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Arthritis Pain Management Tips

Weather and Arthritis PainYes, the weather forecast can make you ache. | By Brenda Goodman

It’s not your imagination; the weather can cloud your health. Here’s what research reveals about the connection between weather and arthritis pain.

Changes in temperature or barometric pressure, a measure that refers to the weight of the surrounding air, trigger joint pain, though researchers aren’t entirely sure why. In 2007, researchers at Tufts University in Boston reported that every 10-degree drop in temperature corresponded with an incremental increase in arthritis pain. Increasing barometric pressure was also a pain trigger in the Tufts study.

In fact, studies in cadavers have found that barometric pressure affects pressure inside the joints. In one experiment, when pressure in the hip joints was equated with atmospheric pressure, it threw the ball of the hip joint about one-third of an inch off track.

Asthma Also Can Be Affected

The conventional wisdom that thunderstorms wash pollen, smoke, mold and pollutants out of the air, making it easier to breathe, may be wrong, according to scientists at the University of Georgia in Athens and Emory University in Atlanta. Climatologists and epidemiologists who looked at 12 years of records from 41 hospitals around Atlanta, found that visits to the emergency room for asthma spiked on the day after a thunderstorm. The link got stronger during storms with moderate-to-high wind gusts and moisture.

Though they aren’t sure why asthma gets worse after a storm, the scientists think that rain causes pollen grains to burst into pieces that are even smaller and easier to inhale. Lightning in the atmosphere may also spark a chemical reaction, turning pollutants into asthma triggers.

Weather Can Activate Migraines

Studies have found that 50 to 80 percent of all people who get migraines believe weather can set off a headache. The exact weather patterns that precipitate migraines remain a mystery, however.

In a study published in 2004, Patricia Prince, MD, of Boston Children’s Hospital, asked 77 migraine sufferers to keep calendars documenting their migraines over a period of two years. She then compared those to records kept by the National Weather Service.

About half of study participants got migraines that coincided with weather changes, but not all who were weather sensitive had the same triggers. Some seemed most vulnerable to a combination of high heat and high humidity, while others got headaches under the exact opposite conditions – low temperatures and low humidity.

Fight Arthritis Pain Without PillsOther methods also can help you conquer arthritis pain. | By Dorothy Foltz-Gray

According to the National Center for Health Statistics, 76.2 million, or 26 percent of Americans, suffer from chronic pain – and more than half of those have some form of arthritis or related condition. The question that plagues many of us is this: Can’t something be done for arthritis pain besides pills?

While over-the-counter and prescription pain medicines can be effective if used properly, there are possible risks whenever you take a pill. So many people want to explore alternative pain relief therapies. There’s an array of options – from electrical stimulation to meditation, topical creams to shoes.

Consider the following expert advice about 15 available therapies.

1. Topical medications

What they are: Gels, creams and patches that are applied to the skin supply sodium channel blockers, such as lidocaine or prilocaine. Prescription NSAIDs that come in drops, gels, sprays or patches are also becoming popular.

How they work: Sodium channel blockers work by numbing nerve endings close to the skin. Topical NSAIDs work by reaching the joint fluid and decreasing inflammatory proteins like prostaglandins, says David N. Maine, MD, director of the Center for Interventional Pain Medicine at Mercy Medical Center in Baltimore. “They have a direct anti-inflammatory effect.”

Pain they work well for: Sodium channel blockers work best for nerve disorders like diabetic neuropathy or neuropathic pain. Topical NSAIDs help relieve the pain and inflammation common in arthritis.

Risks: Although studies don’t yet bear this out, physicians believe topicals may pose fewer cardiovascular and gastrointestinal risks than oral NSAIDs because the topicals are absorbed locally rather than throughout the body. Says Dr. Maine: “GI side effects are rare compared to oral nonsteroidals.” About 10 to 15 percent of patients have some reaction, usually skin related, including rashes, irritation or itching.  

2. Transcutaneous electrical nerve stimulation (TENS)

What it is: TENS involves hooking up to a pocket-sized, portable machine that sends electrical current to painful spots, via wires attached to electrodes placed on the skin.

How it works: “Pain is carried on small fibers called C fibers,” says Girish Padmanabhan, clinical director of outpatient rehab at The George Washington University Hospital in Washington, D.C. “But other sensations are carried by larger fibers. The sensation of the current is transmitted through the larger fibers, which supersedes the smaller fibers,” essentially shutting out the pain. “The electrical current also stimulates the nervous system, possibly stimulating the brain to release endorphins and enkephalins, opiate-like substances that relieve pain.”

Pain it works well for: “TENS is effective in treating any kind of arthritis pain – in treating pain, period,” says Padmanabhan.

Risks: You can’t use it if you have a pacemaker, infection or open wounds.

3. The right shoes

What they are: Well, we all know what shoes are. But according to a 2010 study on 31 people with osteoarthritis at Rush Medical College in Chicago, researchers found that flat, flexible shoes like flip-flops and sneakers (Puma H-Street shoes were used in the study) reduced the force exerted on knee joints by 11 to 15 percent compared with clogs and special walking shoes.

How they work: “Higher [force] on the knee joints is associated with pain,” says lead author and rheumatologist Najia Shakoor, MD. “So, if you exert less [force], you should have less pain.”

Pain they work well for: Wearing flexible shoes may best relieve pain from osteoarthritis (OA) of the knee and perhaps the hip.

Risks: Despite the study findings, Dr. Shakoor hastens to say that flip-flops can cause other problems like plantar fasciitis, inflammation of the connective tissue along the bottom of the foot. And they can put people with osteoarthritis at greater risk for falls. “Flat, flexible, closed shoes with arch support are a good choice,” she adds.

4.Steroid injection

What it is: Steroids, or corticosteroids, such as cortisone, hydrocortisone and prednisone, are synthetic versions of the hormone cortisol, which reduces inflammation.

How it works: A doctor injects a steroid directly into a joint to calm inflammation, says Allen D. Boyd Jr., MD, chief of Adult Reconstructive Surgery and Total Joint Replacement at the University of Rochester Medical Center in New York.

Pain it works well for: “A steroid injection will make almost anyone [with inflammatory joint pain] feel better for days or months or longer,” says Dr. Boyd. “It’s good for anyone with inflammatory arthritis and can be used across the board, including for juvenile arthritis (JA).”

Risks: You can repeat a steroid shot two to three times a year, Dr. Boyd says. More than that may make the ligaments and tendons more fragile, and they can rupture. And there is some small risk of infection with any injection.  

5.Hyaluronic acid injection

What it is: Hyaluronic acid (Synvisc, Hyalgan, Supartz) is a slippery, viscous fluid that is a component of natural cartilage, says Dr. Boyd.

How it works: Hyaluronic acid injection may help damaged cartilage by increasing its nutrition and overall health. “There have been claims that it can help cartilage regenerate,” Dr. Boyd says. “But the science for that is a lot softer. And the effectiveness [of the injections] varies from patient to patient.” Patients get a single injection, or one injection a week for three to five weeks, depending on which hyaluronic acid product is used. If the treatment is helpful, patients can repeat it once a year.

Pain it works well for: It’s suitable only for damaged cartilage in the knee joints, but probably not for JA, Dr. Boyd says, “and some studies show only limited benefits.”

Risks: There’s a small risk of allergic reaction or infection.

6.Exercise/physical therapy

What it is: Physical therapy is a treatment that uses exercises designed to improve posture, strength, function, range of motion and to reduce pain. It boosts energy and mood as well.

How it works: A patient who is new to exercise might begin a program of strengthening, stretching and aerobics by seeing a physical therapist twice a week for 12 weeks. “We ask patients to work toward exercising two to three times a week for 30 to 40 minutes each time,” says Padmanabhan.

Pain it works well for: Exercise works for any kind of arthritis, including OA, rheumatoid arthritis (RA) and ankylosing spondylitis.

Risks: Overdoing exercise is always a risk. Don’t exercise through pain. High-impact activities like running and jumping may worsen joint health and increase your risk of injury, so be sure to check with your doctor or physical therapist before trying them. You may be better to stick with low-impact sports like swimming, water aerobics and cycling.

7. Heat/cold

What it is: You can apply heat with heating pads, warm compresses, heat patches, warm baths or even hot wax. Cold therapy can arrive in a cold pack, ice pack or frozen vegetable packs.

How it works: “Muscle spasms can cause basic constriction of blood flow,” says Padmanabhan. “Heat works by increasing the blood flow to the [painful] area. It also relaxes the muscles.” Cold sensations travel along large nerve fibers, superseding pain sensations that travel along smaller fibers. Cold also reduces swelling and inflammation by constricting the blood vessels.

Pain it works well for: “Heat works better [than cold] for osteoarthritis pain,” say Padmanabhan. Apply heat two or three times a day for 15 minutes at a time. Heated paraffin wax baths can be helpful for patients with RA, especially their hands – as long as they’re not having a flare. Cold works best for inflammation caused by injuries like sprains, strains and pulled muscles and ligaments. Apply cold packs two to four times a day for 15 minutes at a time until pain and swelling lessen.

Risks: Heat can aggravate an acute injury like a muscle sprain or strain, making the swelling and inflammation worse. And overdoing either heat or cold can cause burns; never apply to bare skin.  

8.Trigger point injection

What it is: A physician injects anesthesia such as lidocaine, or anesthesia plus a corticosteroid, into muscle.

How it works: “Trigger points are bundles of muscle that are painful,” says Mehul J. Desai, MD, director of Pain Medicine and Non-Operative Spine Services at The George Washington University Hospital in Washington, D.C. “Putting a needle into the trigger point allows the muscle tissue to go back to its normal structure. An injection can [relieve pain] for weeks or months.” Stretching and exercising the muscle afterward helps the injection’s effect last longer.

Pain it works well for: It can work for any kind of muscle pain caused by arthritis but not for fibromyalgia, says Dr. Desai.

Risks: You shouldn’t have the injections more than three to four times a year. Too many create scar tissue, which can change the muscle’s ability to contract, ultimately causing more pain.


What it is: Meditation is the practice of developing a deep concentration or focus. Tanya Edwards, MD, director of the Center for Integrative Medicine, Wellness Institute at the Cleveland Clinic, defines meditation as an array of mind-body and relaxation techniques – meditation, breath work, progressive relaxation, guided imagery – that help to lessen pain.

How it works: According to Dr. Edwards, stress produces chemicals in the body that increase inflammation. “With relaxation techniques, you have stress reduction and therefore decreased inflammation and less pain,” she says. Meditation also relaxes muscles that tense up with pain. Dr. Edwards suggests meditating for 20 minutes once or twice a day. For moments of acute pain, she also recommends “meditation minutes.” For example, take four to five deep breaths, counting to 10 with each inhalation and exhalation. “Just doing that four to five times a day can decrease depression and improve outlook,” she says.

Pain it works well for: “It works on any kind of pain,” Dr. Edwards says. Numerous studies have found that regular meditation practice reduces the brain’s response to pain.

Risks: None.

10. Nerve block

What it is: A doctor injects a local anesthetic, or a mixture of local anesthetic plus a steroid, into a nerve. Nerve blocks are used to block pain and also to help physicians pinpoint where certain pain is coming from.

How it works: “The anesthetic stops the conduction [of signals] along the nerve, and the steroids help [calm] the inflammatory tissue,” Dr. Desai says.

Pain it works well for: “A block is most commonly used when pain is in the spine and going down into the arm or leg,” says Dr. Desai.

Risks: Infection and bleeding are possibilities. And it’s possible that a physician could target a wrong nerve, which could lead to problems with movement or feeling in areas affected by that nerve.  

11. Acupuncture

What it is: Acupuncture is an ancient Chinese therapy that involves placing tiny needles along meridians in the body to release trapped energy, or chi.

How it works: “Placing the needles increases the production of endorphins, morphine-like substances that are natural pain relievers,” says Dr. Edwards. “It also may increase the blood flow to the area, which helps get rid of by-products like lactic acid that cause pain.”  Afraid of needles? Try accupressure - it involves using the fingers, knuckles and palms to apply pressure instead.

Pain it works well for: “It’s appropriate for any kind of arthritis pain – almost any kind of pain,” Dr. Edwards says.

Risks: If you are on blood thinners, there’s an increased risk of bleeding, and if you are getting chemotherapy, you may have an increased risk of infection.

12. Peripheral nerve stimulation

What it is: A physician implants a trial electrode just under the skin along a painful peripheral nerve (any nerve outside the brain and spinal cord) that receives electrical signals from a small battery-operated generator. If your pain is relieved after a week-long trial, the electrode as well as a small generator are permanently placed.

How it works: The therapy works much the way TENS does. “An electrical current stimulates large fast fibers [whose messages] get to the spinal cord before [those] from the thin fibers that carry pain,” says Dr. Desai.

Pain it works well for: “Although it’s most commonly used for nerve injuries, it’s also used for low back pain [such as that] caused by osteoarthritis,” Dr. Desai says. “The relief can last perpetually.”

Risks: It’s possible to have infection and further nerve injury, says Dr. Desai, “but it’s a low-risk procedure.”

13. Pain pump

What it is: After a short trial, a doctor implants a small pump programmed to deliver varying amounts of pain medication, such as morphine or baclofen (a muscle relaxant), through a catheter threaded into a space around the spinal cord.

How it works: The pump delivers narcotic medication directly to a painful area so that a patient has fewer systemwide side effects than she would with oral narcotics, says Dr. Desai.

Pain it works well for: “It’s used increasingly for low-back pain that could be caused by osteoarthritis or spinal arthritis,” says Dr. Desai.

Risks: As with any surgery, there are risks of infection and bleeding. And it’s possible that the catheter could get blocked, although that’s rare. The battery also has to be replaced every five to seven years. In some whose pumps have delivered medication to a joint, such as a shoulder joint, patients have developed chondrolysis, a rare condition in which cartilage dies.  

14. Facet joint denervation

What it is: A physician uses radiofrequency heat energy to destroy painful nerves that supply the facet joints, or the paired joints at the back of the spine.

How it works: The doctor delivers radio waves through a needle inserted next to the nerve. The injury to the nerve interrupts pain signals. “The nerve typically comes back in three to 12 months,” Dr. Desai says. “If you have arthritis, it’s likely you would have pain again.”

Pain it works well for: According to Dr. Desai, this therapy is very useful for patients with OA in the facet joints. “The therapy can be used for multiple kinds of arthritis. It’s typically used for back pain,” he adds.

Risks: In rare instances, you can have numbness, infection, bleeding or a temporary increase in pain. Or the procedure may not work at all.

15. Deep brain stimulation

What it is: This invasive therapy is used only when all else fails. A neurosurgeon implants an electrode in a part of the brain such as the thalamus. A wire from the electrode is placed under the skin of the head, neck and shoulder, connecting to a generator, which is usually implanted under the skin on the chest.

How it works: “The continual impulses disrupt [pain] messages that the thalamus would otherwise send to the cortex to be interpreted [as pain],” says Dr. Maine.

Pain it works well for: It has been used for chronic low-back and leg pain, nerve pain and stroke-related pain. It’s also been used for central pain – pain caused by damage or dysfunction of the central nervous system – but not very effectively, says Dr. Maine. Although some physicians have used it for arthritis pain, that’s not its primary use. “It’s just being established for use in pain cases,” says Dr. Maine.

Risks: “There’s a possibility of brain injury,” Dr. Maine says. “It’s much more invasive than other methods – and physicians don’t understand clearly how it works. It’s a last resort.”

Warm Water Works Wonders on PainTurn your bath into a powerful weapon against aches, stiffness and fatigue. | By Dorothy Foltz-Gray

Soaking in warm water is one of the oldest forms of alternative therapy, and there’s good reason why this practice has stood the test of time. Research has shown warm water therapy works wonders for all kinds of musculoskeletal conditions, including fibromyalgia, arthritis and low back pain.

“The research shows our ancestors got it right. It makes you feel better. It makes the joints looser. It reduces pain and it seems to have a somewhat prolonged effect that goes beyond the period of immersion,” says Bruce E. Becker, MD, director of the National Aquatics & Sports Medicine Institute at Washington State University in Spokane.

There are many reasons soaking in warm water works. It reduces the force of gravity that’s compressing the joint, offers 360-degree support for sore limbs, can decrease swelling and inflammation and increase circulation. 

So, how long should you soak? Dr. Becker says patients he’s studied seem to reach a maximum benefit after about 20 minutes. And make sure you drink water before and afterward to stay well hydrated.

Here are some other simple steps to make the most of your next bath.

Go warm, not hot. Water temperatures between 92 and 100 degrees are a healthy range. If you have cardiovascular problems, beware of water that’s too hot because it can put stress on the heart. The U.S. Consumer Product Safety Commission says anything over 104 degrees is considered dangerous for everyone.

Don’t just sit there. Warm water is great for relaxing, but it is also good for moving. Warm water stimulates blood flow to stiff muscles and frozen joints, making a warm tub or pool an ideal place to do some gentle stretching. To ease low back pain, trap a tennis ball between the small of your back and the bottom or back of the tub, then lean into it and roll it against knotted muscles. The flexibility lasts even after you get out, says Ann Vincent, MD, medical director of the Mayo Clinic’s Fibromyalgia Clinic in Rochester, Minn. “Patients report that soaking in a warm bath and stretching after that seems to help.”

Add some salts. Data collected by the National Academy of Sciences show most Americans don’t get enough magnesium, a mineral that’s important for bone and heart health. One way to help remedy that: bathing in magnesium sulfate crystals, also known as Epsom salts. They’re relatively inexpensive, can be found at grocery and drug stores and can boost magnesium levels as much as 35 percent, according to researchers at the University of Birmingham in the United Kingdom. But don’t go overboard; the National Institutes of Health warns these salts should only be for occasional use. People with diabetes should be aware, too, that high levels of magnesium can stimulate insulin release.

Consider finding a warm water pool. Warm water can be so helpful in fighting the pain and stiffness of arthritis and fibromyalgia that experts recommend heated pools for exercise. Various studies of patients with both conditions found that when they participated in warm water exercise programs two or three times a week, their pain decreased as much as 40 percent and their physical function increased. The exercise programs also gave an emotional boost, helped people sleep better and were particularly effective for obese individuals.

Hypnosis for Pain ReliefSelf-hypnosis for arthritis may give you some control over pain. | By Jenny Nash

If you’re looking for a gentle way to reduce the pain that comes with chronic conditions like rheumatoid arthritis (RA) or osteoarthritis (OA), hypnosis may just do the trick. Studies show that more than 75% of people with arthritis and related diseases experience significant pain relief using hypnosis.

Forget what you’ve seen in movies about hypnosis. Today’s practitioners are using it to give patients an additional tool to help manage their pain.

Learning to Relax with Hypnosis

Hypnosis isn’t about convincing you that you don’t feel pain; it’s about helping you manage the fear and anxiety you feel related to that pain. It relaxes you, and it redirects your attention from the sensation of pain. In a hypnosis session, which usually lasts 10-20 minutes, you will likely start by focusing on your breathing to help you relax. Then the hypnotist will instruct you to imagine a pleasant place and describe it in detail, refocusing your attention from something that triggers negative emotions to something that will activate positive emotions, such as being at the beach.

If your mind is off to the beach, and you’re imagining the warmth of the sun, the cool of the breeze, the sand at your feet, you’ll be less focused on your pain – and ready for the indirect suggestion of how to react to pain in the future. It might sound something like this: “You will continue to feel this same sensation of pain, but you’ll be much less distressed about it, much calmer, much more at ease, not worried about it.”

Practice Makes Perfect

Hypnosis isn’t a one-shot treatment. At first, it can be part of regular psychotherapy sessions in a doctor’s office. Hypnosis typically helps relieve pain in just 4 to 10 sessions. But some people benefit faster and others not at all. The goal is to teach patients the technique so they can use it on their own when pain strikes.

Some practitioners create recordings for patients that they can play to lead themselves into the hypnotic process. Some patients prefer to come up with their own script and not rely on a recording or the therapist’s voice to activate the process when pain strikes and they need it.

Learning hypnosis takes practice, and some people learn it more easily than others. Practice when you feel little or no pain; when you’re in a lot of pain, it can be harder to do.

Hypnosis Works for Kids, Too

Hypnosis is a tool you also can give a child to help him take control. When he feels pain, he can do something about it immediately without having to wait until mom gets there with the pills or for the pills to take effect. Having hypnosis as a tool also helps eliminate stress that comes from not having control.

For children, creating an active mental escape may be necessary. Rather than relaxing at the beach with a book, a child may want to imagine playing on the playground or kicking a soccer ball down the field.

Is Hypnosis Right for You?

Some people respond to hypnosis better than others, but there’s no harm in trying it. It has no side effects and if it doesn’t work for you, you can stop at any time. But many people report significant reduction in pain and gain a simple tool for easing it that they can use any time.

To find a qualified hypnotherapist, ask your doctor for a referral or contact the Society for Clinical and Experimental Hypnosis or the American Society for Clinical Hypnosis. Health insurance may cover hypnosis for pain therapy performed by a medical or psychological professional.

25 Treatments for Hip and Knee Arthritis PainGuidelines recommend combining drugs with non-medicinal remedies.

When it comes to treating osteoarthritis (OA) in your knees and hips, you may have more options than you realize. In March 2014, the Osteoarthritis Research Society International (OARSI), a nonprofit organization dedicated to promoting osteoarthritis research and treatment, updated its recommendations for the treatment of osteoarthritis targeted to different patient characteristics. A group of 13 experts from around the world reviewed the latest research on OA treatments as the framework for the revised guidelines. OARSI published its first guidelines in 2008.

The four groups of patients identified in the new guidelines are:

  1. Patients with OA in one or both knees only and no co-existing conditions such as diabetes, high blood pressure, cardiovascular disease, kidney failure, GI bleeding, depression or obesity.
  2. Patients with knee-only OA who have co-existing conditions
  3. Patients with multi-joint OA (hip, hand, etc.) and no co-existing conditions
  4. Patients with multi-joint OA who have co-existing conditions

Non-Drug Treatments

Education and self-management. Many organizations, including the National Institute of Health and Clinical Excellence (NICE) and American Academy of Orthopaedic Surgeons (AAOS), recommend patients learn all they can about their arthritis and its treatment. However, one study found that a self-management course did little to improve pain, stiffness or physical function. Researchers have suggested that group educational sessions and telephone-based advice might be helpful, but another study questioned the practicality of these interventions.

Exercise. A variety of exercises, such as strength training, aerobics, range of motion and tai chi, can help with both pain and physical function in knee OA. Strengthening can also help with hip OA pain. Water-based exercises may improve function in both knee and hip joints, but offer only minor benefits for pain.

Weight loss. A 2007 review found reductions in pain and disability in previously overweight patients with knee OA who lost a moderate amount of weight. The recommendation is to aim for a weight loss of 5% within a 20-week period for the treatment to be effective. The benefits of weight loss on hip OA have yet to be proven.

Acupuncture. A form of traditional Chinese medicine involving the insertion of thin, sharp needles at specific points on the body, acupuncture has been touted as a treatment for osteoarthritis pain. A recent analysis of 16 randomized controlled trials found acupuncture was better than sham treatment for relieving OA pain. However, the effect didn’t reach the threshold for clinical significance. The recommendation is “uncertain.”

Balneotherapy. The new guidelines for the first time evaluated the use of balneotherapy, a treatment that involves soaking in warm mineral springs. It was found to be an “appropriate” therapy for people with multi-joint OA and co-existing conditions, who have few other treatment options.

Transcutaneous electrical nerve stimulation (TENS). A technique in which a weak electric current is administered through electrodes placed on the skin, TENS is believed to stop messages from pain receptors from reaching the brain. A recent study found that TENS didn’t relieve pain better than a sham procedure. While it’s uncertain whether TENS can help with knee-only OA, it’s not appropriate for OA in multiple joints.

Knee braces, sleeves, and other devices.One review found knee braces and foot orthoses helpful for reducing pain and joint stiffness and improving function in knee OA, without causing any adverse side effects. The new guidelines recommend using these assistive devices as directed by a specialist.

Canes and crutches. Using a cane may reduce pain and improve function in people with knee OA. However, while it takes the load off the knee, it can add more weight onto other affected joints, such as the hip. There isn’t any evidence that crutches are a good alternative to the cane.


Acetaminophen (Tylenol). Several guidelines recommend acetaminophen as a first-line treatment of mild-to-moderate pain from knee and hip OA. However, because of concerns about risks such as ulcers, GI bleeding, and loss of kidney function in long-term users, current guidelines recommend limiting the dose and treatment time. For people with existing medical conditions such as diabetes, high blood pressure, cardiovascular disease, GI bleeding or kidney failure, the recommendation on acetaminophen is “uncertain.” (According to the committee, an “uncertain” recommendation doesn’t mean you should necessarily avoid the treatment; only that you should discuss it with your doctor and only use it when appropriate for you.)

Nonsteroidal anti-inflammatory drugs (NSAIDs). These medications (aspirin, ibuprofen, naproxen sodium) are another option for pain relief. However, the risk of GI side effects such as ulcers and bleeding is also higher with NSAIDs than with acetaminophen. NSAIDs are also associated with cardiovascular risk and kidney damage. The panel recommends “conservative dosing and treatment duration consistent with approved prescribing limits.” In people at moderate to high risk of GI side effects, the committee recommends adding a stomach-protective drug called a proton pump inhibitor (PPI) while taking NSAIDs. However, people at high risk for side effects like cardiovascular disease or GI bleeding are advised to avoid using NSAIDs entirely.

Topical NSAIDs. These rub-on products may be as effective as oral NSAIDs, but they pose less risk of GI problems. And though topical NSAIDs can cause skin irritation, they’re considered a safer option than oral drugs. Topical NSAIDs are recommended for people with knee-only OA. For those with OA in other joints, the recommendation is “uncertain.”

Diacerein. This slow acting drug may slow cartilage breakdown in people with OA. A 2010 analysis found a small benefit for pain relief compared to placebo, but the drug also increased the risk for diarrhea. Though diacerein may be safer than NSAIDs, more high-quality studies are needed to confirm its effectiveness. For now, the recommendation is “uncertain.”

Duloxetine (Cymbalta). This antidepressant, which was evaluated for OA for the first time in these guidelines, may help with chronic pain. However, side effects like nausea, dry mouth, fatigue, constipation, and increased sweating may keep some people from taking it. Duloxetine is appropriate for people with OA of the knee and other joints. Whether people with knee-only OA and coexisting health conditions should take it is uncertain.

Capsaicin. This analgesic, which is derived from chili peppers, is better than placebo at reducing pain, but it can cause side effects such as a burning sensation or skin redness. It’s appropriate for knee-only OA in people without existing health conditions, but uncertain in people with multi-joint OA and those with health conditions.

Opioid and narcotic analgesics. A review of 18 randomized controlled trials showed a significant reduction in pain, and some improvement in physical function with the use of these strong pain relievers. However, these benefits were countered by significant side effects, including nausea, constipation, dizziness, sleepiness, and vomiting. Overall, about a quarter of patients treated with opioids—and particularly with strong drugs like oxycodone and oxymorphone—dropped out of studies because of side effects. The recommendation on both oral and patch forms of opioid pain relievers is “uncertain.”

Corticosteroid injections. Injecting corticosteroid compounds directly into affected joints can be useful for decreasing pain in the short term, although the effect tends to wear off after a few weeks. To maintain relief, you may need to have corticosteroid injections in the same joint every few months, or use another treatment.

Hyaluronic acid injections. Hyaluronic acid is meant to supplement a natural substance that gives joint fluid its viscosity. Most of the studies conducted have been in patients with knee OA. Although the study outcomes differ, some do find the treatment relieves pain. Hyaluronic acid injections seem to reach their peak benefit 8 weeks after the shot is given, and the effect lasts for about 24 weeks. Side effects were minimal, including temporary pain and swelling at the injection site. Because of inconsistent study results, hyaluronic acid injections are “not appropriate” for people with OA of the hip and other joints, and “uncertain” for those with knee-only OA.

Risedronate (Actonel). This bisphosphonate drug is better known for treating osteoporosis, but it may also reduce cartilage degeneration. More studies are needed to determine whether risedronate helps with symptoms, function, or OA disease progression. For now, the drug is deemed “not appropriate.”


Avocado soybean unsaponfiables. This extract made from avocado and soybean oils blocks pro-inflammatory chemicals and may help regenerate normal connective tissue. A 2008 review comparing this supplement with a placebo found it had a small benefit in reducing pain, particularly in people with knee OA. The recommendation is “uncertain.”


Joint lavage and arthroscopic debridement. The roles of joint lavage (flushing the joint with a sterile saline solution) and arthroscopic debridement (the surgical removal of tissue fragments from the joint) are controversial. Some studies have shown that they provide short-term relief; however, a 2008 Cochrane review suggested that in people with OA, arthroscopic debridement probably does not improve pain or ability to function compared to placebo (sham surgery).

Osteotomy and joint-preserving surgery. For young, active people with hip or knee osteoarthritis, osteotomy (a procedure in which bones are cut and realigned to improve joint alignment) may delay the need for joint replacement. A 2007 Cochrane review that included 13 studies found some evidence that high tibial osteotomy for knee OA helped reduce pain and improve function. An earlier study found the average time between this procedure and joint replacement surgery was six years.

Unicompartmental knee replacement. Approximately 30 percent of people with knee osteoarthritis have disease that is largely restricted to one area of the joint. In these cases, unicompartmental knee replacement (also called partial knee replacement) may offer the same improvement and function as total knee replacement but with less trauma and better range of motion. A 2007 review that compared unicompartmental knee replacement with total knee replacement found a similar improvement in function, but fewer complications and less need for revision surgery after unicompartmental surgery.

Popular Options Not Included in Updated Guidelines

Glucosamine. Some studies show glucosamine improves pain and physical function in OA, while others don’t find a benefit. Whether this supplement changes the joint structure remains controversial. Some studies have showed a slowing of joint space narrowing in the knee. Others haven’t shown this effect. The new treatment guidelines find glucosamine is “not appropriate” for disease modification, and “uncertain” for symptom relief.

Chondroitin sulfate. Chondroitin has also shown some effectiveness at reducing pain, but not all studies have yielded the same results, and many studies have been of poor quality. In some research, chondroitin has shown an effect on joint space narrowing compared to placebo. Because of the mixed results, the recommendation is that chondroitin is “not appropriate” for disease modification, and “uncertain” for symptom relief.

Warming Techniques to Relieve Rheumatoid Arthritis PainTry these simple solutions to ease stiff joints.

Not all rheumatoid arthritis relief is found in the medicine cabinet. Here are some easy ways to relieve your pain.

  • Take a long and very warm shower first thing in the morning to ease rheumatoid arthritis pain. Heat from the shower stream helps reduce morning stiffness.
  • Soak in a warm bath or whirlpool. By immersing yourself in heat, pain will melt away.
  • Buy a moist heat pad from the drugstore, or make one at home by putting a wet wash cloth in a freezer bag and heating it in the microwave for one minute. Wrap the hot pack in a towel and place it over the affected area for 15 to 20 minutes.
  • To soothe stiff and painful joints in your hands, apply mineral oil to your hands, put on rubber dishwashing gloves, and place your hands in hot tap water for 5 to 10 minutes.
  • Incorporate other warming elements into your daily routines, such as warming your clothes in the dryer before dressing or using an electric blanket and turning it up before getting out of bed.

    A physical therapist can give you many additional ideas for using heat to temporarily relieve rheumatoid arthritis pain.