Pain Management Options Based on the category of illness and their stage level of sickness
by Vladimire Herard
Physical, message and alternative therapies, exercise, medical foods, nutrition, NSAIDs, DMARDs, corticosteroids, over-the-counter pain relievers, steroid injections, anti-pain creams, surgeries and medical devices are succeeding in treating senior patients with various forms of arthritis, researchers and experts say.
Through ongoing research and public policy, primary care physicians and specialists affiliated with the American Academy of Orthopedic Surgeons, the American College of Rheumatology, the Arthritis Foundation, the National Fibromyalgia Association, the National Center for Complementary and Alternative Medicine (NCCAM) and the National Institute of Arthritis and Musculoskeletal and Skin Diseases (NIAMS) are finding and recognizing a number of effective treatments and therapies for senior patients with arthritis.
These solutions remedy such forms of arthritis as osteoarthritis, rheumatic arthritis, fibromyalgia, systemic lupus erythematosus, scleroderma, infectious arthritis, gout, polymyalgia rheumatica, polymyositis, psoriatic arthritis, bursitis and tendonitis and back pain.
Influencing research and public policy on these forms of arthritis and on hand to treat them and to apply solutions are teams of primary care physicians, family practice physicians, internal medicine physicians, osteopathic physicians, rheumatologists, orthopedists or orthopedic surgeons, physical therapists, occupational therapists, dietitians, nurse educators, physiatrists, also known as rehabilitation specialists, licensed acupuncture therapists, psychologists and social workers.
Various Forms of Arthritis
With most of these forms, about 46 million sufferers of arthritis of a percentage of 100 rheumatic diseases nationwide experience pain, stiffness, redness and heat in their bodies and the joints, where the bones intersect, NIAMS researchers say.
The patients’ hands, knees and shoulders are stricken with soreness, become difficult to move and grow swollen or inflamed. However, other parts of their anatomies are affected, too, such as their eyes, their chests, their skin, tendons, ligaments, bones and muscles.
Degenerative Joint Disease, Osteoarthritis
Osteoarthritis, also known as OA, the most widely known form of arthritis and a major cause of disability globally, affects 27 million adults nationwide, especially senior citizens and women, the American Academy of Orthopedic Surgeons reports.
Patients suffer from osteoarthritis of the hands, at the ends of fingers and thumbs, spine (neck and lower back), knees and hips, which negatively impacts their quality of life. This usually means joint pain and stiffness.
With the nation’s population aging, the number of individuals stricken with osteoarthritis will increase. NIAMS researchers predict that, as of 2030, 20 percent of the population — or at least 72 million people — will reach age 65 and may be
affected by arthritis. Specifically, half of those at that age will have osteoarthritis in at least one joint.
Degenerative joint disease, also known as DJD, entails the deterioration and ultimate loss of joint cartilage, experts say. Cartilage is a type of protein substance that cushions the bones of a joint. With osteoarthritis, cartilage deteriorates, allowing bones underneath to rub together.
This chronic disease is the chief cause of hip pain. The hip ranks as one of the human body’s biggest “weight-bearing” joints. It is called a “ball-and-socket” joint because the femur, also known as the “round ball-shaped head of the thighbone moves inside the cup-shaped hollow socket (acetabulumi) of the pelvis.”
DJD is a chronic illness targeting millions nationwide with reduced physical activity overtime as a consequence, researchers say. Aside from osteoarthritis, there are four other forms of degenerative joint disease.
The first, post-traumatic arthritis, involves “a severe fracture or dislocation of the hip.” A second form known as rheumatoid arthritis, or RA, is an inflammatory arthritis of the joints.
Avascular Necrosis, Hip Dysplasia
A third form, avascular necrosis, is an ailment in which a healthy blood supply has been cut off from the “ball” or femoral head, leading to bone death and disfigurement. Hip dysplasia is an illness in which the bones around the hip are not properly formed and misalign the hip joint.
Rheumatoid arthritis is connected to a malfunction of the immune system. RA attacks the synovium or the lining of the joints and bones, especially the hands and feet and can harm internal organs.
The 1.3 million individuals with rheumatoid arthritis are afflicted with pain, stiffness, swelling, fatigue, a general feeling of un-wellness, a fever, weight loss, breathing difficulties, rash, itch, joint damage and loss of joint. Additionally, these symptoms may be signs of illnesses other than arthritis, researchers say.
One form of rheumatoid arthritis, titled polymyalgia rheumatica, concerns the “tendons, muscles, ligaments and joint tissues.” As NIAMS researchers report, “symptoms include pain, aching and morning stiffness in the shoulders, hips, neck and lower back”. These symptoms are the first signs of giant cell arteritis, an illness of the arteries manifesting “headaches, inflammation, weakness, weight loss and fever.”
Polymyositis, a form of rheumatic disease, leads to inflammation and weakness in the muscles. It can influence the function of the human body, causing disability.
Another class of arthritis linked to “infectious agents” such as bacteria or viruses includes parvovirus arthritis and gonoccocal arthritis. Some of the symptoms associated with this type of arthritis can be found in Lyme disease, an illness caused by bacteria in the bites of ticks. In these instances, early diagnosis and antibiotic treatment are key to ridding the joints of infection and effecting damage control.
Gout, another form of arthritis, develops from chalky deposits of needle-like crystals of uric acid, accumulating in the joints and in the rim of the ear. Sometimes, the crystals can form in the kidneys and can lead to kidney stones, researchers say. This causes inflammation, swelling and pain.
The big toe is the most impacted but other joints in a patient’s physique such as the insteps, ankles, heels, knees, wrists, fingers and elbows may also be affected and this set of circumstances are called podagra. Experts say about six million adults aged 20 and older are said to have experienced gout at some point in their lives.
While not a true form of arthritis because it does not cause inflammation or damage to the joints, muscles or other tissues, fibromyalgia syndrome is a disorder that causes tissue pain in the bones and joints, stiffness, fatigue, sleep deprivation and “tender points” in the muscles and tendons, including the neck, spine, shoulders and hips. About five million individuals aged 18 and older are struck by this illness, causing limitations in regular physical activity, researchers report.
Often times, arthritis coincides with other conditions, including lupus, an autoimmune disease in which an afflicted person’s immune system goes on the attack of its own healthy cells, tissues, joints, the heart, the skin, the kidneys and similar organs, experts say. This means “inflammation of and damage to the joints, skin, kidneys, heart, lungs, blood vessels, and brain.”
Scleroderma, also titled systemic sclerosis, impacts the skin, blood vessels and joints and internal organs such as the lungs and kidneys. With this condition, an excess amount of collagen, a fibrous protein, takes place in the skin and organs.
Psoriatic arthritis is a form of arthritis that accompanies psoriasis, a condition of scaly skin. It targets the “joints at the ends of the fingers and toes” and includes changes in the fingernails and toenails. Often, back pain may take place if the spine is affected.
Bursitis, another such condition, involves swelling of the bursae, “small, fluid-filled sacs,” that cut back on friction between bones and other structures in the joints. The inflammation may stem from arthritis in the joint or damage or infection of the bursae. The results are “pain and tenderness” that restricts movement of the joints.
Tendonitis leads to the swelling of tendons, tough cords of tissue that link muscle to bone. This stems from overuse, injury or rheumatic illness. Like bursitis, tendonitis causes pain and tenderness and limits of joints.
Back pain is a common condition that, at best, is described as a persistent, blunt ache to immediate acute pain that debilitates its sufferer. It can be caused quickly by an accident, a fall or carrying heavy objects or can grow overtime from the aging of the spine. About 25 percent of adults nationwide will endure a day of back pain in a three-month period, researchers say.
Causes of Arthritis
Degenerative Joint Disease, Osteoarthritis
Degenerative joint disease, or DJD, and osteoarthritis of the knee, as a form of it, is caused by a variety of factors such as age, gender and genetics that influence the shape and functionality of the joints, researchers report. These factors include a prior hip injury, stress on the hip, joint dis-alignment and obesity.
The pain of degenerative joint disease of the hip and osteoarthritis of the knee is caused by the loss of cartilage or tissue lining. The cartilage acts as a cushion and makes for dexterity of the hip. When the cartilage deteriorates, the bones touch and rub together, causing swelling and stiffness.
Rheumatic diseases are caused by genetics and the environment, researchers report. This means that an individual may be born with a vulnerability to these conditions but elements in his or her environment will trigger their onset.
For rheumatoid arthritis and lupus, patients may have “a variation in a gene that codes for an enzyme called protein phosphatase nonreceptor 22.” Some viruses can awaken the disease in those genetically predisposed to it such as the link between the Epstein-Barr virus and lupus.
Gender also plays a role in the development of rheumatic diseases of patients. For example, lupus, rheumatoid arthritis, scleroderma and fibromyalgia are 80 to 90 more likely to take place in women and lupus is more likely to develop in African Americans and Hispanics than in whites. This means that hormones or gender differences factor into the progression of the condition.
Rheumatic diseases strike individuals of all races and ages with some conditions being more common among certain demographics than others. This form of arthritis takes place two to three times more in women than in men. Gout strikes men more than women but, after menopause, the likelihood of gout afflicting women starts to increase.
Gout, with its characteristic development of uric acid in the blood and crystals in the joints and kidney, also known as hyperuricemia, has multiple factors, experts report.
They include genetics with estimates ranging from 20 to 80 percent; gender with more men than women being stricken; obesity because of the presence of excess tissue making room for uric acid production; alcoholism; diet with foods rich in purines; exposure to lead poisoning; kidney failure; certain classes of medications such as diuretics and aspirin; niacin; cyclosporine or other such drugs that suppress the immune system, and levodopa in the treatment of Parkinson’s disease.
Other illnesses are connected to the high level of uric acid in the blood and they include high blood pressure, hypothyroidism, psoriasis, anemia, cancer, Kelley-Seegmiller syndrome or Lesch-Nyhan syndrome.
Uric acid is an element that originates from the dissolution of purines. Purines are a part of all human tissue and can be found in different foods. Uric acid should be digested in the blood and removed through the kidneys in urine. However, if it is not eliminated, it builds up in the blood via the process of hyperuricemia and gout develops.
Foods high in purines include alcohol, anchovies, asparagus, beef kidneys and other organ meats, brains, dried beans and peas, game meats, gravy, herring, liver, mackerel, mushrooms, sardines, scallops and sweetbreads and some ought to be avoided, researchers say.
Patients with certain rheumatic diseases, lupus, or ankylosing spondylitis, also known as spinal arthritis, are just as likely to cultivate fibromyalgia. NIAMS researchers have also found that women with family members with fibromyalgia will contract the illness themselves and it is unclear that this may be linked to genetics or environment or both.
A number of factors determine the onset of back pain, NIAMS researchers say.
The first factor involves advancing age, starting at age 30 to 40. The second one is fitness level, especially for individuals who do not regularly perform physical exercise and have weak back and abdominal muscles that do not support the spine.
A third factor is a diet high in calories and fat and leading to obesity, which places stress on the back. Genetics, as a fourth factor, also plays a role in terms of the likelihood of developing ankylosing spondylitis.
Race also factors in fifthly with African American women three to four times more likely than white women to develop spondylolisthesis, a disease in which a vertebra of the lower spine, also known as the lumbar spine, slips.
A sixth factor is the onset of other illnesses that cause or lead to back pain such as such as endometriosis; diskitis; fibromyalgia; kidney stones; osteoarthritis; osteomyelitis; osteoporosis, rheumatoid arthritis; ankylosing spondylitis; spinal stenosis, “a narrowing of the spinal column that” places stress on the spinal cord and nerves; and cancers and tumors throughout the body that may affect the spine.
Occupational risk factors as a seventh rank that involves heavy lifting, pushing or pulling. The twisting or vibrating of the spine that such activity entails can cause injury and back pain. Otherwise, a sedentary job or desk job may cause back pain with poor posture or uncomfortable seating.
An eighth and final factor is cigarette smoking because of its connection to develop low back pain with sciatica, a category that involves radiating pain to the hip or leg because of stress on a nerve.
For instance, smoking may block your body’s capacity to bring nourishment to the disks of the lower back or lead to back pain through excessive coughing, obesity, osteoporosis, accidents, falls, back injuries, back surgery or fractured bones.
Symptoms of Arthritis
According to NIAMS researchers, symptoms of the various forms of arthritis vary. This includes degenerative joint disease, arthritis in general, osteoarthritis, gout and fibromyalgia.
Degenerative Joint Disease
The major symptoms of degenerative joint diseases, especially of the hip, is pain in the groin, outside of the hip, the lower area of the back and a thigh to its knee.
Oftentimes, sufferers may confuse the pain in the hip area with back pain and this category of pain may be treated accordingly until a primary care physician, diagnoses it as degenerative joint disease.
Arthritis in General
The symptoms of arthritis in general are described by researchers as “swelling in one or more joints;” early morning joint stiffness that takes an hour; consistent pain or tenderness in a joint; limited capacity in using a joint, and; joint warmth and redness.
The main symptoms of osteoarthritis, one of the major forms of degenerative joint disease, includes pain or stiffness while standing or walking for a short time, taking the stairs up or down and sitting in or getting up from chairs; pain during physical activity; pain or stiffness while being physical active in a chair; stiffness while climbing out of bed; swelling in one or more parts of the knee, and; a grinding feeling in the knee when in use.
Osteoarthritis is characterized as developing slowly. In the early stages of the disease, joints may be painful after physical labor or exercise. Hours or days later, joint pain may persist. Additionally, a patient may endure joint stiffness, especially when he or she wakes up in the morning or lies or sits in a particular position for too long.
While osteoarthritis can take place in any joint, it mostly impacts the hands, knees, hips and spine near the neck or lower back.
With the hands, osteoarthritis may present as “small, bony knobs at the end joints” near the nails of fingers. They are referred to as Heberden’s nodes. Related knobs, known as Bouchard’s nodes, can manifest themselves on the middle joints of fingers. Fingers grow swollen and gnarled with pain, stiffness and numbness. Additionally, the base of the thumb joint is stricken by osteoarthritis.
For the hips, just as with knee osteoarthritis, the symptoms of hip osteoarthritis are pain and stiffness in the joint, groin, inner thigh and buttocks as well as knees. Hip osteoarthritis may restrict movement, making day-to-day activity such as wearing clothes or shoes difficult.
Spinal osteoarthritis, which affects the spine, may appear as stiffness and pain in the neck and lower back. Frequently, arthritic spines can lay stress on the nerves where they are outside of the spinal column, producing weakness or numbness in the arms and legs.
Signs and symptoms for gout include hyperuricemia, the formation of uric acid in the blood and crystals in the joints; the presence of such crystals in joint liquid; more than one incident of arthritis; arthritis that is cultivated in the course of a day, resulting in a red, warm and swollen joint, and; a bout of arthritis in one joint, namely the toe, ankle or knee.
Symptoms for fibromyalgia include “pain; fatigue; cognitive and memory lapses, also known as ‘fibro fog’; sleep disturbances; morning stiffness; headaches; irritable bowel syndrome; painful menstrual periods; numbness or tingling of the hands and feet; restless legs syndrome; temperature sensitivity, and; sensitivity to loud noises or bright lights.”
Often, individuals stricken with fibromyalgia also have other chronic pain disorders such as fatigue syndrome, endometriosis, inflammatory bowel disease, interstitial cystitis, temporomandibular joint dysfunction and vulvodynia.
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SOURCES: Advocates for Fibromyalgia Funding, Treatment, Education and Research, http://www.affter.org American Academy of Orthopedic Surgeons,
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