As if the pain of sore
and swollen joints isn't bad enough, now arthritis sufferers have to endure the confusion
and frustration of having some of their most effective pain relievers declared risky.
The arthritis medication Vioxx was pulled from the
market Sept. 30 after studies indicated it increased the chance of heart attack and
stroke. The other shoe fell when Celebrex, another arthritis drug in the same class of
Cox-2 inhibitors, was linked to serious cardiovascular side effects.
A short time later, similar problems were seen with
the popular painkiller naproxen (sold over the counter as Aleve). So, what's an arthritis
sufferer or ailing weekend warrior to do?
Plenty, say arthritis experts.
People need to take control of their symptoms by
trying various things and seeing what works for them, says Veronica Braun, president of
the San Diego chapter of the Arthritis Foundation.
"We live in a culture where we just want to
take a pill and feel better. But, that's not always possible," she said. "People
should look at (the recent medical findings) as an opportunity to search out other things
-- everything from exercise to stress reduction, to acupuncture -- to help relieve their
pain."
Arthritis experts offer the following
pain-management recommendations to prove there is life after Vioxx. Just be sure to
consult your doctor before taking any medications or beginning any exercise, weight-loss
or pain-relief treatments.
Some ways to manage your pain:
Acupuncture
By helping to release pain-relieving chemical
substances such as endorphins in the central nervous system, acupuncture shows promise for
pain relief associated with osteoarthritis.
A recent study sponsored by the National Institutes
of Health found that acupuncture treatment significantly reduced pain and eased movement
for patients with arthritic knees who were taking pain medicine. The study involved 570
knee patients who experienced a 40 percent improvement in function with acupuncture after
14 weeks.
"Acupuncture seems to help some people, and it
appears to be safe," said Dr. Gary Firestein, director of the University of
California, San Diego's division of rheumatology, allergy and immunology. "If you're
uncomfortable and in pain and you don't want to take medication, acupuncture may be a
reasonable approach."
Exercise
"The muscle-skeletal system is at its best when
it moves. It's not designed to be immobile. In fact, you can induce arthritis by
immobilizing some joints," Firestein says.
Stretching and nonweight-bearing exercise such as
swimming and cycling can increase the range of movement, reduce fatigue and generally make
patients feel better.
"Becoming as fit as you can and strengthening
the muscles around the joint can have a dramatic effect," Williams says.
Relaxation practices
People in pain experience physical and emotional
stress. Muscles tighten, breathing becomes fast and shallow, and your heart rate goes up.
Relaxation techniques, meditation or gentle mind-body exercises can help reverse these
effects.
"We encourage people (with arthritis) to do
yoga and tai chi. Not only is the stretching and movement helpful, but so is the stress
release," said Braun.
Chiropractic care
"Chiropractors can be helpful for neck and back
pain," Firestein says. "It's not been established (as a remedy) for
osteoarthritis because the damage is already there. But, for muscle spasms and
inflammation, chiropractors can break that cycle with physical manipulation."
Heat/ice
Using heat and cold treatments can reduce the pain
and stiffness of arthritis and ailing joints. Ice packs numb the sore area and reduce
inflammation and swelling when there's damage to a joint, such as a sprained ankle.
Heat relaxes muscles and stimulates blood
circulation and often works best for achy joints or a stiff back.
Drugstores carry a wide range of helpful products,
including freezer gelpacks and eight-hour heat wraps. Even a package of frozen peas can be
used as an ice pack in a pinch.
Dietary supplements
Although there's no substantive scientific evidence
that nutritional supplements can ease arthritis and muscle/joint pain, some people swear
by them.
One of the most popular is glucosamine-chondroitin,
lauded by some for relieving achy joints and rebuilding cartilage. It's the focus of a
large study by the National Institutes of Health.
"Although there's been no real proof, many
people say it really helps them," said UCSD pharmacist specialist Gordon McGuire, who
takes the supplement along with Motrin for a partially torn rotator cuff.
Some studies on fish oil and other omega-3 fatty
acids suggest that in high doses, they may have some anti-inflammatory and analgesic
effects, Firestein said.
Other supplements such as methyl sulfonyl methane
(MSM) and S-adenosylmethionine (SAM-e) are touted by some alternative-medicine
practitioners as being helpful for joint pain sufferers, however there's insufficient data
to prove their effectiveness.
Massage
Massage can bring warmth and relaxation to painful
areas, according to the Arthritis Foundation, which recommends self-massage and
professional treatments.
"Massage never hurt anybody, and it feels
awfully good," Firestein said.
Arthritis patients should make sure their massage
therapist has experience working with people with joint inflammation. And, when performing
self-massage, stop if you feel any pain and don't massage a joint that is swollen or
painful.
Weight loss
People who are overweight have a greater risk of
developing osteoarthritis in the joints. Every extra pound you carry around translates to
added stress on your knees, back and hips.
"Drop 10 or 15 pounds and your hips and knees
will say 'thank you,'" Firestein said.
Surgery
Going under the knife for back, hip or knee pain
should be a last resort and reserved "only for people who are unable to perform daily
living activities or are waking in the middle of the night with pain," Firestein
said.
