Five Steps to Pain Relief
There’s no one best way to manage arthritis pain or achieve pain relief. Part of the frustration for people in pain, doctors acknowledge, is that no single technique is guaranteed to produce complete and consistent pain relief. Often you need a combination of methods. And you may need to change your mix of techniques over time – adding this, dropping that – as your condition changes.
Some people first try nonprescription medications such as aspirin, acetaminophen (Tylenol), ibuprofen (Advil, Motrin) or naproxen (Aleve) and get pain relief, and some will eventually turn to their doctors for stronger prescription medications. After time, people may resort to surgical repair or replacement of a persistently painful joint or removal of pain-causing tissues.
Meanwhile, between medications and surgery, think of arthritis pain management as a continuing journey, with options at each stop along the way that progress from least risky and least invasive on up. Consider this your travel guide. Read on to learn about the options at each stop and you can plan your itinerary and decide the order in which you try each option.
First step: learning about your arthritis pain
Patient education is potentially the most critical therapy in arthritis pain management, according to the American Pain Society. Learning all you can about pain treatments can help break down roadblocks to pain relief. Preconceived notions and misconceptions held by health care workers, employers, patients or their family members can be big roadblocks.
Some examples? A health care worker who doesn’t take pain seriously, a relative who downplays pain and isn’t supportive, a patient who fears becoming addicted to pain medication or believes assistive devices, such as canes, indicate weakness. The health care system itself can put up barriers, too, such as making access to pain treatment difficult, although studies have shown pain is undertreated.
Second step: rehabilitating your body
• Regaining posture. Proper posture is no slouch in preventing arthritis pain. Years of compensating for a sore knee can result in pain in a hip or ankle. Jutting the abdomen forward can cause lower back pain, as can slouching in a desk chair. Physical therapists can observe how you sit, stand and walk and teach you how to adjust your posture so you can move with less pain, which may allow you to do more health-improving exercise.
• Exercising. Getting regular exercise strengthens joint-supporting structures and improves flexibility. A physical therapist can suggest appropriate movements that provide a full range of motion. Physical activity also gets your heart pumping blood faster through your body, warming tissues and bringing them oxygen and nutrients needed for repair. Losing just 10 pounds of body weight takes 30 to 60 pounds of pressure off the knee.
• Finding solutions. Sore joints don’t just keep you from getting much-needed exercise; they also make necessary activities problematic: bathing, dressing, writing, driving and performing one’s job, for instance.
Third step: helping yourself at home
Besides reaching into your medicine cabinet and doing your exercises, what can you do in the comfort of your own home to achieve pain relief? Stay warm, get cool and rest.
1. Heat. Warming tissues eases arthritis pain by increasing blood flow to affected areas, which can help decrease inflammation, relax tight muscles and eliminate waste products such as lactic acid that cause stiffness and soreness. Five ways to bring on the heat:
• Soak it in. A hot bath or dip in a Jacuzzi can bring immediate pain relief. If you have respiratory or cardiac problems that may keep you from using warm water therapy, or if you are older than 70 (as we age, our bodies do not regulate heat as well), check with your doctor before plunging in.
• Pad the results. For pain relief in an isolated part of the body, electric heating pads are a popular choice. The downside is that more than 100,000 people burn themselves with such pads every year, often when they fall asleep or use them along with heat-inducing creams. Better options include microwaveable pads or heating pads with automatic off-switches in case you doze off.
• Wrap it up. An increasingly popular method for pain relief is to use low-level continuous heat wraps, which can be worn on various parts of the body – including the neck, elbow, lower back, and knee – and even slept in for up to eight hours.
• Adjust the contrast. Contrast baths – alternating soaks in hot and cold water – can decrease swelling and pain. The process is as simple as filling one sink with cold water (65 degrees Fahrenheit) and another with warm water (110 degrees Fahrenheit). Leave your hands or feet in the warm water for five to 10 minutes then plunge them in the cold for one minute. Return to the warm for three to four minutes before dipping in the cold for another minute. Repeat this four or five times.
• Wax on, wax off. Coating hands or feet in melted paraffin wax traps the heat right where you need it – on your sore joints. Leave wax on while it cools and hardens, then peel away. Bonus: In addition to providing heat to ease arthritis pain, the wax treatment softens skin.
2. Cold. Cold therapy, also called cryotherapy, can involve cold packs, ice packs, ice massage, cold compression wraps or fluids that cool the skin as they evaporate. Cold works by decreasing blood flow to reduce swelling, slowing the transmission of pain signals through nerves and inhibiting inflammatory chemicals. For pain and swelling after exercise, during a flare or for 48 to 72 hours after an injury, ice massage can be done for seven to 10 minutes; cold packs and wraps can be used for 15 to 30 minutes.
3. Rest. Balancing activity with rest periods can help diminish inflammation. Whether you take time out to relax your entire body or you rest a specific joint by wearing a brace or splint, allowing yourself to refresh mentally and physically can reduce arthritis pain and restore energy.
Fourth step: consulting nonphysicians
Managing pain often involves taking control of your body. The three methods below are physical approaches you can try without a prescription. But “without a prescription” doesn’t mean “without a doctor’s knowledge.” You should always tell your doctor about methods you try.
1. Acupuncture. The largest acupuncture study ever conducted shows that the technique significantly reduced pain and improved function for 570 patients with knee osteoarthritis who had moderate or severe pain despite taking anti-inflammatory or pain medications. The study also showed that acupuncture, like many complementary treatments, requires patience. Although people in the study had a 40 percent reduction in pain from acupuncture, they did not begin to benefit significantly more than the sham acupuncture group until week 14 of the 26-week study.
2. Massage. Two thousand years ago, Hippocrates advised doctors to gain experience in “rubbing that can bind a loose joint and loosen a hard joint.” Massage remains popular today and can provide temporary pain relief, says Dr. Matteson.
There are numerous ways to press the flesh, from full-body Swedish massage; to deep-tissue massage that uses pressure and slow strokes on deeper muscle tissue to relieve tension; to myofascial release, which uses long, stretching strokes to relieve tension around the connective tissue of the muscles.
3. Ultrasound. Using sound waves to penetrate tissues and provide heat, ultrasound may be useful for relieving pain and inflammation caused by injuries to soft tissue, muscle spasms and arthritis in a specific location such as the hand. Ultrasound treatments are performed by physical therapists or occupational therapists.
Fifth step: calming the mind to calm the body
Easing anxiety, reducing emotional distress or depression and getting better sleep may help reduce pain, improve the ability to enjoy life again, increase the ability to cope and improve psychological well-being – the main goals of chronic pain management, according to the American Pain Society.
Tuning out or turning down arthritis pain may be possible through psychotherapy techniques such as:
• Hypnosis. An induced form of relaxation requiring self-motivation and practice, hypnosis can help some people manage pain or shift their attention from it. How does it work? In a nutshell, hypnosis gives your normally subdued subconscious mind control and gives your overworked conscious mind a break, allowing you to reach a state of deep relaxation.
• Biofeedback. People in pain can learn to control their body’s responses to pain triggers. With biofeedback, sensors connect the body to a machine showing how thoughts and actions can affect the autonomic nervous system, which controls the involuntary action of the heart, lungs, stomach and intestines as well as the release of stress hormones, such as adrenaline or cortisol, from glands. Learning how to control involuntary responses like breathing and heart rate may allow other physical reactions to be controlled, too.
• Cognitive Behavioral Therapy (CBT). If you’ve ever received unexpected bad news, your body probably reacted with a strange sensation in your gut. Although the pang isn’t pleasant, it provides more proof that what your body feels is connected to what your mind thinks. Psychotherapists using CBT help people understand that connection and learn to control their thoughts so they can control feelings and physical reactions.
