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Arthritis is a painful condition that causes swelling, stiffness and discomfort in and around the joints. Millions of people in the UK are affected by arthritis or similar conditions.
Research commissioned by BBC News found that over a quarter of adults in the UK (26%) reported living with chronic pain. As there is no cure for arthritis at present, it is important that people who suffer with the condition find ways to manage and cope with pain to minimise the impact it has on their lives.
Treatments that may help with the pain associated with arthritic conditions include over-the-counter medicine, prescribed medicine and diet and lifestyle changes. Some arthritis sufferers also turn to alternative therapies to complement their treatment.
What is Arthritis
There are two main types of arthritis:
- Osteoarthritis
- Rheumatoid arthritis
Osteoarthritis is the most common type of arthritis. It most commonly affects older people (middle aged or above) and is more common in women. Those with a family history of arthritis are more at risk of developing the condition.
In its early stages, osteoarthritis affects the smooth cartilage lining of the joint. This can restrict movement and cause pain and swelling.
As it progresses, the tendon and ligaments are forced to work harder due to thinning cartilage. This can cause increased swelling and tiny bony spurs called osteophytes start to form.
When a significant amount of cartilage is worn down, there is essentially very little material between the bones which causes bones to rub against one another as they meet at the joint. This can cause them to become misshapen and bones may move out of their usual position.
Joints most commonly affected by arthritis include:
- Hands
- Knees
- Ankles
- Spine
- Hips
Although it is more often associated with the older generation, people of any age can develop arthritis. Younger people sometimes develop the condition as the result of an injury to their joint.
Rheumatoid arthritis is less common than osteoarthritis. It is a long-term, chronic auto-immune condition. An auto-immune condition happens when the immune system malfunctions and starts to attack the body’s own cells, tissues or organs by mistake. In the case of rheumatoid arthritis, the body starts to attack the cells that line the joints. This can make them become swollen and painful and leads to damage to the joints, cartilage and bone over time.
It is unclear why this happens although women, smokers and those with a family history of the condition are considered more at risk.
Medication and medical advice
The common symptoms of arthritis include:
- Joint pain, tenderness and stiffness
- Swelling and inflammation around the joint area
- Restricted movement of the joints
- Redness over the affected joint and skin that feel warm to touch
- Weakness and muscle wastage
As it is a long-term condition that cannot currently be cured, treatment for arthritis involves managing the pain and uncomfortable symptoms associated with it. This can be done using a mix of medication, lifestyle changes and pain management techniques.
Common medications used to treat arthritis include painkillers and anti-inflammatory drugs.
Arthritis is a painful condition and you may need to take painkillers for short-term relief when the pain is bad. These might be over-the-counter painkillers such as:
- Paracetamol
- Ibuprofen
If these pain medicines are not providing enough relief, your GP may prescribe something stronger, such as:
- Opiates, for example codeine (these have side effects including drowsiness and constipation. There is also a risk of addiction).
- Non-steroidal anti-inflammatory drugs (NSAIDs) which work by reducing inflammation. They come in both tablet and topical cream form that you rub into the affected area. Some NSAID creams may be available without a prescription.
- Capsaicin cream is used when topical NSAIDs prove ineffective. Capsaicin cream works by blocking the nerves responsible for sending pain messages to your affected joints. It takes a while to work, but most people notice a difference after two weeks of using the cream.
- Steroid injections. Steroids contain a synthetic version of the hormone cortisol. When injected into joints or muscles, steroids reduce swelling in the immediate area of the injection. This can provide temporary relief from pain that lasts weeks or sometimes months.
Lifestyle modifications
We know that diet plays a significant role in our overall health. Eating the right foods and knowing what to avoid may help you to cope with arthritis pain and discomfort, as well as keep at a healthy weight.
Some people may find following an anti-inflammatory diet helps them. Research also suggests eating less red meat and avoiding processed foods is a good idea if you have pain from swelling and inflammation resulting from arthritis. Healthy fats such as omega-3 (found in oily fish) may help, as may oils rich in monounsaturated fat (such as olive oil).
It is also recommended to ensure you have adequate fibre intake (30g per day) as currently most people in the UK do not meet fibre recommendations. Fibre rich foods include lentils, pinto beans, brown rice, flax seeds and fruits.
Eating a healthy, balanced diet that focuses on fresh ingredients, fibre rich foods and good fats can help with weight management and cholesterol reduction, as well as contributing to overall wellbeing.
Other lifestyle modifications that play a role in managing the pain and discomfort that comes with having arthritis may include:
- Exercise: Gentle, regular exercise such as swimming or yoga can help to reduce stiffness and improve joint mobility.
- Resistance exercises: These can also help to strengthen the muscles around the joint which can reduce pain and improve function.
- Weight management: Maintaining a healthy weight can help to reduce the strain on your joints, especially weight-bearing joints such as the hips, knees and ankles.
- Wear suitable shoes: Comfortable, well-fitting shoes that feature arch support are best for arthritis pain. Tight-fitting or high-heeled shoes should be avoided. Some retailers now stock special shoes designed with arthritis sufferers in mind.
- Using assistive devices: Using suitable, assistive devices for walking and moving around can help to take some of the pressure off swollen and stiff joints.
Occasionally, when pain cannot be managed through medication, painkillers or lifestyle changes, surgery may be required. This might involve replacing, repairing or strengthening the damaged joint.
Pain management techniques
Deep breathing exercises
Deep breathing can calm the heightened anxiety and tension our bodies experience as a reaction to feeling pain. Try taking a very deep breath, feeling the whole chest fill with air right into the diaphragm, hold it for a few seconds then breathe out slowly. This can be repeated until you get a steady cycle of breath going. Deep breathing can help with blood flow, calm the mind and make you feel more relaxed.
Meditation
Meditation puts the body into a state of extreme focus or relaxation. There are various meditation practices to explore including mindfulness meditation, visualisation, body scan meditation and transcendental meditation. You can learn more about how to meditate in this video by expert Dr Becky Spelman.
Hot and cold therapy
Applying heat or cold to the affected joint can help reduce pain and stiffness. Heat can help relax muscles and increase blood flow, while cold can help reduce inflammation and numb the pain. This might be done using a heat pad or hot water bottle and/or ice pack.
Assistive devices
Using assistive devices such as canes, walkers or braces can help reduce the strain on your joints and improve mobility.
Hydrotherapy
Aquatic therapy or hydrotherapy involves doing exercises in a pool where the temperature is set to 33-36 degrees, significantly warmer than a standard pool. The warmth of the water allows joints to relax and the water adds additional support as you exercise.
TENS machine
This type of small machine uses electrical impulses. It is attached to the skin using sticky pads and minor electrical currents are then used to disrupt the pain signals being sent to your nerves. The currents can also trigger the release of endorphins in the brain which act as a natural painkiller and may provide temporary relief to arthritis sufferers.
Physiotherapy
A trained physiotherapist can guide you through a series of exercises and movements to help with strengthening the joints and muscles and improving flexibility. This can help to maintain mobility and keep you active.
Occupational therapy
An occupational therapist (OT) is a specialist who can provide tips, tools and advice on living with arthritis. They teach people how to perform tasks more easily and safely and how to navigate their normal routines with arthritis, including using suitable equipment such as splints or walkers and how to modify activities.
In addition to physical therapy, some people living with chronic pain find that they benefit from psychological therapy such as Cognitive Behavioural Therapy (CBT). The goal of CBT is to reframe how you think and approach problems.
In the case of pain management, the goal would be to understand your thoughts and attitudes towards your diagnosis and symptoms and try to redirect negative thoughts to more helpful and positive ones. The technique is not for everyone and it requires significant engagement from the participant for it to work.
Support and self-care
If you are suffering from pain, discomfort or reduced mobility it is important that you look after yourself. Having the support of others can greatly improve outcomes for anyone living with a chronic condition.
Even on bad days, you need to try to stay positive, which is not always easy. To help with this you should aim to:
- Have a support system around you (such as friends and family)
- Get enough good quality sleep and maintain a sleep hygiene routine
- Accept help when you need it
- Not push yourself too hard
- Reduce and manage stress
- Try to maintain a positive mindset and outlook
- Eat a healthy, balanced diet
- Stay hydrated
- Remember to take any prescribed medication as directed
- Attend appointments and engage with your therapists
Alternative therapies
Some people like to use alternative therapies as a way to complement their other pain management techniques. These include:
Acupuncture
This is an ancient practice, originating in China, where fine needles are inserted into the skin. The aim is to clear blockages in energy channels called ‘qi’ (pronounced ‘chi’). There is limited research about how far acupuncture can help arthritis; however, the treatment is thought to release endorphins that help relieve pain and stimulate cortisol that helps with swelling.
Massage
Massage therapy that involves applying medium pressure to the body can help to relieve arthritic pain (this involves self-massage). Massage usually involves kneading, pressing and rubbing the skin and muscles to relieve tension and soreness. If you decide to try a professional massage to help with arthritic pain, be sure to select a qualified therapist and inform them of any medical conditions you suffer from.
Hypnotherapy
Hypnotherapy utilises the mind/body connection. A trained hypnotherapist will use techniques that lead patients into a relaxed state of hypnosis. While in this trance-like state you may be more open to specific suggestions about how to reach your goals (such as lowering pain) and becoming less fearful or anxious about your condition.
Vitamins and supplements
Vitamin K and vitamin D are important for bone strength and vitamin K also helps with cartilage structure. If your diet lacks omega-3 fatty acids these can be taken as a supplement. Glucosamine and chondroitin are amongst the most common supplements taken for arthritis. Spices such as turmeric and ginger are also thought to have anti-inflammatory properties. It is best to consult your doctor or specialist before taking vitamin supplements and do not exceed the stated dose.
Homoeopathy/essential oils
Essential oils can be applied directly to the skin in a carrier oil (such as during a massage), vaporised in a diffuser or added to a warm bath. Some oils such as lavender or chamomile are said to help with relaxation and aid sleep and it is recommended to add a few drops to your pillow before bed. Thyme oil in particular is thought to be anti-inflammatory. There is limited scientific evidence to support the efficacy of essential oils in managing arthritis, but many people still enjoy them for their pleasant scents.
Alternative remedies and therapies should not be used in place of medical advice. The effectiveness of alternative therapy may vary from person to person and it is important to discuss any plans you have for alternative treatments with your doctor prior to starting them.
It is important to work with your healthcare provider to develop a personalised plan for managing your arthritis pain and discomfort. With the right combination of treatments and lifestyle modifications, you can learn to cope with your symptoms and improve your quality of life.
