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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 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 joint, 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 a 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 (orthopedists), 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 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 arthriitis 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.
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.
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 health care or treatment of serious symptoms.