful muscle. This may increase blood flow and bring warmth to a stressed area. However, arthritis-stressed joints are very sensitive so the therapist must be very familiar with the problems of the disease. 

Acupuncture-This procedure should only be done by a licensed acupuncture therapist. In acupuncture, thin needles are inserted at specific points in the body. Scientists think that this stimulates the release of natural, pain-relieving chemicals produced by the brain or the nervous system. 
Osteoarthritis and rheumatoid arthritis are chronic diseases that may last a lifetime. Learning how to manage your pain over the long term is an important factor in controlling the disease and maintaining a good quality of life. Following are some sources of long- term pain relief. 

Long-Term Relief 

Medications 

Nonsteroidal anti-inflammatory drugs (NSAIDs)-These are a class of drugs including aspirin and ibuprofen that are used to reduce pain and inflammation and may be used for both short-term and long-term relief in people with osteoarthritis and rheumatoid arthritis.

Disease-modifying anti-rheumatic drugs (DMARDS )-These are drugs used to treat people with rheumatoid arthritis who have not responded to NSAIDs. Some of these include methotrexate, hydroxychloroquine, penicillamine, and gold injections. These drugs are thought to influence and correct abnormalities of the immune system responsible for a disease like rheumatoid arthritis. Treatment with these medications requires careful monitoring by the physician to avoid side effects.

Corticosteroids-These are hormones that are very effective in treating arthritis. Corticosteroids can be taken by mouth or given by injection. Prednisone is the corticosteroid most often given by mouth to reduce the inflammation of rheumatoid arthritis. In both rheumatoid arthritis and osteoarthritis, the doctor also may inject a corticosteroid into the affected joint to stop pain. Because frequent injections may cause damage to the cartilage, they should only be done once or twice a year. 

Weight reduction-Excess pounds put extra stress on weight-bearing joints such as the knees or hips. Studies have shown that overweight women who lost an average of 11 pounds substantially reduced the development of osteoarthritis in their knees. In addition, if osteoarthritis has already affected one knee, weight reduction will reduce the chance of it occurring in the other knee.

Exercise-Swimming, walking, low-impact aerobic exercise, and range-of- motion exercises may reduce joint pain and stiffness. In addition, stretching exercises are helpful. A physical therapist can help plan an exercise program that will give you the most benefit. (The National Arthritis and Musculoskeletal and Skin Diseases Information Clearinghouse has a separate fact sheet on arthritis and exercise. See the end of this fact sheet for contact information.) 

Surgery-In select patients with arthritis, surgery may be necessary. The surgeon may perform an operation to remove the synovium (synovectomy), realign the joint (osteotomy), or in advanced cases replace the damaged joint with an artificial one. Total joint replacement has provided not only dramatic relief from pain but also improvement in motion for many people with arthritis. 

What Alternative Therapies May Relieve Arthritis Pain?

Many people seek other ways of treating their disease, such as special diets or supplements. Although these methods may not be harmful in and of themselves, no research to date shows that they help. Nonetheless, some alternative or complementary approaches may help you to cope or reduce some of the stress of living with a chronic illness. If the doctor feels the approach has value and will not harm you, it can be incorporated into your treatment plan. However, it is important not to neglect your regular health care or treatment of serious symptoms. 

How Can You Cope With Arthritis Pain? 

The long-term goal of pain management is to help you cope with a chronic, often disabling disease. You may be caught in a cycle of pain, depression, and stress. To break out of this cycle, you need to be an active participant with the doctor and other health care professionals in managing your pain. This may include physical therapy, cognitive-behavioral therapy, occupational therapy, biofeedback, relaxation techniques (for example, deep breathing and meditation), and family counseling therapy. 

Another technique is to substitute distraction for pain. Focus your attention on things that you enjoy. Imagine a peaceful setting and wonderful physical sensations. Thinking about something that is enjoyable can help you relax and become less stressed. Find something that will make you laugh-a cartoon, a funny movie, or even a new joke. Try to put some joy back into your life. Even a small change in your mental image may break the pain cycle and provide relief. 

The Multipurpose Arthritis and Musculoskeletal Diseases Center at Stanford University, supported by the National Institute of Arthritis and Musculoskeletal and Skin Diseases (NIAMS), has developed an Arthritis Self-Help Course that teaches people with arthritis how to take a more active part in their arthritis care. The Arthritis Self-Help Course is taught by the Arthritis Foundation and consists of a 12- to 15-hour program that includes lectures on osteoarthritis and rheumatoid arthritis, exercise, pain management, nutrition, medication, doctor-patient relationships, and nontraditional treatment. 

You may want to contact some of the organizations listed at the end of this fact sheet for additional information on the Arthritis Self-Help Course and on coping with pain, as well as for information on support groups in your area. 

Things You Can Do To Manage Arthritis Pain 

Eat a healthy diet 
Get 8 to 10 hours of sleep at night. 
Keep a daily diary of pain and mood changes to share with your physician. 
Choose a caring physician. 
Join a support group 
Stay informed about new research on managing arthritis pain. 

What Research Is Being Conducted On Arthritis Pain? 

NIAMS, part of the National Institutes of Health, is sponsoring research that will increase understanding of the specific ways to diagnose, treat, and possibly prevent arthritis pain. 

Recent NIAMS studies show that levels of several neuropeptides (compounds produced by cells of the nervous system), such as substance P, are increased in arthritic joints. Substance P is involved in the transmission of pain signals via the nervous system. At the University of Missouri-Kansas City, researchers are studying effects of substance P in the spines of animals with chronic arthritis. Findings from this study may be used to develop specific drugs for chronic pain such as that associated with arthritis. 

NIAMS studies are also looking at other aspects of pain. At the Specialized Center of Research in Osteoarthritis at Rush-Presbyterian-St Luke's Medical Center in Chicago, Illinois, researchers are studying the human knee and analyzing how injury in one joint may affect other joints. In addition, they are analyzing the effect of pain and analgesics on gait (walking) and comparing pain and gait before and after surgical treatment of knee osteoarthritis. 

At the University of Maryland Pain Center in Baltimore, NIAMS researchers are evaluating the use of acupuncture on patients with osteoarthritis of the knee. Preliminary findings suggest that traditional Chinese acupuncture is both safe and effective as an additional therapy for osteoarthritis, and it significantly reduces pain and improves physical function. 

At Duke University in Durham, North Carolina, NIAMS researchers have developed cognitive-behavioral therapy (CBT) involving both patients and their spouses. The goal of CBT for arthritis pain is to help patients cope more effectively with the long-term demands of a chronic and potentially disabling disease. Researchers are studying whether aerobic fitness, coping abilities, and spousal responses to pain behaviors diminish the patient's pain and disability. 

NIAMS-supported research on arthritis pain also includes projects in the Institute's Multipurpose Arthritis and Musculoskeletal Diseases Centers. At the University of California in San Francisco, researchers are studying stress factors, including pain, that are associated with rheumatoid arthritis. Findings from this study will be used to develop patient education programs that will improve a person's ability to deal with rheumatoid arthritis and enhance their quality of life. At the Indiana University School of Medicine in Indianapolis, health care professionals are monitoring joint pain in patients with osteoarthritis and documenting this information. The goal of the project is to improve doctor-patient communication about pain management and increase patient satisfaction.

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Notes and Insights:

Happy Birthday!
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See /about/donate.html for more information.

Thank you!!!
A huge thank you to our Individual Benefactor Jay Lynn Peterson. Thanks for supporting Arthritis Insight!

Gimpfest 2001-Chicago here we come! 
Gimps from all over will invade Chicago in May! There will be fun, food and a whole lot of laughing going on! It's a chance to meet your online support pals in person, a chance to get some real hugs from your chat room pals. A good time will be had by all! http://fadedjeans.com/chicago 

Special Offers for Arthritis Insight Members

Whenever possible we will try get to our sponsors to agree to discounts and the like for our members. Here are our current special offers:

Sore No More gel ( http://www.sorenomore.com/ ) will send a free sample of the pain relieving gel to any Arthritis Insight Community Member who emails them at dma@glogerm.com 

Weekly News Summary
Karen Sears

SCIENTISTS DISSECT BRAIN'S HUMOR CENTER
What do engineers use for birth control? Their personalities! Whether you found this joke funny might reveal something about the way your brain works, according to researchers. Their study, which investigated how the human brain processes this joke and 29 others, identified a particular area of the brain that appears to be involved in your sense of humor.
Reuters Health, Feb 26
http://dailynews.yahoo.com/h/nm/20010226/hl/brain_humor_1.html 

PLAINTIFFS' LAWYER WARNS HMOs ABOUT SUITS
One of the nation's top plaintiffs' attorneys warned managed care plans Monday that if they do not change their practices, they may be bankrupted by the class action suits being filed against them.
Reuters Health, Feb 26
http://dailynews.yahoo.com/h/nm/20010226/hl/hmo_1.html 

SURVEY: AMERICANS WORRY ABOUT CHRONIC ILLNESS
At a time when 45% of people in the US are living with a chronic medical condition, a survey released Monday shows that many Americans are concerned about the quality of care the chronically ill receive.
Reuters Health, Feb 26
http://dailynews.yahoo.com/h/nm/20010226/hl/illness_1.html 

ONE IN FIVE U.S. ADULTS REPORT DISABILITY
Disability appears to be an important public health problem in the US, even among working adults. An estimated one in five US adults said they had a disability in 1999, according to the Centers for Disease Control and Prevention.
Reuters Health, Feb 23
http://dailynews.yahoo.com/h/nm/20010223/hl/diability_1.html 

NIKE RECALLS MORE THAN 200,000 PAIRS OF SNEAKERS
About 225,000 pairs of Jordan Trunner LX and Jordan Trunner 2000 cross-training sneakers are being recalled by Nike USA, the Consumer Product Safety Commission announced Thursday.
Reuters Health, Feb 23
http://dailynews.yahoo.com/h/nm/20010223/hl/nike_1.html 

HEALTH CARE FRAUD MOVES TO THE INTERNET
The Internet is presenting white-collar criminals with new opportunities for health care fraud, several speakers said Thursday.
Reuters Health, Feb 23
http://dailynews.yahoo.com/h/nm/20010223/hl/www_2.html 

ACUPUNCTURE SHOWN TO REDUCE ARTHRITIS PAIN
Acupuncture in addition to conventional therapy reduces the pain suffered by people with osteoarthritis, according to the results of an NIH-supported study presented here at the annual meeting of the American Academy of Pain Medicine.
Reuters Health, Feb 23
http://dailynews.yahoo.com/h/nm/20010223/hl/acupuncture_1.html 

HERBS AND SURGERY CAN BE A HARMFUL COMBINATION
Using herbal supplements before undergoing surgery may interfere with anesthesia or put patients at risk for complications such as increased bleeding. Patients would do well to lay off the herbs before going under the knife, according to Dr. Suzanne Yee, a plastic and cosmetic surgeon of the University of Arkansas at Little Rock.
Reuters Health, Feb 23
http://dailynews.yahoo.com/h/nm/20010223/hl/herbs_2.html 

ANERGIC T-CELLS, RHEUMATOID ARTHRITIS SYNOVIAL T-CELLS SHARE GENE-EXPRESSION
PATTERNS
Transcriptional changes common to anergic and rheumatoid arthritis synovial T cells may provide insights into cellular defects characteristic of rheumatoid arthritis, according to a report in the February issue of the Journal of Clinical Investigation.
Reuters Health, Feb 23 (free registration required)
http://rheumatology.medscape.com/reuters/
prof/2001/02/02.26/20010223scie002.html 

ANTIMALARIAL HELPS PREVENT BONE LOSS IN WOMEN WITH LUPUS
The antimalarial drug hydroxychloroquine appears to have an unexpected benefit in protecting against low bone mineral density (BMD) and osteoporosis in women with systemic lupus erythematosus (SLE).
Reuters Health, Feb 23 (free registration required)
http://rheumatology.medscape.com/reuters/
prof/2001/02/02.26/20010223clin010.html 

US WORKERS TOO STRESSED TO TAKE VACATION
Many Americans are involuntary workaholics, results of a recent survey suggest. More than 30% of workers gobble their lunch while they work and nearly 20% said they are too overworked to use their annual vacation time--even though they already have fewer vacation days than workers in other industrialized nations.
Reuters Health, Feb 22
http://dailynews.yahoo.com/h/nm/20010222/hl/stressed_1.html 

80 NOBEL LAUREATES BACK STEM CELL RESEARCH
Stepping into a heated political and ethical debate, 80 U.S. Nobel laureates have signed a letter to President George W. Bush (news - web sites) urging him to not block the first flow of federal grants for research on human embryo cells, The Washington Post reported Thursday.
Reuters, Feb 22
http://dailynews.yahoo.com/h/nm/20010222/hl/stemcell_1.html 

SUPREME COURT LIMITS REACH OF DISABILITIES LAW
A divided US Supreme Court restricted the reach of a federal law that protects disabled Americans from discrimination, ruling on Wednesday that states may not be sued by workers seeking money damages.
Reuters, Feb 22
http://dailynews.yahoo.com/h/nm/20010222/hl/disabilities_1.html 

TOO MUCH IRON, NOT ANEMIA, PROBLEM IN US STUDY
American doctors have been trained to relentlessly check patients for anemia, but most older people may have too much iron in their bodies rather than too little, researchers said on Thursday.
Reuters, Feb 22
http://dailynews.yahoo.com/h/nm/20010222/hl/anemia_1.html 

NATIONAL REGISTRY ESTABLISHED FOR ALOPECIA AREATA
A national registry for alopecia areata, a disease whose hallmark is unexplained hair loss, has been established by the National Institute of Arthritis and Musculoskeletal and Skin Diseases (NIAMS), a part of the National Institutes of Health (NIH).
Medscape Wire, Feb 22 (free registration required)
http://rheumatology.medscape.com/
MedscapeWire/2001/0200/medwire.0222.National.html 

LESSONS IN MUSCLE FITNESS FROM HIBERNATING BEARS
Bears and bedtime conjure up cozy images of cuddling and nursery rhymes. But for those confined to bed following illness or injury, real-life hibernating "Teddies" could provide clues as to how to prevent muscle loss due to prolonged immobility.
Reuters Health, Feb 21
http://dailynews.yahoo.com/h/nm/20010221/hl/bears_1.html 

"KEY-HOLE" SURGERY BRINGS LONG-TERM REFLUX RELIEF
"Key-hole" surgery can significantly cut long-term symptoms of gastroesophageal reflux disease (GERD), without some of the downside of traditional invasive surgery, new study results show.
Reuters Health, Feb 21
http://dailynews.yahoo.com/h/nm/20010221/hl/reflux_1.html 

SPORTS NUMB PAIN DIFFERENTLY IN MEN AND WOMEN
The stress of competitive sports is believed to have a temporary pain-numbing effect, with the adrenaline produced by the game basically overriding athletes' pain perception. But there may be distinct differences in how such ``stress-induced analgesia'' operates in men and women, new research shows.
Reuters Health, Feb 21
http://dailynews.yahoo.com/h/nm/20010221/hl/sports_1.html 

TOP COURT SAYS LAW BARS SUITS ON MEDICAL DEVICES
The Supreme Court ruled on Wednesday that federal law preempts state law liability claims alleging fraud against the Food and Drug Administration (news - web sites) (FDA) during the federal agency's regulatory process for marketing clearance for certain medical devices.
Reuters, Feb 21
http://dailynews.yahoo.com/h/nm/20010221/hl/devices_1.html 

CELECOXIB SHOWS EFFICACY IN TREATMENT OF ANKYLOSING SPONDYLITIS
A daily dose of 200 mg celecoxib significantly improves pain and function in patients with ankylosing spondylitis, according to a report in the January issue of Arthritis and Rheumatism.
Reuters Health, Feb 21 (free registration required)
http://orthopedics.medscape.com/
reuters/prof/2001/02/02.22/20010221clin002.html 

BONE MINERAL DENSITY DECREASED IN PATIENTS WITH NONAXIAL PSORIATIC ARTHRITIS
Patients with nonaxial psoriatic arthritis have significantly less systemic bone mass than healthy individuals, researchers in Italy report.
Reuters Health, Feb 20 (free registration required)
http://orthopedics.medscape.com/reuters/
prof/2001/02/02.21/20010220clin010.html 

PATIENTS WITH CHRONIC FATIGUE BENEFIT FROM GRADED EXERCISE
Many patients with chronic fatigue syndrome have inaccurate illness beliefs that may perpetuate their condition. A study in the February 17 issue of the British Medical Journal finds that providing patients with medical
explanations for symptoms to encourage graded exercise can substantially improve their condition.
British Medical Journal, Feb 20 (free registration required)
http://rheumatology.medscape.com/
MedscapeWire/2001/0200/medwire.0220.Patients.html 

STRUCTURAL DAMAGE IN RHEUMATOID ARTHRITIS
Slides/transcripts of the presentations as delivered by the faculty at Structural Damage in Rheumatoid Arthritis symposium held at Pennsylvania Convention Center, Philadelphia, Pennsylvania on October 31, 2000
Release Date: February 20, 2001 Medscape
(free registration required)
http://rheumatology.medscape.com/
CMECircle/rheumatology/2001/CME01/public/toc-CME01.html

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Contribute
Have you written something you think our subscribers would like to read? Send it to Tina@arthritisinsight.com and maybe we'll use it in our newsletter.

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A Closing Thought

Deep thoughts to ponder:

WHY...?
Why does the sun lighten our hair, but darken our skin?
Why can't women put on mascara with their mouth closed?
Why doesn't glue stick to the inside of the bottle?
Why don't you ever see the headline "Psychic Wins Lottery"?
Why is "abbreviated" such a long word?
Why is a boxing ring square?
Why is it called lipstick if you can still move your lips?
Why is it considered necessary to nail down the lid of a coffin?
Why is it that doctors call what they do "practice"?
Why is it that rain drops but snow falls?
Why is it that to stop Windows 95, you have to click on "Start"?
Why is it that when you're driving and looking for an address, you turn down the volume on the radio?
Why is lemon juice made with artificial flavor, and dishwashing liquid made with real lemons?
Why is the man who invests all your money called a broker?
Why is the third hand on the watch called a second hand?
Why is the time of day with the slowest traffic called rush hour?
Why is the word dictionary in the dictionary?
Why isn't there a special name for the tops of your feet?
Why isn't there mouse-flavored cat food?
You know that little indestructible black box that is used on planes? Why can't they make the whole plane out of the same substance?
Can fat people go skinny-dipping?
Why do you need a driver's license to buy liquor when you can't drink and drive?

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Arthritis Insight Newsletter Copyright 2001

Staff
Page last updated on February 28, 2001