Arthritis And Joint Pain Management
Many professional organizations have guidelines for managing arthritis pain. A common theme across guidelines is that pain management strategies should be flexible, include options that do not involve medication, and be tailored to meetthe needs of the patient. Such guidelines suggestthe following for managing arthritis symptoms such as pain:
- Over-the-counter medications like acetaminophen or ibuprofen and other nonsteroidal anti-inflammatory drugs .
- Physical activity/exercise or community-based physical activity programs.
- Exercise therapy, including physical therapy.
- Self-management education workshops.
- Weight loss, if overweight or obese.
- Cognitive behavioral therapya psychological, goal-directed approach in which patients learn how to modify physical, behavioral, and emotional triggers of pain and stress.
Emerging evidence suggests that these are safer and more effective treatments for managing long-term arthritis pain than opioids.
- A recent study of individuals with knee and hip osteoarthritis, the most common types of arthritis, found that after one year, people who took over-the-counter medications had greater reductions in pain severity than people who took opioids.
Safer options exist to help manage arthritis pain.
Cracking And Popping With Knee Arthritis
Cracking and popping are often wrongly perceived to be coming from bones rubbing against each other. Knee arthritis symptoms that are associated with the bones rubbing are more sensations of grinding and grating.
Cracking and popping are caused by trapped nitrogen gas bubbles escaping from the joint. The gas bubbles build up during sedentary activities, which is why the noises are most commonly noticed during the first few movements of waking up in the morning, or after sitting for a prolonged period of time.
The more active a knee joint is in the day, the less it will crack and pop.
If an individual has a particularly large bony spur, then this can also cause a cracking sensation during certain movements as it rubs against the joint surface.
Risk Factors For Knee Arthritis
- Age. Osteoarthritis is a degenerative, wear and tear condition. The older you are, the more likely you are to have worn-down knee joint cartilage.
- Heredity. Slight joint defects or double-jointedness and genetic defects may contribute to osteoarthritis in the knee.
- Excess weight. Being overweight or obese puts additional stress on the knees over time.
- Injury. Severe injury or repeated injury to the knee can lead to osteoarthritis years later.
- Overuse. Jobs and sports that require physically repetitive motions that place stress on the knee can increase risk for developing osteoarthritis.
- Gender. Postmenopausal women are more likely to have osteoarthritis than men.
- Autoimmune triggers. While the cause of rheumatoid arthritis remains unknown, triggers of autoimmune diseases are still an area of active investigation.
- Developmental abnormalities. Deformities such as knock knee and bowleg place higher than normal stress on certain parts of the knee joint and can wear away cartilage in those areas.
- Other health conditions. People with diabetes, high cholesterol, hemochromatosis and vitamin D deficiency are more likely to have osteoarthritis.
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New Arthritic Knee Pain Treatment Can Lessen Pain Without Surgery
- A nonsurgical, minimally invasive treatment effectively provides pain relief both immediately and in the long term.
- Patients usually go home the same day after a short post-operative observation after undergoing genicular artery embolization or GAE.
Arthritis is one of the leading causes of joint-related pain for people throughout the world. Nevertheless, there may be a promising nonsurgical procedure that might relieve pain for at least 12 months.
Researchers at UCLA Health have studied a nonsurgical and minimally invasive treatment option for arthritis that effectively provides pain relief both immediately and in the long term.
Through a technique called genicular artery embolization, or GAE, physicians can relieve arthritis pain in the knees within hours of the procedure.
Arthritis is pain and swelling in the bodys joints after cartilage becomes damaged from overuse. It causes stiffness, immobility, and discomfort, which typically worsens with age.
When cartilage gets worn down, inflammatory enzymes are released, causing joint pain.
And with more than 100 types of arthritis, it is one of the most common ailments affecting people.
Genicular artery embolization is an outpatient procedure designed to limit inflammatory enzymes. GAE takes approximately 1 to 2 hours to complete, and patients usually go home the same day after a short post-operative observation.
What Questions Might A Healthcare Provider Ask To Diagnose Arthritis Of The Knee
Your healthcare provider will interview you when you report your symptoms. Some questions might include:
- Does anyone in your family have arthritis of the knee?
- Does your knee swell up?
- Is your skin often red?
- Is your skin often warm?
- Do you have symptoms in one knee or both?
- How long have you had these symptoms?
- What medications do you take?
- How severe is your pain?
- Do you struggle to walk?
- Do the symptoms interfere with your daily activities?
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How Is Knee Arthritis Treated
There is no cure for knee arthritis, but there are many ways you can relieve your symptoms and help prevent these from getting worse. Of the following strategies for managing knee arthritis, exercise and weight loss are seen as particularly important.
Read more about pain relief medications.
Other treatments and tips
How Is Osteoarthritis Managed
There is no cure for osteoarthritis, but most people with osteoarthritis can manage their symptoms, continue with daily activities and live healthy and enjoyable lives. Be careful of any products or treatments that claim to cure osteoarthritis completely your doctor will help to find the right treatment for you.
The Australian Commission on Safety and Quality in Health Care has developed a guide to help you discuss the main treatment options for osteoarthritis of the knee with your doctor.
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Transcutaneous Electrical Nerve Stimulation
Transcutaneous electrical nerve stimulation uses a machine that sends electrical impulses through sticky patches, called electrodes, attached to the skin. This may help ease the pain caused by your osteoarthritis by numbing the nerve endings in your spinal cord which control pain.
Treatment with TENS is usually arranged by a physiotherapist or doctor, who can advise you on the strength of the pulses and how long your treatment should last.
How Is Osteoarthritis Of The Knee Diagnosed
The diagnosis of knee osteoarthritis will begin with a physical exam by your doctor. Your doctor will also take your medical history and note any symptoms. Make sure to note what makes the pain worse or better to help your doctor determine if osteoarthritis, or something else, may be causing your pain. Also find out if anyone else in your family has arthritis. Your doctor may order additional testing, including:
- X-rays, which can show bone and cartilage damage as well as the presence of bone spurs
- magnetic resonance imaging scans
MRI scans may be ordered when X-rays do not give a clear reason for joint pain or when the X-rays suggest that other types of joint tissue could be damaged. Doctors may use blood tests to rule out other conditions that could be causing the pain, such as rheumatoid arthritis, a different type of arthritis caused by a disorder in the immune system.
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When Should You Talk To Your Doctor About Knee Pain
If you have a sudden and minor injury, such as banging your knee against a table, its likely you wont need a doctor visit only some ice and ibuprofen. But if theres a more serious injury that causes pain to linger, or if your pain doesnt have a specific cause, its important to consult your health care provider, according to both Johns Hopkins Medicine and the Mayo Clinic.
Thats particularly important if youre having issues in other joints, such as your shoulders, hips, lower back, wrists, hands, and/or ankles. In that case, you may be dealing with arthritis, which requires a comprehensive treatment approach that goes beyond addressing just your knees.
You should call your doctor right away if:
- Youre unable to put any weight on your knee
- Your knee feels unstable
- Youre unable to fully extend or flex your knee
- You have a fever, swelling, or redness in addition to pain
Your health care provider will review your symptoms, list of current medications, and medical history. They will also examine your knee, pressing on it to see where its tender. They may also put your knee through some different range of motion tests to check the integrity of your tendons, ligaments, and menisci of the knee .
They may diagnose knee problems though imaging such as:
- Computed tomography scan
- Radionuclide bone scan
Grinding And Grating With Knee Arthritis
The sensation of grinding and grating is caused by the unsmooth bones in the joint rubbing against each other. It is also known as crepitus and most commonly felt under the kneecap during weight-bearing activities.
The kneecap is more affected than other parts of the knee joint due to muscle tension or previous injuries causing it to misalignment and track outside of the groove that it is supposed to sit it.
This eventually leads to friction and wearing of the cartilage on the underside of the kneecap.
Some individuals experience grinding and grating, but have no joint pain at all.
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What Is The Treatment Gap And Am I In It
If you have a disability due to knee pain despite treatment and have been told your knee is not ready for knee replacement, then you are in the treatment gap. The treatment gap is defined as the time spent between when the non-surgical treatment stops working and when your knee is suitable for joint replacement.
On average, the treatment gap straddles a period of 10 years, although, if arthritis onset is present at a younger age, then, it may stretch over most of a persons adult life. 1% of the entire population is thought to be in the treatment gap. Consequently, in the Bristol area alone there are over 5,000 individuals for whom non-operative treatment has or will not deliver a satisfactory result and for whom surgery will not be an option.
Protection Rest Ice Compression And Elevation
Rest, ice, compression, and elevation may help treat mild knee pain that results from a soft tissue injury, such as a sprain.
Protection refers to protecting the knee from further injury, for example, by taking a break from the activity that caused it.
Rest can reduce the risk of further injury and give tissues time to heal. However, stopping all movement is not advisable, as this can lead to stiffness and, in time, muscle weakness.
Ice can help reduce swelling and inflammation. It should be wrapped in a cloth and applied for 20 minutes several times on the first day of injury. Never put ice directly the skin, as this can lead to further damage.
Compression with a knee support, for example, can increase comfort levels. The support or bandage should be firm but not tight.
Elevation, or keeping the leg raised, will encourage circulation and reduce swelling. Ideally, the knee should be above the level of the heart.
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Why Has My Doctor Not Booked Me In For Surgery
Doctors are frequently asked my knee seems to be heading for a total replacement. Why cant we just get on and do it? When the medical professional opts to first try a less invasive solution, patients are left with the impression that a lower-cost treatment is being sought or that the doctor is not convinced as to the severity of the ailment.
Why are surgeons reluctant to immediately recommend a knee replacement? The answer lies in the outcomes. Surgeons know that if a knee replacement is performed before bone on bone arthritis is present then fewer patients will be satisfied with the final result.
Historically, in these cases, partial knee replacements present a satisfaction rating of 95% whereas, total knee replacements come in at 70%. When performed on young patients with mild arthritis, this score drops to less than 50%. Surgeons will always seek to maximise patient satisfaction and for this reason, they may be reluctant to immediately suggest more radical procedures.
Sprains Strains And Injuries
Sprains and strains happen when tissues in the knee become stretched by unusual or increased activity, or an awkward twist or trip.
PRICE, described above, should lead to a reduction in pain and improved movement within days, and a gradual improvement over the weeks to follow.
A sprain often resolves itself, but some problems can require more treatment. For example, an injury to the pad of tissue in the knee joint known as the meniscus may require surgery.
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Complementary And Alternative Medicine
Many complementary and alternative medicine treatments have been used to treat knee osteoarthritis, with variable success. Glucosamine and chondroitin supplements have been marketed since the 1990s as disease-modifying options. A double-blind RCT showed little benefit from the use of glucosamine combined with chondroitin in participants with mild knee osteoarthritis.15 However, a greater benefit was noted in persons with moderate to severe pain. Glucosamine is safe, but the benefit is variable. Chondroitin does not decrease pain from osteoarthritis of the knee or hip.15
The benefit of acupuncture is not clear. A meta-analysis did not demonstrate any clinically relevant improvement in pain or function scores with acupuncture compared with sham acupuncture.16 However, in the short term and in the long term , patients who received either acupuncture or sham acupuncture felt better than those who received usual care. Another study showed that six months of treatment with traditional Chinese acupuncture decreased pain scores and increased functionality an average of 40 percent compared with sham acupuncture or no treatment.17
Buckling With Knee Osteoarthritis
As knee osteoarthritis progresses, the supporting structures of the knee start to become weak and are unable to stabilize the knee properly during painful movements.
This can result in the knee buckling or giving way. It is most common during twisting movements or unexpected movements such as stepping off a curb that you didnt realize was there.
Occasionally, floating pieces of cartilage in the knee can get trapped during walking activities or climbing stairs.
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S To Treat Osteoarthritis Knee Pain
First, maintain your weight at a healthy range. Obesity is one of the main preventable risk factors for OA as it puts tremendous pressure on your knees
Second, do regular light to moderate exercise. Studies have shown that walking, stair climbing, swimming or cycling can help strengthen your muscles and reduce strain on your knees.
Third, apply heat and vibration therapy with the HeatPulse.
How Common Is Osteoarthritis
Women are more likely to develop osteoarthritis than men. Australian studies show that about 1 in 10 women report having the condition, compared with about 1 in 16 men.
Osteoarthritis can develop at any age, but it is more common in people aged over 40 years or in those who have previously injured a joint. One in 5 Australians over the age of 45, and one in 3 over 75 years have osteoarthritis.
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What Causes Osteoarthritis
Osteoarthritis does not have a specific, single cause. However, experts note that certain things put you more at risk of developing osteoarthritis in some joints, including:
- being overweight
- having a previous injury to the joint, such as a dislocation or a fracture
- frequent kneeling, climbing and squatting
- jobs that involve heavy lifting
- repetitive use of the hands
You may also be more likely to develop the condition if your family has a history of osteoarthritis.
Osteoarthritis Of The Knee
Knee OA is a very common source of pain that can limit your mobility.
Causes of Knee OA
The cause of OA is unknown. These risk factors make it more likely you will develop knee OA:
- Age: OA can occur at any time of life, but it is most common in older adults.
- Sex: Women are more likely to have knee OA than men.
- Obesity: Being overweight adds stress to your knees. Fat cells also make proteins that can cause inflammation in and around your joints.
- Injuries: Any knee injury, even old ones, can lead to knee OA.
- Repeated stress: Frequent stress on your knee from your job or playing sports can increase risk for OA.
- Genetics: You can inherit a tendency to develop OA.
- Bone deformities: If you have crooked bones or joints, you are at higher risk.
- Some metabolic diseases: Diabetes and hemochromatosis, a condition in which your blood has too much iron, have been linked to OA
Symptoms of knee OA develop slowly and worsen over time.
- Pain: Movement causes pain. Sometimes your knee will ache while sitting still.
- Stiffness: Your knees may be stiff first thing in the morning or after sitting for a long time.
- Loss of motion: Over time, you may lose the ability to bend and straighten your knee all the way.
- Creaking and grating : You may hear crackling noises or feel a grating sensation.
- Instability: Your knee may give out or buckle, or feel like it could.
- Locking: The knee may lock or stick.
- Swelling: Your knee may get puffy all around or on one side.
Your doctor will check for:
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