null

Osteoarthritis and Joint Pain

Posted by My Doctor Suggests on Dec 9th 2020

Osteoarthritis is the most common form of arthritis and joint pain, affecting millions of people in the U.S. and world-wide.

The simplest way to describe arthritis is that it’s the wear and tear on the cartilage of your joints. This cushioning tissue is firm, thick and slippery it covers and protects the ends of bones where they meet to form a joint.

With arthritis, there are changes in the cartilage that cause it to break down. When it breaks down, the bones rub together and cause damage and pain. Experts don’t know why this breakdown in cartilage happens, but aging, joint injury, being overweight and genetics may be part of the reason. When you have arthritis, such simple, everyday movements can hurt. Using the stairs can be painful. Walking a few steps, opening a door and even combing your hair can be hard.

Arthritis is mainly a disease of the spine, hip, hand, knee and foot. But it can happen in other joints as well. A joint is where two bones connect, and these connections are spread throughout your body.

Some people who repetitively stress one joint or a group of joints, such as foundry workers, farmers, coal miners and truck and bus drivers, are particularly at risk.

The major factor for osteoarthritis of the knee comes from having an occupation that involves bending the joints. Curiously, long-distance running, does not increase the risk of developing this disorder. However, once osteoarthritis develops, this type of exercise often makes the disorder worse. Obesity may be a major factor in the development of osteoarthritis, particularly of the knee and especially in women.

Spotlight on the Ageing Factor

Many myths about osteoarthritis remain. For example, people think that it is an inevitable part of ageing, like grey hair and skin changes. They also believe that it results in disabilities and that most treatments are not effective.

As people age, the following conditions may occur:

  • The cartilage that lines the joints tends to become thin.
  • The surfaces of a joint may not slide over each other as well as they used to.
  • The joints may become more susceptible to injuries.

However, osteoarthritis is not an inevitable part of ageing It is not caused simply by the wear and tear that occurs with years of joint use. Other factors may include single or repeated injury, abnormal motion, metabolic disorders, joint infection or another type of joint disorder.

Ligament damage is also common with ageing. Ligaments, which bind joints together, tend to become less elastic as people age, making joints feel tight or still. This change results from chemical changes in the proteins that make up the ligaments. Consequently, most people become less flexible as they age.

Ligaments tend to tear more easily, and when they tear, they heal more slowly. Older people should have their exercise program reviewed by a trainer or doctors so that exercises likely to tear ligaments can be avoided.

Sometimes the pain caused by osteoarthritis cannot be relieved by a simple analgesic such as acetaminophen. More potent analgesics such as tramadol or rarely opioids, may be required, but most doctors will prescribe them only when necessary, to avoid problems with side effects and possible addiction.

However, some of these drugs can cause confusion in older people. Nonsteroidal anti-inflammatory drugs (NSAIDS) that are rubbed into the skin over the affected joint may be a better option for older people. Less of the NSAID is absorbed than if it is taken by mouth, which minimizes the risk of side effects.

Probable Causes

Normally, cartilage reduces the friction level in joints and protects them from wearing out, even after years of typical use, overuse or injury. Osteoarthritis is caused most often by tissue damage.

In an attempt to repair a damaged joint, chemicals accumulate in the joint and increase the production of the components of cartilage, such as collagen (a tough, fibrous protein in connective tissue) and proteoglycans (substances that provide resilience.)

Next, the cartilage may swell because of water retention, become soft and then develop cracks on the surface. Tiny cavities form in the bone beneath the cartilage, weakening the bone.

The attempt of the tissues to repair the damage may lead to new growth of bone and other tissue. Bone can overgrow at the edges of the joint, causing bumps (osteophytes) that can be seen and felt. Ultimately, the smooth, slippery surface of the cartilage becomes rough and pitted, so the joint can no longer move smoothly and absorb impact. All the components of the joint-bone, joint capsule (tissues that enclose most joints), synovial tissue (tissue lining the joint cavity), tendons, ligaments and cartilage, fail in various ways, thus altering the function of the joint.

Symptoms

Usually, osteoarthritis symptoms develop gradually and affect only one or a few joints at first. Joints of the fingers, base of the thumbs, neck, lower back, big toes, hips and knees are commonly affected.

Pain, often described as a deep ache, is the first symptom and when, in the weight-bearing joints, usually made worse by activities that involve weight bearing (such as standing). In some people, the joint may be stiff after sleep or some other inactivity, but the stiffness usually subsides within 30 minutes, particularly if the joint is moved.

As the condition causes more symptoms, the joint may become less movable and eventually may not be able to fully straighten or bend. New growth of bone and other tissue can enlarge the joints. The irregular cartilage surfaces cause joints to grind, grate or crackle, when they are moved, and tenderness develops.

Bony growths commonly develop in the joints closes to the fingertips (called Heberden nodes) or middle of the fingers (called Bouchard nodes).

In some joints, (such as the knee), the ligaments, which surround and support the joint, stretch so that the joint becomes unstable.

Alternatively, the hip or knee may become stiff, losing its range of motion. Touching or moving the joint (particularly when standing, climbing stairs or walking) can be very painful.

Osteoarthritis often affects the spine Back pain is the most common symptom. Usually, damaged disks or joints in the spine cause only mild pain and stiffness.

However, osteoarthritis in the neck or lower back can cause numbness, pain and weakness in an arm or leg, if the overgrowth of bone presses on nerves. The overgrowth of bone may be within the spinal canal in the lower back (lumbar spinal stenosis), pressing on nerves before they exit the canal to go to the legs.

This pressure may cause leg pain after walking, suggesting incorrectly, that the person has a reduced blood supply to the legs (intermittent claudication). Rarely does the bony growth compress the esophagus, making swallowing difficult.

Osteoarthritis may be stable for many years or may progress very rapidly, but most often, it progresses slowly after symptoms develop Many people develop some degree of disability as a result.

People who have episodes of red, hot and swollen joints, should be evaluated by a doctor because these episodes are not usually caused by osteoarthritis and could result from an infection or gout.

Your Doctor may do the diagnosis of osteoarthritis based on the characteristic symptoms, physical examination, certain blood test and the appearance of joints on x-rays (such as bone enlargement and narrowing of the joint space).

However, x-rays are not very useful for detecting osteoarthritis early because they do not show changes in cartilage, which is where the earliest abnormalities occur. Also, changes on the x-ray may show only a minor change in a person who has severe symptoms, or an x-ray may show numerous changes in a person who has very few, if any symptoms.

Magnetic Resonance Imaging (MRI) can reveal early changes in cartilage, but it is rarely needed for the diagnosis. There are no blood tests for the diagnosis of osteoarthritis, but certain blood tests may hep rule out other disorders (such as rheumatoid arthritis).

If a joint is swollen, Doctors may inject an anesthetic to numb the area and then insert a needle into the joint to draw a sample of the joint fluid. The fluid is examined to differentiate osteoarthritis from other joint disorders such as infection and gout.

A Natural Remedy:

Curcumin is found in the spice, turmeric. It is available in capsule form from health food stores or some drug stores. Curcumin is an anti-inflammatory which helps to reduce or eliminate joint pain. Results can take a few weeks to manifest and make a difference.

Medications:

As you assess the offered medications, note that they come with some undesirable side effects.

Medications that can help relieve osteoarthritis symptoms, primarily pain, include:

  • Acetaminophen (Tylenol and others) have been shown to help some people with osteoarthritis who have mild to moderate pain. Stronger NSAIDS are available by prescription from your Doctor.
  • NSAIDS can cause stomach upset, cardiovascular problems, bleeding and liver and kidney damage. NSAIDS as gels, applied to the skin over the affected joint, have fewer side effects and may relieve pain just as well.
  • Duloxetine (Cymbalta) is normally used AS AN ANTIDEPRESSANT. This medication is also approved to treat chronic pain, including osteoarthritis pain.

Therapy

A Physical Therapist can show you exercises to strengthen the muscles around your joint, increase your flexibility and reduce pain. Regular gentle exercise you can do on your own, such as swimming or walking, can be equally effective.

An Occupational Therapist can help you discover ways to do everyday tasks without putting extra stress on your already painful joint. For example, a toothbrush with a large g rip could make brushing your teeth easier if you have osteoarthritis in your hands. A bench in your shower could help relieve the pain of standing if you have knee osteoarthritis.

If conservative treatments don’t help, you may want to consider procedures such as:

  • Cortisone injections may relieve pain in the joint. During this procedure, your Doctor numbs the area around your joint, then places a needle into the space within your joint and injects medication. The number of cortisone injections you can receive each year, is generally limited to three or four injections, because the medication can worsen joint damage over time.
  • Lubrication injections of hyaluronic acid may offer pain relief by providing some cushioning in your knee, though some research suggests these injections offer no more relief than a placebo. Hyaluronic acid is similar to components normally found in your joint fluid.
  • Realigning bones. If osteoarthritis has damaged one side of your knee more than the other, an osteotomy might be helpful. In a knee osteotomy, a surgeon cuts across the bone either above or below the knee. Then the surgeon removes or adds a wedge of bone to help shift your body weight away from the worn-out part of your knee.
  • In joint replacement surgery (arthroplasty), your surgeon removes your damaged joint surfaces and replace them with plastic and metal parts. Surgical risks include infections and blood clots. Artificial joints can wear out or come loose and may need to eventually be replaced.

Lifestyle and Home Remedies

Learn all you can about your condition and how to manage it, especially about how lifestyle changes can affect your symptoms. Exercising and losing weight, if you’re overweight, are important ways to lessen the joint pain and stiffness of osteoarthritis.

Low-impact exercise can increase your endurance and strengthen the muscles around your joint, making your joint more stable. Try walking, bicycling or water aerobics. However, if you feel joint pain, then stop.

New pain that lasts for hours after you exercise, probably means you’ve been over-doing it and not that you’ve caused damage, or you should stop exercising. Try again a day or two later, at a lower level of intensity.

Carrying extra weight increases the stress on our weight bearing joints such as your knees and hips. Talk to a dietitian about healthy ways to lose the excess weight. Every pound you lose, can relieve some of the pressure on your joints and reduce your pain.

Here’s some other things to try that may help reduce the pain:

Gentle movement therapies. Tai Chi and Yoga involve gentle exercises and stretches combined with deep breathing have helped many others to reduce the stress in their lives and at the same time, reduced the osteoarthritis pain and improved movement.

Make sure the Yoga you choose is a gentle form and your instructor knows which of your joints are affected. Avoid any moves that cause pain in your joints.

Both Heat and Cold can relieve pain and swelling in your joints. Heat, especially moist heat, can help muscles relax and ease pain. Cold applications can relieve muscle aches after exercising and decrease muscle spasms.

Topical Capsaicin (a chili pepper extract) applied to your skin over an arthritic joint has helped some people. You may have to apply it three to four times a day for several weeks before you see a benefit and improvement. Wash your hands well after applying the capsaicin cream because it may cause some irritation.

Braces or Shoe inserts may help reduce pain when you stand or walk. These devices can help support your joints and help take off some of the pressure. Other assistive devices may also help to relieve stress on your joints. A cane can help take weight off your knee or hip as you walk. Hold the cane in the hand opposite the leg that hurts.

Gripping and grabbing tools may make it easier to work in the kitchen if you have osteoarthritis in your fingers. Check medical supply stores or ask your Doctor or occupational therapists about assistive devices.

Transcutaneous electrical nerve stimulation (TENS). This utilizes a low-voltage electrical current to relieve pain. It provides short-term relief for some people with knee and hip osteoarthritis.

Complementary and Alternative medicine treatments that have shown promise for osteoarthritis include:

  • Curcumin: This is an anti-inflammatory found in turmeric. It is a natural remedy for the reduction of pain in inflamed joints which cause pain.
  • Acupuncture: Some studies indicate that acupuncture can relieve pain and improve function in people who have knee osteoarthritis. During acupuncture, hair-thin needles are inserted into your skin at precise spots on your body.
  • Glucosamine and Chondroitin: Studies have been mixed on these nutritional supplements. A few have found benefits for some people, while many indicate that these supplements work no better than a placebo. Both of these supplements can interact with blood thinners such as warfarin and cause bleeding problems.
  • Avocado-Soybean unsaponifiables: This nutritional supplement-a mixture of avocado and soybean oils – is widely used in Europe to treat knee and hip osteoarthritis. It acts as an anti-inflammatory and some studies have shown it and slow or even prevent joint damage.
  • Omega-3 Fatty acids: Found in fatty fish and fish oil supplements and has been helpful for some people to help relieve pain and improve function.

Coping and Support

Your ability to cope despite pain and disability caused by osteoarthritis, often determines how much of an impact this condition will have on your life Talk to your Doctor if you’re feeling frustrated, because he/she may have ideas about how to cope or refer you to someone else who can help.

Physical Measures

Appropriate exercises – including stretching, strengthening and postural exercises – help maintain healthy cartilage, increase a joint’s range of motion and more importantly, strengthen surrounding muscles so that they can absorb stress better.

Exercise can sometimes slow down the worsening of osteoarthritis of the hip and knee. Doctors recommend people exercise in water (such as in a pool) because water spares the joints from stress.

Stretching exercises should be done DAILY

Exercise must be balanced with a few minutes of rest between the different exercises. It’s not a good idea to immobilize a joint because it may likely worsen the condition, rather than relieve the pain.

Using excessively soft chairs, recliners, mattresses and car seats may worsen the symptoms. People should not put pillows under their knees when reclining because doing so can cause the hip and knee muscles to become tight People with low back pain and sciatica should not put a pillow between their knees in an attempt to relieve the stress on the lower back and hip.

Moving car seats forward, using straight backed chairs with relatively high seats (such as kitchen or dining room chairs), firm mattresses and bed boards are often recommended as are wearing supportive or athletic shoes.

Toilet seat risers can make standing up easier and less uncomfortable for people who have pain of the knees or hips, particularly if their muscles are weak.

Here are some additional measures which may be helpful:

  • Physical therapy, often with heat therapy, such as heating pads and occupational therapy may also be helpful.
  • Range of motion exercises done gently in warm water are helpful because heat improves muscle function by reducing stiffness and muscle spasm.
  • Cold may also be applied to reduce pain caused by temporary worsening in a painful joint.
  • Shoe inserts, supportive shoes or athletic shoes may help reduce pain caused by walking.
  • Special equipment including canes, crutches, walkers, neck collars, elastic knee supports to protect joints from overuse, or a fixed seat placed in a bathtub to prevent too much stretching while washing, should be used as needed.
  • Weight loss can relieve some of the pressure on joints.
  • Electrical stimulation such as transcutaneous electrical nerve stimulation (TENS) may also help relieve pain.
  • Acupuncture has been successful for some people, by releasing various chemical messengers in the brain (neurotransmitters) that serve as natural painkillers.
  • Massage by trained therapists and deep heat treatments with diathermy or ultrasonography may also be useful for reducing pain.

How Useful are Drugs?

Drugs are prescribed and used to supplement exercise and physical therapy. Drugs which may be used in combination or individually, do not directly alter the course of osteoarthritis. Drugs are used to reduce symptoms and thus be helpful in allowing more normal daily activities.

A simple pain reliever (analgesic), such as acetaminophen, used before activities that cause discomfort or used regularly to relieve more constant joint discomfort, may be all that is needed for mild to moderate pain.

Although side effects are not common, people should not take any drugs in higher than recommended doses, particularly if they have liver disease. People should also make sure not to simultaneously take one of the numerous over-the-counter drug products that contain acetaminophen.

People who feel they may need a more potent analgesic, should be careful about drugs like tramadol or rarely, opioids.

The Last Word

Kaiser Permanente, the largest Managed-Care organization in the U.S. has published a nutritional update for Physicians, in their official medical journal. One of their principal recommendations was that people should consider a daily diet of whole, plant-based foods and reduce or eliminate their consumption of meats, dairy, eggs and all refined or processed foods.

No matter what disease a group of subjects had, studies revealed that people’s diet choices impacted the progression and/or resolution of the disease. When given better and more healthy diets, people simply got better.

Diseases don’t run in families…Diets run in families. Just because a family, for years, had a poor nutritional diet, doesn’t mean that today’s generation must follow the same pattern. Thanks to science, we know much more today, regarding how to live longer and healthier lives – and at the top of the list is a healthier diet.

In a beehive, all the bees are virtually identical, except for one – and that’s the Queen Bee. She is much larger than the worker bees; She is much longer-lived and lays all the eggs. What makes her life so unique and different is the special diet she is given as a young larva. The Royal Jelly she consumes turns off the enzyme that has been suppressing the expression of the “Royal Genes.” The unique diet of Royal Jelly alone creates the Queen.

Stop Messing with My Food

Food Processors and handlers of foods alter them by adding chemicals and preservatives, both as a cost-saving measure and to increase its shelf life.

The nutritional value of the resulting “food” is often very low and some of the additives can be harmful to our health and well-being.

The labels on these foods, many times do not tell the whole truth about what the product actually contains and may in fact prevent us from making the best choices based on good nutritional information.

If obesity is part of the problem regarding our ability to manage osteoarthritis, continuing to eat a diet based on saturated fats, trans-fats, excessive consumption of salt, sugar, processed foods and alcohol, then the other things that you do to improve your diet, will prove, for the most part, to be ineffective.

A plant-based, whole foods diet will help you not only to reach a healthy weight but give you more energy. Then as your mobility increases, you will be able to exercise more regularly and strengthen your weight-bearing joints, including your knees.

We have been conditioned by the food industry to make choices without thinking about what the consumption of many of our foods will do to our bodies.

Make a commitment today to closely monitor what you are putting into your grocery cart. If you suspect that you’ve picked some food items that could be detrimental to your health, don’t hesitate to put these back on the shelf and make some better, healthier choices.

Foods are the building blocks and the key to maintaining a healthy body and a feeling of well-being. It all comes down to the food choices you make for yourself and your family.