Many people diagnosed with arthritis say the worst aspect of their illness is the pain. It is one of the hardest and most depressing things to bear.  

It can be very difficult to deal with and can affect all aspects of your life.  However, the more you know about arthritis, the more empowered you will feel - and the more you will be able to help yourself and directly minimise your discomfort.

All individuals have their pain threshold and tolerance  - so the first important point is to be able to describe yours in particular.  You can then move forward and together with your doctor find out ways that can help you personally find relief. 

The good news is that there are a number of strategies that in combination with medication can help you contend with arthritis pain.  Part of the challenge of learning to live with the condition is discovering what treatments and techniques work for you in order to improve your quality of life.

Many things can prevent pain such as:

• Early diagnosis
• Weight control
• Physical activity
• Physical therapy
• Occupational therapy
• Surgery

Check with your doctor about what could be relevant for you.

This section highlights some important points about medication and looks at alternative ways to alleviate pain.

Pain medication

For effective pain management, it is important to make sure that the dosage and timing of the medication you are given is correct to control your particular discomfort.  It is also important to take your prescribed pain-killers regularly, according to this prescribed timing, rather than waiting for your pain to return.  This is crucial for two reasons:

• Taking your tablets at regular intervals will mean that you will experience far less pain compared to waiting to feel it return. 
• If you only take your tablets when the pain is particularly bad you will be learning to link your drug with pain relief and this is more likely to lead to drug dependence.

Things you should ask about your medication:

• How many times a day it should be taken and at what dosage?
• Should it be taken with or without food?  Some drugs are not absorbed properly with food, whilst others may cause stomach problems if not taken with food - it is important to know what is right for your medication.
• How long must the drug be taken for?  Is it to be taken for a specific course of treatment or merely as long as the symptoms persist?
• Will it be immediately effective or not?  With some medication it can take a while for the benefits to become apparent.  If this is the case it would be useful to know to keep you focused on taking the medication in the short term.
• What side effects can you expect and will they decrease over time?  Common side effects with pain relievers include: constipation, indigestion, dizziness, nausea, vomiting - but the range is infinite and different people may experience different side effects with the same drug. 

Do remember to let your doctor know if you are experiencing any side effects as there may be strategies that he/she can give to help relieve them.  For instance, one of the most common side effects of arthritis drugs is irritation of the stomach lining - gastritis.  One way to reduce this is by taking the medication another way than by mouth.  In this situation, taking medication as a suppository may help to reduce intestinal irritation.

Types of medications

There are numerous drugs available for the treatment of arthritis in all its forms and the number of drugs available is growing every month.  However, selecting the right drug for the right person is not straightforward, as not everyone responds in the same way to the same drug.  There may well be a process of trial and error before the best treatment is found.

Nonsteroidal anti-inflammatory drugs  (NSAIDS) are commonly used to treat rheumatoid arthritis and are generally the first drug that is prescribed when you are newly diagnosed.  They work by reducing inflammation and fever and relieving pain but they do not halt the disease process. Aspirin is a common NSAID.

Oral corticosteroids usually work quickly to control inflammation in rheumatoid arthritis.  They work by mimicking the action of corticosteroid hormones produced within the body as natural anti-inflammatories.  But they can have serious side effects, so long-term use is discouraged.  Nevertheless, they can be directly injected into inflamed joints for quick relief.

Disease-modifying anti-rheumatic drugs (DMARDS) are also known as SAARDS. These are slow acting but are able to delay progression of the disease.

Newer rheumatoid arthritis medications include biologic-response modifiers, which are capable of interfering with the autoimmune response seen in the disease.  These drugs are genetically engineered to target proteins known to play a major role in rheumatoid arthritis.

Heat and cold therapy

The use of heat and/or cold can be an easy, effective and inexpensive way to manage the pain of arthritis.  However, it is important to be aware of some simple rules when using these strategies to ensure that they are productive and do not cause additional complications.

Using cold packs

An ice pack can be a useful tool in relieving pain.  With rheumatoid arthritis, it can decrease the pain and swelling of inflamed joints by constricting the blood vessels and preventing fluids from leaking into surrounding tissues.  It can have a longer effect than heat purely because it takes longer to warm up than cool down!

Check with your doctor if this is a suitable option - it is not a good idea to use cold packs if you have circulatory problems or heart disease.

To create a renewable ice pack - put ice cubes in a freezer bag, and wrap in a clean tea towel.

Apply the ice pack for no more that 15-20 minutes at a time.  Longer than this may cause the area to over-freeze  - which can decrease circulation.  Watch if the treated area looks red with blotchy white spots - this is a warning sign that it is too cold.  Also, always wait a couple of hours before reapplying.

Delivering the cold with moisture allows a gradual and deeper penetration of the cold and a decrease in the risk of over-cooling the tissues.  To achieve this, wet a towel with warm water, wrap up the ice pack and apply immediately.

To create a malleable ice pack, make a slushy consistency by adding 1 part alcohol to 4 parts water and freezing in a freezer bag.

Using heat packs

A heat pack can be a useful tool in relieving joint pain.  Check with your doctor if this is a suitable option.

Apply the heat pack for 20-30 minutes and leave for a couple of hours between applications.

The nervous system will try to compensate for overheating by causing muscle joints to become stiff, so it is important not to use analgesic lotion at the same time.

Delivering the heat with moisture can increase the effectiveness of the pain relief.  To do this, place your heating pad in a protective plastic bag before wrapping in a moist towel.

Alternative ways to alleviate pain

Water therapy, in the shape of whirlpool baths or a warm shower can ease aching joints and promote relaxation.

Have a massage  - it can decrease pain and increase circulation, energy levels, and flexibility and as such is a very effective stress buster.  However, find a qualified therapist who has experience with arthritis patients and check with your doctor that your arthritis would benefit.

Imagery, visualisation, breathing techniques can be effective tools in many areas of healthcare, not just pain management.  There is some evidence that they can reduce anxiety, improve self-confidence and decrease distress when dealing with diseases such as cancer.  All of these are also important goals when developing strategies to deal with arthritis.  They have the advantage that you can access them at all times.

12/03/2009