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Arthritis pain: Do's and don'ts

Arthritis pain can be frustrating. And so is sorting through your pain relief options. To help you figure out the best means of relieving your arthritis pain, Gene Hunder, M.D., emeritus professor of medicine and a rheumatology specialist at Mayo Clinic, Rochester, Minn., answers some commonly asked questions about arthritis pain. Dr. Hunder is an authority on rheumatology and is editor in chief of the book "Mayo Clinic on Arthritis."

Will physical activity make your arthritis pain worse?

If you already have joint damage, you can make your arthritis pain worse with activities that are stressful to your joints or that require repetitive motion.

However, if you have only mild joint damage and most of your symptoms are related to the ligaments, tendons and muscles surrounding your joints — not the joints themselves — a gentle exercise program could improve your arthritis pain. Be sure to include stretching and muscle strengthening in your exercise program.

Work with your doctor to determine the right solution and exercise program for your specific situation. Arthritis varies a great deal from one person to another. Ask your doctor to carefully define the type and extent of your arthritis. Use that information to decide the best approach to your hobbies and activities.

What sorts of activities should generally be avoided and what types of activities are good for most people with arthritis pain?

Activities that put sudden pressure on involved joints — such as jogging and playing tennis — are likely to make the symptoms of arthritis worse and cause increased swelling and inflammation. Activities that are likely to help include exercises that strengthen your muscles, protect your joints, and reduce stress and joint damage. For example, strengthening the muscles on the front and back of your thigh (quadriceps and hamstrings) helps protect your knee and hip joints. Your doctor might be able to teach you some exercises to increase your muscle strength without abusing your joints.

Do what you can to stay physically active while taking into consideration the condition of your joints. For example, you may be able to walk a mile or more at a comfortable pace with well-fitting shoes. But you probably have to give up on high-impact activities, such as running, which put a lot of stress on many different joints. If your joints are too painful or damaged to allow an activity such as walking, then swimming or other water exercise may be a better choice for keeping you active and getting toned.

How can you reduce the stiffness and pain that come from sitting for a long time?

Many people with arthritis experience stiffness after sitting or resting, especially if they've used their joints actively before sitting or resting. Most people with rheumatoid arthritis have stiffness after rest, such as in the morning. These are common symptoms of arthritis. Movement will tend to diminish some of the symptoms.

If you must sit for a long time, adjust your position often to prevent or lessen stiffness. For example, turn your head at different angles, shift the position of your arms, and bend and stretch out your legs. Such slight movements may help prevent excessive stiffness. Many times the stiffness may be worse for a few days after you've used your joint strenuously.

When does arthritis pain indicate you should call your doctor?

If new pain develops or you have persistent symptoms — lasting more than several days — call your doctor. Treatment is often more effective when arthritis symptoms are caught early. If you have symptoms that you know are from overdoing it and they disappear in a few days, you probably don't need to call your doctor.

What medications are best for arthritis pain relief?

The good news is that there are now many medications available for arthritis. Most are relatively safe and well tolerated, but no medication is completely free of possible side effects. If your symptoms are a regular problem, you need professional advice from your doctor about what medications to take and how much.

If your pain is present only occasionally and follows some unusual activity, you could try one or two acetaminophen tablets (Tylenol, others), which are sold over-the-counter. Many such preparations are available. Ordinarily, all work equally well. Some people prefer aspirin instead. If you have a history of peptic ulcer disease, bleeding, asthma or allergies, talk to your doctor before taking aspirin or a drug like ibuprofen.

If your symptoms are prolonged and are related to activities that you don't participate in all of the time, nonsteroidal anti-inflammatory drugs (NSAIDs) — such as ibuprofen (Advil, Motrin, others) and naproxen (Aleve, others) — may bring relief. These drugs can be purchased without a prescription. Weekend tennis players, gardeners and others with mild osteoarthritis can overcome some of the disagreeable stiffness by taking only one or two over-the-counter NSAID tablets for one or two days.

If your symptoms are more prolonged and severe, joint involvement may be more advanced, and you may need larger doses of drugs on a regular basis. Until recently we prescribed COX-2 inhibitors for patients who had stomach pain or other side effects from other NSAIDs. However, recent data suggest that COX-2 drugs may cause heart problems in some patients. Consult your doctor if you aren't getting sufficient pain relief from your medications.

Are alternative treatments helpful for arthritis pain?

This question raises complex issues, and there's no short and easy answer that applies to all alternative arthritis treatments. Even the definition of alternative treatments varies from one source to another. For example, heat, massage and stretching — which help relieve arthritis symptoms for many people — have been listed as alternative treatment by some, but in reality these have been standard practice for many years.

The best treatments of this type are straightforward and have your doctor's or physical therapist's stamp of approval. Some activities may be more interesting and fun to do, such as tai chi. A good rule of thumb: If it keeps you active, then it's helpful.

The problem with many alternative preparations is that they haven't been adequately studied. In most people, arthritis symptoms vary from day to day. So if you take an herbal preparation, for example, on a day that you might have felt better anyway, you may become convinced that the herb made you better. In arthritis treatment studies, as many as 30 percent of people taking an inactive substance (placebo) improve, at least temporarily.

Finally, quality standards for over-the-counter alternative drugs don't exist. Research shows that there's a great variation in the amount of active substance in different brands and even different lots of the same brand. This alone may be reason to avoid them.

Finding an effective and safe medication for arthritis pain is a complex task that may take years. Trying to shortcut standard practices may lead to harmful effects and wasted money, time and effort.

By Mayo Clinic staff

AR00029

August 02, 2005

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