Joint-related Pain and Arthritis

Key Points:

1. Joint-related pain is very common but the treatments are often inadequate.

2. Multiple factors are associated with the development of joint-related pain, such as inflammation, underlying structural changes, overactive nervous system, dietary deficiency or genetic predisposition.

3. There are several management options available to alleviate the joint-related pain, which includes lifestyle modifications, medications, physical therapy, minimally invasive procedures and/or surgery.

Arthritis is a term for more than 100 medical conditions that affect the musculoskeletal system, specifically joints where two or more bones meet. The most common types are osteoarthritis, rheumatoid arthritis and gout.

Issues

• Treatment for joint pain is often inadequate.

• Joint pain is associated with loss of function, and treatment should focus not only on pain but also on activity and function.

• Medications are sometimes unsafe, and rehabilitation and physical therapy are essential.

• Chronic joint pain can be manageable, but patients might continue to suffer.

• In addition to the suffering and discomfort associated with joint pain, the problem can exact substantial financial and other costs.

What causes joint paint?

In rheumatoid arthritis (present in about 1 percent of the population), the pain is predominantly related to inflammation in joints related to certain chemical messengers such as TNF-alpha, interleukin -6 and interleukin-1. Many effective therapies have successfully target this inflammation. 

In osteoarthritis (present in about 10 percent of the population), the pain is much less well understood and, as a result, treatment is much less satisfactory. Pain could arise from bone marrow lesions, cartilage defects, meniscal tears, effusion/synovitis (inflammation, swelling), possibly osteophytes (bone spurs), deterioration of ligaments and tendons. 

Other factors include obesity (which is the strongest correlate of pain and can cause pain in an anatomically normal joint), low level systemic inflammation, low vitamin D levels (<25nmol/l), depression, anxiety, genetic factors, repetitive movements, trauma, and variations in weather patterns. 

Management options

Don’t delay. See you doctor early to get a proper diagnosis. Because arthritis can get worse if left untreated. 

The best way to live well with joint-related pain is by working closely with your multidisciplinary healthcare team. Your doctor might advise you of the followings:

1. Lifestyle modification – stop smoking, weight loss, cutting down alcohol, healthy balanced diet

2. Analgesia – Paracetamol, NSAIDs, Corticosteroids, Nerve medications (such as gabapentinoids, TCA, etc), topical medications

3. Individually tailored physical therapies – such as mobility, strengthening and fitness exercises, proper footwear, aids and equipments, etc. These could be organised through physiotherapists, occupational therapists, podiatrists.

4. Coping strategiest – distraction techniques, relaxation techniques, TENS machine, stress management, pacing techniques etc.

5. Minimally invasive procedures, such as joint injection, nerve block, radiofrequnecy neurotomy

6. Surgery – such as arthroscopy, repairs, arthroplasty

7. Neuromodulation

Remember, staying active is one of the most effective treatments of arthritis.
Contact us to find out how we can help.

Reference:

1. Treating people with Joint pain. International Association for the Study of Pain. Fact Sheet No. 1; 2016. Accessed on 27 March 2021.

2. Jones G. Predispositions and Other Important Factors in Joint Pain. International Association for the Study of Pain. Fact Sheet No. 7; 2016. Accessed on 27 March 2021.

3. 10 steps for living well with arthritis. Arthritis Australia. 2016. Accessed on 29 March 2021.