PAIN: A Personal Challenge


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“There is no universal treatment for pain management,” said Dr. Robert Sheu, Director of the Pain Division in the Department of Pain and Palliative Care at Beth Israel Medical Center. “Different forms of arthritis respond to various treatment options and every individual is unique in his or her response. It is critical that people speak to their physicians and explore all of the treatments available before making a decision about which is the right one.”

There are over 100 types of arthritis, most of which fall into two general categories, inflammatory and non-inflammatory. According to Sheu, inflammatory conditions such as rheumatoid arthritis (RA) “often respond well to anti-inflammatory medications, such as traditional nonsteroidal anti-inflammatory drugs (NSAIDs), as an initial form of treatment.” In addition to NSAIDs, corticosteroids may be recommended to reduce swelling and inflammation. Also, medications such as disease-modifying antirheumatic drugs (DMARDs) and the biologic response modifiers (BRMs) work on reducing pain by slowing the disease process before lasting damage to joints can occur.

Non-inflammatory arthritis, such as osteoarthritis (OA), is often more localized than inflammatory types of arthritis, and is commonly caused by mechanical problems or general “wear and tear” on the joints.

Pain in this case is sometimes treated with analgesics, like acetaminophen, which are low in cost and effective in reducing pain. However, this class of medication does not treat any underlying inflammation, which may be occurring in the joint. “Although conditions such as OA are often referred to as non-inflammatory, people tend to experience some inflammation in their joints,” Sheu said.

With this in mind, anti-inflammatory medications may be prescribed to alleviate pain in conditions such as OA. Localized steroid injections that involve corticosteroids administered directly into the knee or hip joint can also be successful in temporarily reducing the pain associated with non-inflammatory arthritis.

For people who feel that they may have exhausted all of their pain medication options, Sheu said, “Don’t give up. Research on pain continues to grow and new products that may help you are constantly being developed.” He continues, “For instance, one of the most exciting advances that have recently come to fruition is the development of a topical NSAID gel or patch which can be placed directly on the site of pain.” These topical treatments contain diclofenac, an NSAID that has proven to be beneficial for patients with arthritis. By directly applying this medication to the site of pain rather than ingesting it orally, this patch is ideal for people who experience adverse gastrointestinal side effects from oral NSAID medications.

For more detailed information about the variety of medications to treat arthritis, be sure to speak to your doctor and order a copy of the Arthritis Today 2009 Drug Guide from the New York Chapter of the Arthritis Foundation.

It is also important to remember that medications should only be one part of a more comprehensive pain management treatment strategy. Emotional issues such as stress, anxiety and depression can all contribute to a person’s level of pain. “Often, we find that pain acts as a barometer for stress. The more stress that a person is experiencing, whether brought on by personal, professional or financial issues, the more pain they are likely to experience,” Sheu said.

People should also be aware of the impact that activity level can have on pain. Keeping your joints moving, through exercise, helps make them stronger and more flexible. This, in turn, can help to reduce your pain. Dr Sheu explains, “A physical therapist can work with you to develop an individualized activity program. The primary goal in pain management is to not only reduce your pain while at rest, but to allow you to function well in your daily activities. Exercise therapy is a critical piece of this strategy.”

There are many steps involved in successful pain management. However, the first step in taking control of your pain is to speak with a qualified physician (such as a rheumatologist or pain specialist) about your symptoms. Write down your concerns and discuss them openly and honestly with your physician. Your doctor will work with you to find effective ways to manage your pain. According to Sheu, “One thing that is important to realize is that the treatment of pain should be no different than treating any other medical condition. You do not need to just accept and live with your pain! There are many options out there. You just have to find the one that is right for you.”

You can learn more about various pain management strategies and medications by calling The New York Arthritis Exchange™ telephone hotline at 212-984-8730, or in the 914 and 845 area codes only, 800-246-2884 and requesting a copy of Managing Your Pain or the Arthritis Today 2008 Drug Guide. You can also log on to www.arthritis.org and click on “Conditions and Treatments,” then click on “Pain Center.”

The Arthritis Foundation’s mission is to improve lives through leadership in the prevention, control and cure of arthritis and related diseases. The New York Chapter of the Arthritis Foundation provides an array of patient service programs that have a strong positive impact on the lives of people dealing with the daily effects of this challenging disease. These include: an information and referral service, financial assistance to low-income people with arthritis, public education forums, advocacy programs, warm water and land exercise classes and self-help courses.

EDITOR’S NOTE: The following is an upcoming program in Queens. The Albert W. Grokoest and Muriel C. Hoyt Mind Body Connection Family Symposium will be held on June 24 from 5:30 – 8 p.m. at Flushing Hospital, 4500 Parsons Boulevard, Flushing. The Mind Body Connection Symposium was developed to introduce the various complementary therapies and self-help techniques available to people affected by arthritis. For more information, please contact ayanawoods@arthritis.org or call 212-984-8730.