I was with some friends the other day who were bemoaning the fact that they were generally in good health, but their joint aches and pains were significantly impacting their daily lives. They asked me what I recommended for osteoarthritis. I winced a little bit because I knew that there is no perfect cure, and that most arthritis pain treatments have unwanted side effects when used long-term.

“Garden-variety” arthritis from wear-and-tear is called osteoarthritis. It is one of the most common causes of pain as we age. There are other kinds of autoimmune arthritis, where the body’s immune system attacks joint tissue (such as rheumatoid and psoriatic arthritis) and those have different treatment options that I won’t review here.

But if you’re like 27 million Americans with osteoarthritis, you probably have tried several treatments already, without full relief of your pain. In summary, here are the options before you:
Mechanical Options

1. Exercise: Some find that their arthritis is worse in the mornings after having been still and asleep at night. People with osteoarthritis often say that “it takes a while to get going in the morning, but once my joints warm up I feel better.” That’s true for exercise as well (it reduces arthritis pain). Weight training can strengthen the muscles around arthritic joints, taking some of the strain off them. Simple walking can be helpful in reducing pain. Gentle stretching can improve joint flexibility and reduce pain.
2. Physical therapy: Therapists can provide a monitored program that reduces pain and provides assistive devices (such as canes, splints, orthotics, or walkers) to offload weight on a painful joint while still allowing maximum movement. Therapists may also use heat and massage to help with the pain.
3. Weight Management: Every additional pound of weight puts more pressure on joints that have worn out cartilage or bone spurs. It makes sense that losing weight reduces joint pain.
4. Surgery: In severe cases of arthritis, the joints are worn down to the point of grinding bone on bone. Once you reach a certain level of joint destruction, joint replacement surgery becomes a good option.

Medical Options

5. Acetaminophen (Tylenol) is still considered first-line therapy for arthritis pain. It does not reduce swelling at the site of the joint, but modifies pain perception in the brain.
6. Non-steroidal Anti-Inflammatory Drugs: include over-the-counter drugs such as ibuprofen and naproxen. They work by reducing inflammation at the site of the arthritis. The downside is that long term use of NSAIDs can cause stomach ulcers or bleeding in the intestinal tract. It is important not to take these medicines for too long, and to always follow the Drug Facts label recommendations for dosing.
7. Steroid Injections: may provide temporary relief of arthritis pain by flooding the area with a strong anti-inflammatory medicine. These cannot be used too frequently because they weaken bones and can make you prone to fractures.
8. Hyaluronic Acid Injections: the “shock absorbing” protein found in joint fluid may be injected into the joint as a temporary pain reducing measure. Most people depend on these injections as a bridge to surgery. One of the risks of these injections is joint infections.
9. Narcotic Analgesics: prescription pain medicines may be effective at reducing severe arthritis pain, but the risk for dependence and possible addiction is very high. Most doctors are now being urged (because of the opioid epidemic) to avoid prescribing narcotics for more than 7 days. Atypical narcotics such as Tramadol, are sometimes a reasonable short term option.

And that’s pretty much it. I try to encourage my patients to be realistic about their pain management options – knowing that it’s unlikely that the pain can be taken away completely. Arthritis management requires a multi-pronged strategy that mixes mechanical and medical options to keep pain from limiting activities and the enjoyment of life. In the end, “tolerable pain’ rather than “no pain” may be as good as it gets.

References
http://www.mayoclinic.org/diseases-conditions/osteoarthritis/symptoms-causes/syc-20351925
https://medlineplus.gov/osteoarthritis.html

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Dr. Val Jones MD – Health Tip Content Editor
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