Joint Pain – Not Due to Old Age?

It is assumed that creaking ankles, hips and knees are normal aches and pains that occur with age. But this may not be true. Your symptoms could indicate that you have arthritis. Fortunately, medicine has progressed to provide relief, be it anything from exercises, drugs, alternative supplements or joint replacement.

Painful joints, knee twinges, severe pain from shoulder to the elbow was considered normal with old age. But, this is a wrong notion. Often, we presume that getting pain in the joint is a normal part of aging and we have to learn to endure it. According to experts, this notion is far from the truth. They refer to the multiple treatment options available, such as exercise, medications, alternative supplements and joint replacement surgery.

This is a grave problem as pain could affect all aspects of your life. Raymond Gaeta, MD, Director of Pain Management Services, Stanford Hospital & Clinic, Stanford University say that not only is pain an endurance of hurt but it also has an effect on your handling of life, occupation and relations with family and friends.

A recently published nationwide telephone survey by Gaeta showed some striking results. Virtually one in five people, about 19%) suffered from chronic pain similar to the one caused by arthritis. Still, almost half the people had no idea what is the cause for their pain. The huge majority, almost 84% were using over the counter medications for their pain.

Gaeta says that the problem is that people are used to the fact that the body heals itself naturally and always expect the same to happen. Even in case of chronic pain, people endure it or consume pain relievers, other than consulting a doctor. The problem is that people do not visit their doctors. There a lot of techniques available for pain management but the first step begins with ascertaining what is wrong.

As per Shannon Whetstone Mescher, Vice president of Programs and Services, Arthritis Foundation, an ordinary is not able to differentiate between pain in the joint, torn tendon and pain surrounding the joint area. A doctor should assess you to ensure that you actually have joint pain and the reason for its occurrence.

Arthritis – Right Diagnosis

Arthritis is an all comprising term that basically means inflammation of the joints; however its diagnosis is not simple. Robert Hoffman, MD, Chief of Rheumatology, University of Miami Miller School of Medicine states that there are more that 100 different forms of arthritis recognized. This is the reason as to why getting the right diagnosis is essential. Only this can enable the correct treatment.

According to Jason Theodoskais, MD, MS, MPH, FACPM, Preventive and Sports Medicine Specialist, University of Arizona Medical Center and author of The Arthritis Cure, another good motive to consult a doctor is that a lot of people suffer from other conditions that could worsen arthritis.

For instance, gout is a type of arthritis that could cause osteoarthritis. Hemochromatosis is a hereditary disease that involves unusually high storage of iron in the body that can cause diabetes, arthritis and heart disease. Also, joint pain can occur due to cancer that has reached the joints. Until the source of the problem is addresses, it is not possible to give the correct treatment or pain relief, Theodoskais notes.

The most common pain related conditions are the following:

Osteoarthritis – This type of arthritis is referred to as a degenerative joint disease. It is the most common type of arthritis in the people over 50. As we age, the rubbery cartilage that acts as a shock absorber in our joints becomes rigid resulting in loss of elasticity and is therefore more prone to injury. With the wearing of cartilage, the ligaments and tendons stretch resulting in pain. It could happen in nearly all body joints but is more common in the knees, hips, spine and fingers.

Some of the symptoms are pain, joint ache, bony knots in the fingers and soreness. Drugs, painkillers, and alternative supplements (such as glucosamine and chondroitin) could help in pain relief. However, lifestyle changes for instance weight loss might also be essential to ease stress on weight bearing joints.

Rheumatoid Arthritis – This type of arthritis is very diverse from degenerative joint disease. In this case, there is inflammation in joints of both sides of the body in a symmetrical fashion that enables it to be distinguished from other types of arthritis. But, a lot of symptoms seem similar, such as stiffness, swelling, joint pain and exhaustion. According to researchers, an external organism such as a bacteria or virus could change the immune system resulting in an attack to the joints and at times to other organs.

Hoffman says that rheumatoid arthritis is not only a chronic joint disease; it could result in early death. In the case of rheumatoid arthritis, enough evidence exists to prove that an early diagnosis and vigorous treatment could be of great help in preventing disability, maintaining function and improving survival.

Polymyalgia Rheumatica (PMR) and Temporal Arteritis (TA) – These two inflammatory diseases usually occur simultaneously and are considered to be related. The PMR disease involves larger joints of the body such as shoulders and hips. TA is the inflammation of the blood vessels in the head and includes the eyes. Both these conditions are a result of the immune system of the body reacting in contrast to itself.

Stiffness and pain in hip joints and shoulder, loss of weight, fever and exhaustion are the symptoms of PMR. Usually, there could be only one symptom, for instance inability to raise the arms to brush your hair or not easily being able to move out of a chair. A severe headache is the most common symptom of TA and in case it is not treated it could lead to stroke, permanent blindness or transient ischemic attacks (mini-strokes.)

The cause for the occurrence of these disorders is unknown; however, they appear to arise most commonly in people of Northern European or Scandinavian descent. According to Gaeta, once the disorder is diagnosed its treatment is very clear-cut which is the use of prednisone, a steroid. However, a lot of people are not aware of this type of arthritis. This requires consultation with your doctor.

Fibromyalgia – This chronic disorder causes tenderness and pain at various points throughout the body. This results in fatigue and serious sleep problems. The cause of fibromyalgia is not fully understood. However, it is not related to any nerve, joint injury or muscle. According to a theory its occurrence could be related to over-sensitive nerve cells of the brain and spinal cord. It could also be on account of an imbalance in brain chemicals, which manages mood, reduces tolerance for pain, probably setting off a vicious cycle of sleep disorders, sensitivity, exhaustion, sluggishness and pain.

Although fibromyalgia has no cure there are treatments that focus on managing fatigue, pain, depression as well as any other symptoms so as to come out of the loop of sensitivity, pain, and reduced physical activity.

Anti-depressant drugs taken in low doses prior to bedtime could offer better and relaxing sleep. For people suffering from fibromyalgia other types of sleeping pills are not very useful. Non-steroidal anti-inflammatory drugs (referred to as NSAIDs) such as naproxen and ibuprofen could help in lessening pain. However, the long term use of this medication is advisable only if taken under the observation of a doctor.

Depression – Being sad is not the only trait of depression. There could also be physical symptoms such as inexplicable pains and aches as shown by studies. Some of the common complaints are recurring headaches, joint pain, stomach pain and back pain where all of these symptoms could conceal the depression. The physical symptoms could be related to or enhanced on account of depression and could remain for a longer duration than the emotional symptoms.

Few doctors like Hoffman, are of the opinion that these physical symptoms are actually indications of fibromyalgia. He says that commonly the two conditions coexist. He also feels that depression could heighten the awareness of pain. So, treating depression is also essential.

Charles Weiss, MD and Chairman Emeritus, Department of Orthopedics and Rehabilitation, Mt. Sinai Medical Center, Miami Beach, Florida, suggests that you could request your family doctor to refer a specialist dealing with the type of pain you are going through, advises.

Lifestyle Changes

Experts say that even though joint pain cannot be cured, you can get relief from the pain. Various treatments are available to help you ranging from lifestyle changes, drugs and surgery. Usually, it should be tried in the same order as mentioned.

Lose excess weight – In case you are overweight, the initial step is to lose the excess weight. As pointed out by Whetstone Mescher, a recent study shows that even losing 11 pounds can reduce the risk of osteoarthritis in the knee by at least 50%.

Begin exercising – The subsequently step could be to plan with a physical therapist and develop a workout program that suits you. Usually, most people with painful joints get trapped in a vicious cycle. The ache in their joints stops them from working out and this in turn results further weakening of their joints and cause deterioration in their condition, explains Whetstone Mescher.

She says that a physical therapist is important, particularly in case you have no idea where to start. They can recommend the best exercises to suit you and enable you to improve stamina, strength and range of motion. Also, they can suggest precise joint exercises that can be designed particularly to provide relief from pain.

Exercising for 40 minutes a day for three or four days per week is usually suggested. Some of the other recommendations are:

* In case you can access a pool, water exercises are usually suggested. The buoyancy of water sustains the body weight and takes away the stress from achy and stiff joints, thus making it easier to workout.

* Low impact exercises, such as walking and biking that do not result in pounding strain on the joints could also help. However, high impact exercises, for instance jogging ought to be generally avoided. Whetstone Mescher opines that you should not swear by the ‘No pain, no gain’ saying.

Wear proper footwear – Letha Griffin, MD, team physician and bone expert of Georgia State University, Atlanta suggests using of cushiony soft shoes that can give an additional level of protective padding.

In case you smoke, you should stop it as it has been proved that smoking could effect the health of the bone as well as your response to any treatment.

Relief Using Painkillers

In case lifestyle changes do not provide relief, often drugs are prescribed. In the instance of mild pain often a simple painkiller could help, for instance ibuprofen, aspirin, acetaminophen (Tylenol) or other non-steroidal anti-inflammatory drugs (known as NSAIDs). A more recent of class of NSAIDs called Cox-2 inhibitors is available, for instance Bextra, Vioxx and Celebrex.

In September 2004, Merck, the drug manufacturer of Vioxx voluntarily withdrew it from the markets all over the world. This was on account of clinical trials showing increase in the risk of stroke and heart attack on using the drug.

In April 2005 the FDA directed Celebrex that it should include warnings of the possible risk of strokes, stomach ulcer bleeding and heart attacks. The FDA also ruled that Bextra should be pulled down from the markets as it posed risks to the stomach, heart, skin and the resultant problems overshadowed its benefits.

In April 2005, the FDA ruled that all over the counter anti-inflammatory drugs barring aspirin to amend their labels and include information of the possible risks of heart problems and stomach ulcer bleeding.

For a lot of people, especially seniors who are on multiple drugs for some other conditions, for instance high blood pressure, your doctor might eventually settle on a painkiller to be prescribed depending on what is most safe for you. For instance, high dosage of acetaminophen could harm the liver. In such a case, this medication will not be prescribed for a person who has liver problems.

This is the reason as to why it is so essential that the elderly should not self medicate, states Weiss. He advises that you should always consult your doctor before using any medication even if they are available over the counter and do not require a prescription. Keep him informed of all the other medications prescribed by other doctors. Also, enquire about the dosage you should take as it could differ according to the person’s age.

According to Weiss, irrespective of the type of the prescribed painkiller, seniors must be checked for any loss of blood, kidney and liver problems and variation in blood pressure.

Pain Relief – Other Ways

Cold or heat could also give short term pain relief, according to Whetstone Mescher. She feels that some patient prefer ice packs, where as other might prefer heat packs. It is advisable to try both options to determine what comforts you. None of the packs should be placed on the joints for over 20 minutes on any occasion.

Weiss feels that some patients could find help using creams, for instance Ben-Gay as they provide a peppery, warm feeling. Applying the cream using the rubbing motion stimulates the skin surrounding the joint and helps reduce pain.

Joint fluid supplements – In case of people who have not obtained relief from pain medications or lifestyle changes, another latest method referred to as joint fluid supplements (referred as viscosupplements by doctors) could be suggested.

These supplements include hyaluronic acid in a synthetic form. Hyaluronic acid is a natural chemical that performs as a shock absorber and a lubricant in the joint. However, it is not accepted by all doctors. Some doctors opine that the benefits are only modest and do not make up for the discomfort experienced by the use of injections.

Steroid shots – One of the other options is the use of corticosteroids. Injecting shots of steroids that are nothing but artificial versions of the natural hormones of the body in the joint so as to diminish inflammation and reduce pain, as per Weiss. Although such injections offer only short term relief, increasing the duration of use is not suggested as it could result in the possibility of side effects.

Alternative supplements – In the past few years, many studies have proven that using t glucosamine and chondroitin sulfate could provide relief from pain on account of osteoarthritis. Additionally, it has been shown in research that these supplements, especially glucosamine, could slow down or in some cases prevent the development of osteoarthritis. Most of the studies were on knee osteoarthritis; however experts believe that other joints could also be benefited in the same manner.

Glucosamine supplements obtained from crustacean shells are believed to restore missing fluid and encourage the growth of cartilage, thus aiding in joint repair, according to Weiss. Often when chondroitin sulfate is taken with a combination of glucosamine can prevent cartilage from breaking down. These supplements are considered effective and safe. However, they act slowly and require many weeks, possibly months of treatment to obtain relief.

Joint replacement – If everything else does not give relief from disability and pain, your doctors could suggest surgery where a damaged or arthritic joint is removed and in its place an artificial joint referred to as prosthesis is placed. These artificial joints made out of plastic and metal could be as excellent as the real joint can helps to restore function and movement.

Weiss is of the opinion that joint replacement is exceptionally successful and lasts for more that 20 years in case of over 90% of patients. But there can be some risks. A few patients can develop complications and a small percentage of patients die, particularly the elderly at greater risk. Weiss believes that the latest sophisticated software is of great help to the doctors enabling them to navigate better in the joint area and thereby can attain utmost benefit with negligible risk.