Natural Treatments for Rheumatoid Arthritis

May 3, 2010

After all of the information that WebMD has provided on Rheumatoid Arthritis, including the drugs and surgical interventions, there are home remedies that people with this painful inflammatory disease can utilize to diminish their pain to a tolerable level. As I’ve told you before, check with your medical provider before implementing anything you read on this or any other blog or website.

Natural Treatments for Rheumatoid Arthritis

Looking for some natural treatments for RA? Natural therapies are popular today as people seek to control their health and healing. For those with RA, natural therapies may let you have greater control of your pain and activities.

What are some natural treatments for RA?

According to the National Center for Complementary and Alternative Medicine (NCCAM), natural treatments for RA may range from moist heat, magnets, and massage to herbs, natural supplements, and relaxation remedies.

Although some of these natural treatments may help RA, none of these therapies is fully grounded in science. Before you use any unprescribed remedy, always talk to your doctor.

How are heat and cold used to relieve RA symptoms?

Many doctors recommend heat and/or cold treatments to reduce RA symptoms.

Cold compresses reduce joint swelling and inflammation. You can apply a cool compress or ice pack to the affected joint during an RA flare-up to help ease inflammation and pain.

You don’t want to overdo cold treatments. Apply the cold compress for 15 minutes at a time with at least a 30-minute break in between treatments.

Heat compresses relax your muscles and stimulate blood flow.

To use heat therapy, you can try a moist heating pad or a warm, damp towel. Many people like using the microwavable hot packs. Don’t go too hot. Your skin should not burn.

You can also use heat therapy by standing in the shower. Letting the warm water hit the painful area on your body may help ease pain.

A hot tub is a good way to relax stiff muscles — and it’s enjoyable. (Caution: Avoid hot tubs or spas if you have high blood pressure, heart disease, or are pregnant.)

Can magnets improve RA symptoms?

Magnets are commonly said to be helpful alternative therapies for pain control. Found at most natural food stores, magnet therapies come in a variety of forms, such as bracelets, necklaces, inserts, pads, or disks.

Most research on magnets has been done in people with osteoarthritis, the wear and tear type of arthritis associated with aging.

In people with osteoarthritis, some preliminary studies have shown that magnets improved joint pain better than a placebo in people with knee or hip arthritis. Doctors do not understand exactly how magnets might relieve pain.

It’s unclear if magnets might also help those with rheumatoid arthritis.

What about mind/body therapies for RA?

Many studies have reviewed the use of mind/body therapies for pain. Mind/body therapies may be helpful when added to conventional treatments.

Mind/body therapies may help with stress management. They can help improve sleep and pain perception.

Deep abdominal breathing: Taking deep, slow breaths from the abdomen (not the chest) can help alter your emotional state. Deep breathing can make a stressful moment lessen in intensity.

What about mind/body therapies for RA?

With deep breathing, you can decrease stress hormones. Deep breathing also helps slow your heart beat during stressful moments.

Progressive muscle relaxation: Concentrating on different muscle groups, contract then relax all of the major muscle groups in the body.

Start with your head, neck, and arms. Then contract and relax your chest, back, and stomach. Finish by doing your pelvis, legs, and feet.

Along with muscle relaxation, use deep breathing. Breathe in while tensing the muscles. Breathe out or exhale while relaxing the muscles.

Visualization: Visualization can help reduce stress and pain. With this exercise, you close your eyes, breathe deeply, and imagine that you’re in quiet, peaceful place.

Using visualization during stressful times can be soothing and refreshing.

Meditation: Meditation brings about relaxation and stress reduction. It can slow the heart rate and breathing. Meditation reduces stress and helps with your pain perception.

Those who practice meditation tell of having decreased anxiety and depression. They also report increased concentration and resilience.

Tai chi: Studies are being done on tai chi for pain reduction. The movements of tai chi are gentle, graceful, and mystical.

For those with arthritis, tai chi is a safe way to relieve pain. Tai chi can help increase range of motion and joint strength.

Some believe that tai chi has a spiritual modality. Tai chi allows people to practice mindfulness as they focus in the moment and away from the pain.

Acupuncture: With acupuncture, the practitioner uses stainless steel needles to stimulate the major pathways — called “meridians” — in the body. The goal is to stimulate various points targeted at specific areas of the body.

Traditional Chinese medicine practitioners believe acupuncture can heal imbalances of energy, or “qi.” The practitioner tries to restore balance to the sick body and boost the immune system. Good health happens when qi flows unrestricted throughout the body.

Some doctors believe acupuncture needles decrease pain by triggering pain-blocking chemicals called endorphins. Endorphins are known as the body’s natural opioid. Other theories suggest that acupuncture may block pain signals.

Although little research has been done on people with rheumatoid arthritis, studies do show an improvement in pain, particularly in people with back pain. Some studies have also shown a decrease in pain in people with osteoarthritis.

Biofeedback: With biofeedback, you learn to control automatic responses such as heart rate and blood pressure.  By placing electric sensors on the body, information is sent to a monitor. You then have to react to stimuli such as thoughts, pictures, or sounds.

Working with a therapist, you’ll study your body’s reactions to the stimuli. The therapist will help you recognize feelings of increased tension and learn ways to calm yourself.

There is insufficient medical evidence to determine how well biofeedback helps pain from arthritis.

Are there safe supplements for RA?

There are a few studies showing some benefit for certain supplements and natural remedies. However, the research is preliminary, so the true impact these supplements may have on RA is uncertain.

Keep in mind that even natural supplements can interact with medicines. Be sure your doctor is aware of all medicines and supplements you are taking.

Supplements for RA that have the best medical research to back them up include:

Borage. Some studies show that borage seed oil along with anti-inflammatory painkillers can reduce RA symptoms. These findings show reduced tender and swollen joints of RA after six weeks. Borage seed oil appears to be safe but may cause soft stools, diarrhea, and bloating. Borage seeds and other plant parts, such as the leaf or flower, may contain substances that are potentially harmful to the liver. Borage seed oil does not contain these harmful substances.

Fish oil. Studies show that omega-3 fatty acids in fish oil have an anti-inflammatory effect in the body. Several studies have shown that fish oil supplements may help reduce morning stiffness with RA. In addition, the omega-3 fatty acids in fish oil help protect against heart disease. People with RA are at a higher risk of developing heart disease. Fish oil appears to be safe when used appropriately. Doses greater than 3 grams per day may increase the chance of bleeding.

Thunder god vine. A few studies have shown a decrease in pain and tender joints in people with RA. A larger government-funded study is under way comparing thunder god vine with traditional medicine for rheumatoid arthritis. Thunder god vine appears to be safe. However, pregnant women should not take this supplement as it may cause birth defects.

Can Your Diet Help Relieve Rheumatoid Arthritis?

If you suffer from rheumatoid arthritis, you may have heard that a specific diet or certain foods can ease your pain, stiffness, and fatigue. Someday, food may be the medicine of choice for those with arthritis and related inflammatory diseases. For now, though, here’s information that may help you separate the facts from the myths about diet and rheumatoid arthritis.

Eating certain foods or avoiding certain foods may help your rheumatoid arthritis symptoms. However, according to the Arthritis Foundation, there is no scientifically substantiated “arthritis diet.” On the other hand, if you find certain foods worsen your rheumatoid arthritis symptoms and others help your symptoms to improve, it makes sense to make some adjustments in your diet.

A recent study showed that 30% to 40% of people with rheumatoid arthritis may benefit from excluding “suspect” foods that are identified with an elimination diet. An elimination diet guides you in removing suspected “trigger” foods from your daily diet. Then, after a period of time, you slowly add the suspect foods back into your diet and watch for increased pain and stiffness. For some people, eliminating those foods that seem to trigger pain and stiffness may help decrease rheumatoid arthritis symptoms.

Can some fats increase the inflammatory response in people with rheumatoid arthritis?

Yes. Studies show that saturated fats may increase inflammation in the body. Foods high in saturated fats, such as animal products like bacon, steak, butter, and cream, may increase pro-inflammatory chemicals in the body called prostaglandins. Prostaglandins are chemicals that cause inflammation, pain, swelling, and joint destruction in rheumatoid arthritis.

In addition, some findings confirm that meat contains high amounts of arachidonic acid. Arachidonic acid is a fatty acid that’s converted to pro-inflammatory chemicals in the body. Some people with rheumatoid arthritis find that a vegetarian diet helps relieve symptoms of pain and stiffness. Other people with rheumatoid arthritis, however, get no benefit from eating a diet that eliminates meat.

Is omega-6 fatty acid linked to increased inflammation associated with rheumatoid arthritis?

Omega-6 fatty acids are in vegetable oils that contain linoleic acid. That includes corn oil, soybean oil, sunflower oil, wheat germ oil, and sesame oil. Studies show that a typical western diet has more omega-6 fatty acids compared to omega-3 fatty acids. Omega-3 fatty acid is a polyunsaturated fat found in cold-water fish.

Consuming excessive amounts of omega-6 fatty acids may promote illnesses such as cancer and cardiovascular disease. It may also promote inflammatory and/or autoimmune disease such as rheumatoid arthritis. Ingesting fewer omega-6 fatty acids and more omega-3 fatty acids, on the other hand, may suppress inflammation and decrease the risk of illness.

Many studies show that lowering the ratio of omega-6 fatty acids to omega-3 fatty acids contained in the diet can reduce the risk of illness.

How can omega-3 fatty acids help rheumatoid arthritis?

Omega-3 fatty acids, the polyunsaturated fats found in cold-water fish, nuts, and other foods, may have an anti-inflammatory effect in the body. The marine omega-3 fatty acids contain EPA (eicosapentaenoic acid) and DHA (docosahexaenoic acid). These are substances that may decrease inflammation. Some studies show a positive anti-inflammatory effect of omega-3 fatty acids with rheumatoid arthritis. The same is true for cardiovascular disease. This is important because people with rheumatoid arthritis have a higher risk of cardiovascular disease.

Human studies with marine omega-3 fatty acids show a direct relationship between increased DHA consumption and diminished C-reactive protein levels. That means reduced inflammation.

Which foods have omega-3 fatty acids that might be good for rheumatoid arthritis?

For omega-3 fatty acids, select cold-water fish such as salmon, tuna, and trout. Some plant foods are also sources of omega-3 fatty acids. They include walnuts, tofu and soybean products, flaxseed and flaxseed oil, and canola oil.

Can fish oil supplements help rheumatoid arthritis?

According to the American College of Rheumatology, some patients with rheumatoid arthritis report an improvement in pain and joint tenderness when taking marine omega-3 fatty acid supplements. You may not notice any benefit at first from taking a fish oil supplement. It may take weeks or even months to see a decrease in symptoms. But studies do show that some people who have a high intake of omega-3 fatty acids benefit from decreased symptoms and less use of anti-inflammatory drugs.

The American College of Rheumatology reminds consumers that fish oil supplements may have high levels of vitamin A or mercury.

Can a Mediterranean-type diet help rheumatoid arthritis?

Many studies suggest that a diet high in fruits, vegetables, and vitamin C may be linked to a lower risk of rheumatoid arthritis. In fact, we know that rheumatoid arthritis is less severe in some Mediterranean countries such as Greece and Italy. In those countries, the main diet consists of large amounts of fruits, vegetables, olive oil, and fatty fish high in omega-3s. The Mediterranean-type diet may even protect against severe rheumatoid arthritis symptoms.

Fruits, vegetables, grains, and legumes are high in phytonutrients. These are chemicals in plants that have disease-fighting properties and immune-boosting antioxidants such as vitamin C, vitamin E, selenium, and the carotenoids. A plant-based diet is also high in bioflavonoids. These are plant compounds that reportedly have anti-viral, anti-inflammatory, and anti-tumor activities.

Nutrition researchers who test the antioxidant activity of foods believe that certain foods may reduce the risk of some degenerative diseases associated with aging. These diseases include arthritis, heart disease, diabetes, and cancer. More recent findings show that the higher intake of omega-3 fatty acids with the Mediterranean diet may be linked to the improvement in rheumatoid arthritis symptoms.

What vitamins and minerals are important for people with rheumatoid arthritis?

Folic acid, or folate, is a B vitamin found in food. It can also be obtained by supplementation. It is important to you if you take methotrexate, a commonly prescribed medication for rheumatoid arthritis. Your body uses folic acid to manufacture red blood cells. Supplementing with folic acid may allow people with rheumatoid arthritis to stay on methotrexate longer. That way they can benefit from relief of pain and inflammation without suffering the medication’s side effects.

Selenium helps to fight free radicals that cause damage to healthy tissue. There are some studies that indicate people with rheumatoid arthritis have reduced selenium levels in their blood. Current findings are preliminary and so no recommendations have been made for selenium supplementation. One 3.5-ounce serving of tuna gives you a full day’s requirement of selenium.

Supplementing your diet with bone-boosting calcium and vitamin D is important, especially if you take corticosteroids (like prednisone) that can cause bone loss. The risk of bone loss is higher in people with rheumatoid arthritis. So check with your doctor to see how much calcium and vitamin D you need to get daily through foods, supplements, and sunlight.

What about alcohol and rheumatoid arthritis?

A recent study published in the Annals of Rheumatic Diseases (2008) concluded that drinking alcohol may be linked to a significantly reduced chance of getting rheumatoid arthritis. While the researchers did not know how alcohol protects against rheumatoid arthritis, they believed the data should encourage further study on how arthritis may be prevented through diet and lifestyle measures. Talk to your doctor about drinking alcohol if you take any rheumatoid arthritis medication. Avoid alcohol if you take methotrexate because liver damage could be a serious side effect.

Can weight loss help my rheumatoid pain and stiffness?

Yes. Studies show that dropping extra pounds is important for your joints and overall health. Excess pounds put extra strain on knees, hips, and other weight-bearing joints, not to mention your heart. Being overweight or obese actually worsens the joints — making them stiffer and more painful — and can exacerbate rheumatoid arthritis flares.

Rheumatoid Arthritis and Exercise

Learn about the importance of exercise for rheumatoid arthritis. Arthritis exercises can safely provide pain relief and build muscle strength.

When joints are stiff and painful, exercise might be the last thing on your mind. Yet when you have rheumatoid arthritis, exercising regularly is one of the best things you can do to take care of yourself and your joints. Here is why exercise is so important:

  • People who exercise live longer, with or without rheumatoid arthritis.
  • Regular exercise can actually reduce overall pain from rheumatoid arthritis.
  • Exercise can keep your bones strong. Thinning of the bones can be a problem with rheumatoid arthritis, especially if you need to take steroids. Exercise helps bones keep their strength.
  • Exercise maintains muscle strength.
  • Regular exercise improves functional ability and lets you do more for yourself.
  • People with rheumatoid arthritis who exercise feel better about themselves and are better able to cope with problems.

Is Exercise Safe If You Have Rheumatoid Arthritis?

Is exercise safe? Yes — certain kinds of exercise are proven to be safe for people with rheumatoid arthritis. There are three types you can do: stretching, strengthening, and conditioning.

  • Stretching exercises are the simplest and easiest. They consist of stretching and holding different joint and muscle groups for 10 to 30 seconds each. Stretching improves flexibility, and daily stretching is the basis for any exercise program.
  • Strength exercises involve working the muscle against resistance. This can be either with or without weights. Resistance training strengthens the muscle and increases the amount of activity you can do pain-free.
  • Conditioning exercise, also called aerobic exercise, improves cardiovascular fitness. There are countless benefits to aerobic exercise! Among them, it makes your heart and blood vessels healthier, prevents disability, and improves mood and well-being. Good conditioning exercises for people with rheumatoid arthritis include low-impact activities like walking, swimming, bicycling, or using an elliptical machine. Any of these will get your heart pumping.

    After being cleared by your doctor, you should try to do 20 to 30 minutes of low-impact conditioning exercise on as many days as you feel you can. More is better, but any amount is better than none at all!

Exercises to Avoid if You Have Rheumatoid Arthritis

Are there any kinds of exercise you should avoid if you have rheumatoid arthritis? In general, you should be careful about activities that put a lot of stress on a joint, or are “high-impact,” such as:

  • Jogging, especially on paved roads
  • Heavy weight lifting

That’s not to say that these activities are totally off-limits. If you’re interested in trying them, talk to your doctor first.

Your rheumatologist can help you create an exercise program that is right for you. This may also involve meeting with a physical therapist. Physical therapists can identify what areas you need to work on, choose the right exercises for you, and tell you how vigorously you should exercise.

There are also community exercise programs designed just for people with arthritis. People with Arthritis Can Exercise (PACE) and the Arthritis Self Help Course (ASHC) are offered by the Arthritis Foundation (www.arthritis.org).

You should work with your treatment team to design the right plan before starting to exercise, especially if you have other medical problems.

As you start to exercise regularly, you’ll realize the benefits, and you’ll know you’ve taken control of your rheumatoid arthritis. Soon, not only will your joints feel better — you’ll feel better too.

Hand Exercises for Rheumatoid Arthritis

7 hand-stretching exercises to ease rheumatoid arthritis symptoms.
By Denise Mann
WebMD Feature
Reviewed by Louise Chang, MD

You need your hands to cook, clean, type, and do just about everything else. But you probably don’t think much about how important manual dexterity is unless you have rheumatoid arthritis (RA) or another type of arthritis that attacks your hand and finger joints.

RA is a disease in which the body’s immune system engages in friendly fire against the joints. It often starts in your hands before spreading to the other joints.

“The hands and the feet are usually hit first, and these are the joints that are predominantly involved in everyone with RA,” says Eric Matteson, MD, a professor of medicine at the Mayo Clinic in Rochester, Minn. Hand exercises can help maintain range of motion, flexibility, and strength in your hands.

There is not a one-size-fits-all hand exercise prescription for people with RA, but a rheumatologist, physical therapist, or occupational therapist can help design a program especially for your hands. Here are seven hand exercises your program may include.

  • Hand Exercise for Rheumatoid Arthritis: No. 1: Start by holding your hand upright and pointing your wrist, fingers, and thumb upward. This also serves as the neutral starting position for many of the hand exercises that follow. Hold for 5 to 10 seconds.
  • Hand Exercise for Rheumatoid Arthritis: No. 2: Keep your wrist straight in the neutral starting position and bend the base joints of your fingers, which connect the fingers to the palm. Keep your middle and end joints and your wrist straight. “This is already a big effort for people with RA,” Matteson says. Hold for 5 to 10 seconds. Repeat twice daily on each hand.
  • Hand Exercise for Rheumatoid Arthritis: No. 3: Keep your wrist and the base joints straight, and bend your middle and end joints of your fingers toward your palm, one at a time. Hold each position for five seconds. Repeat on all 10 fingers twice a day.
  • Hand Exercise for Rheumatoid Arthritis: No. 4: Bend each finger from the base joint downward using your other hand to move your fingers. Repeat this movement using the second row of knuckles in your finger. Repeat this exercise on the third row of joints in your fingers, closest to the fingertips. Hold for 10 seconds. Repeat on all 10 fingers twice a day.
  • Hand Exercise for Rheumatoid Arthritis: No. 5: With your hand straight and fingers pointing upward, bend your fingers downward so they are touching your palm. Do not make a fist. Instead, your fingertips should be touching the palm of your hand. Hold for five seconds. Repeat on both hands twice a day.
  • Hand Exercise for Rheumatoid Arthritis: No. 6: Starting with your wrist, fingers, and thumb pointing upward, make an “O” by touching your index finger to your thumb. Hold this for at least 5 and up to 20 seconds. Repeat two to 10 times twice a day.
  • Hand Exercise for Rheumatoid Arthritis: No. 7: With your hands in the neutral position and all of your knuckles straight, slowly and gently spread your fingers as far apart as you can, like a fan opening up. From this position, make a fist. Hold each position for five seconds. Repeat on both hands twice a day.

“These hand exercises are really effective for stretching and maintaining mobility in your hands if you have RA,” he says. “We don’t do these exercises for strength because the strength that comes with good hand mobility in the activities of daily living is quite satisfactory.”

Hand Exercises for RA to Avoid

Certain exercises may also do more harm than good, adds Francoise Cherry, a certified hand therapist at the Hospital for Joint Diseases in New York. “Most patients say, ‘I have been squeezing a ball,’” she says. “But don’t do this because it puts more stress in the joints.”

Hand Exercises for Rheumatoid Arthritis: Pain Is Not OK

Matteson says there is one rule about hand exercises and RA you should always follow: Hand exercises for rheumatoid arthritis should not hurt.

“If you experience pain, stop the hand exercises,” he says. “Once the pain has subsided, you can repeat the exercises with reduced intensity and speed.”

If the pain comes back or you can’t perform the hand exercises at reduced intensity, there may be something else going on, like a joint dislocation. If this occurs, “talk to your doctor,” he says.

Hand Exercises for RA: Protect Your Joints

Alexandra MacKenzie, an occupational therapist at the Hospital for Special Surgery in New York, stresses that joint protection is key. “We focus on protecting the joints, making sure inflammation is down and teaching people how to modify their activities,” she says.

Lifestyle changes can also help protect hand and wrist joints and preserve their function.

For example, “using heat first thing in the morning, which is when joints are the stiffest because they were not moving all night, can be helpful,” she says. This can take the form of a heating pad or just soaking your hands in warm water in the shower.

Jar openers and other adaptive equipment may also help, she says.

Cherry says hand and wrist splints are also important for people with RA. Splints help support and align joints. “The pattern of hand deformity is uniform in rheumatoid arthritis, and we have splints that target this deformity,” she says.

Your Medical Team for Rheumatoid Arthritis

Living with rheumatoid arthritis (RA) can sometimes feel like a full-time job. It’s important to remember that you can’t gain control of it all by yourself. It’s a complicated condition that can affect your whole life; it needs a coordinated approach.

Luckily, you don’t have to do it alone. You can build a “dream team” of professional health care providers who are trained to help you. Creating a coordinated medical team gives you the best chance against rheumatoid arthritis. Who should you look for to be on your team? There are several key players you should turn to.

Your Rheumatologist

A rheumatologist is a medical doctor with specialized training in rheumatology (joint disease). Your rheumatologist is at the center of your RA treatment team.

Visiting your rheumatologist regularly is the best thing you can do to get control of your rheumatoid arthritis. This is the person who will monitor your disease and its progression and make changes to your treatment plan.

Your Primary Care Doctor

You may also see a primary care or “regular” doctor, who will manage any other medical problems you may have. Primary care also includes general check-ups and preventive health maintenance (like mammograms or cholesterol checks).

Your Physical Therapist

Physical therapists are skilled at identifying muscle groups and joints that need improvement. They can assess your level of fitness and ability and design an exercise plan to help you build strength and flexibility where you need it most. Since exercise is key to keeping joints healthy, make sure you don’t keep your physical therapist on the sidelines.

Your Occupational Therapist

Occupational therapists help you keep your independence. If rheumatoid arthritis starts to slow you down, or if daily tasks become difficult, a visit with an occupational therapist will probably help. Occupational therapists have a playbook of “work-arounds” to let you continue to live your own way. They can also provide or recommend an arsenal of assistive devices that will smooth out the rough spots in your daily routine.

Your Psychologist, Psychiatrist, or Social Worker

Coping with rheumatoid arthritis is something that can be learned. Many people need extra support with the psychological and emotional challenges it brings. These professionals specialize in the more human and emotional aspects of managing your condition:

  • Social workers can help you navigate the health care system; provide counseling during tough times; and help you find community or government resources to help you get the care and support you deserve.
  • Psychologists and psychiatrists provide counseling, psychotherapy, or stress management therapy. Psychiatrists can also prescribe medicines, such as antidepressants, if needed.

Your Orthopedic Surgeon

Surgical therapy for rheumatoid arthritis has improved greatly over the past decades. There is a variety of surgical procedures that can help you keep good use of your joints for as long as possible. If you feel like your current treatment isn’t working, ask your rheumatologist if surgery is a reasonable option.

Organizing Your Medical Team

To organize your medical team, start with your rheumatologist, who probably has a network of contacts with whom you can get in touch.

  • Keep records. Don’t assume all your team members are communicating or sharing copies of your chart. Recent changes to health care law make it your legal right to receive a copy of your medical record. Ask for it, and carry all your records to your appointments.
  • Communicate. Make sure each team member knows about important changes, like recent surgeries, hospitalizations, or major changes in your medicines.
  • Keep in touch. Maintain your relationships with the members of your team, by keeping your appointments and taking an interest in your care plan.
  • Ask questions. People who take an interest in their care for rheumatoid arthritis stay involved and tend to do better.

Working With Your Doctor to Manage Your Rheumatoid Arthritis

Studies have shown that people with rheumatoid arthritis who see a rheumatologist regularly (several times a year) do better than people who visit erratically or not at all. The first step is finding one!

  • Your primary care doctor can refer you to a rheumatologist. If you like your doctor and have a good relationship, chances are good you’ll get along with the rheumatologist your doctor recommends.
  • You may be able to see a rheumatologist directly without a referral; check your insurance plan and its list of providers.
  • Ask around: someone you know may have had a good experience and be able to recommend a rheumatologist.
  • The American College of Rheumatology (www.rheumatology.org) maintains a national database of members. Go to their web site and click on “Find a Rheumatologist.”

In many parts of the country, rheumatologists are in short supply. Even if you feel like the situation with your own rheumatologist could be better, don’t stop going. Either try to find a way to work through the problems, or continue your regular visits while you search for a new rheumatologist.

Regular visits to a rheumatologist are your “early warning system” for rheumatoid arthritis. Because this is a long-term disease, it’s important to catch any changes early.

What can you expect from regular rheumatologist visits?

  • Frequent exams of your joints to look for swelling, changes in strength, or changes in range of motion.
  • Periodic X-rays and blood tests to follow active inflammation or joint changes.
  • Fill out a questionnaire at least twice a year to document your ability level and any changes. Download the Health Assessment Questionnaire (HAQ) at aramis.stanford.edu or ask your doctor for a copy of the questionnaire.

At least once a year, discuss the “big picture” of your treatment plan with your doctor. This can include:

  • A diagnosis of the stage and severity of your rheumatoid arthritis
  • An estimation of the yearly progression of your disease so far. While not perfect, this can be used to predict future progression.
  • New joint damage that has occurred, if any
  • Any changes in your level of functioning
  • Referrals or the addition of new treatment team members, if needed. This could include physical or occupational therapists, psychologists, orthopedic surgeons, or other health professionals.

Many times, you may feel like not much at all was done, or nothing has changed. Was the visit a waste of your time, or your rheumatologist’s time? Nothing could be further from the truth.

  • If no changes to therapy need to be made, chances are good your rheumatoid arthritis is stable and progressing slowly, if at all.
  • Regular visits, however brief, build the relationship between you and your rheumatologist. Your case of rheumatoid arthritis is unique, because everyone is affected differently. The more often you go, the better your doctor can understand you as a person, as well as your rheumatoid arthritis and how it affects your life overall.

Coping with Rheumatoid Arthritis Pain

Being in pain can be the hardest part of living with rheumatoid arthritis. While medicines help, they don’t always make the pain go away completely.

Coping with your pain means acknowledging that the problem is not just the pain itself. Constant pain has an effect on your whole life.

Most people with rheumatoid arthritis are faced with frequent or ongoing pain. While you may not be able to avoid pain, you can take control of the situation. Is the pain of rheumatoid arthritis starting to affect your life? There are specific positive steps you can take to live with it — but keep it in its place:

Get Educated About Arthritis Pain

Understanding your pain will better help you deal with it. There are a number of types of pain caused by rheumatoid arthritis.

  • Acute pain from inflammation. Anyone with rheumatoid arthritis knows the pain that comes with a flare.
  • Pain from joint damage. Joints may become damaged over time by rheumatoid arthritis and cause pain even though your arthritis itself is inactive.
  • Exacerbation of pain. After living a long time with pain and the other struggles of rheumatoid arthritis, you can get stressed and worn out. The real pain you feel is made worse by your emotional state.

Most people with rheumatoid arthritis will experience all of these types of pain. This can become a complicated and overwhelming situation and requires an overall approach.

There are educational programs available to help people who have to live with pain. The benefits they provide can make a big difference.

  • Learn how pain works, why it happens, and what it means.
  • Gain coping and life-management skills for when you are in pain.
  • Get trained in cognitive-behavioral therapy or biofeedback. These are methods of reducing the pain you feel by using your mind.

Contact the Arthritis Foundation (www.arthritis.org) to find your local chapter and sign up.

Come Up With a Pain Management Plan

When pain strikes, consider it a signal to take positive action, not to give in and suffer. Even if you are not able to eliminate pain completely, you are doing what you can to help yourself. There are a number of tools at your disposal to manage pain. Experiment until you find what works for you.

  • Pain-relieving medicines. Consider taking your pain medicines on a schedule, rather than waiting until you are in more pain and have to play “catch-up.” Severe rheumatoid arthritis pain usually requires maximum doses of NSAIDs, although side effects must be considered at higher doses.
  • Meditation and relaxation. Escape from stressful situations and relax your mind. Meditation can help relieve pain, and it is a skill that can be learned.
  • Distraction. Focusing on pain makes it worse, not better. Do something you enjoy instead – or any activity that keeps you busy and has you thinking about something else.
  • Heat, cold, and massage. These tried-and-true treatments are easy and can provide some quick relief for mild symptoms.

Nurture a Healthy Attitude

No one should have to live with pain. It doesn’t seem fair, and it’s not. It is natural to sometimes feel like a victim, or experience any number of other emotions.

  • Frustration
  • Despair
  • Anger
  • Anxiety
  • Depression

While these emotions are normal human responses to chronic pain, they don’t help you feel any better. In fact, just the opposite — they can bog you down in negative thoughts, making the situation worse.

There is nothing positive about pain, but you can take a positive approach to living with it. Know the strategies and commit to giving them a chance.

  • Cognitive-behavioral training. This is a kind of psychotherapy you can do yourself. A psychologist or other mental health professional can teach you the methods. Cognitive-behavioral training can help you avoid negative thoughts that make pain worse.
  • Join a support group. Being with people who understand what you’re dealing with makes you feel less alone.
  • Exercise. Believe it or not, exercise will make your joints feel better, not worse. Even if you’re in pain, there are some exercises you can do. Talk to your doctor or a physical therapist. Build an exercise schedule into your treatment plan and stick to it. Over time, the results can be dramatic.
  • Eat a healthy balanced diet. Drink alcohol only in moderation. Don’t smoke! Cigarettes, alcohol or unhealthy foods can seem comforting when you are in pain, but in the long-term they won’t help. You deserve better — you deserve the benefits of a healthy lifestyle.
  • Get additional support from a mental health professional. The vast majority of people with rheumatoid arthritis are not mentally ill, but being in chronic pain can cause feelings of depression. Asking for help can be a sign of strength, not weakness.

Visit the Arthritis Foundation Pain Center for more information. Link to
http://www.arthritis.org/conditions/pain_center/default.asp.

Life With Rheumatoid Arthritis

Aggressive treatment with new, sophisticated drugs can prevent disability.
By Jeanie Lerche Davis
WebMD Feature

Carla Guillory was in her 30s — enjoying life, raising her kids — when the first symptoms began. “We’d been hiking on vacation, and I thought I had bruised my foot, but it didn’t seem to get better. Then my hands started aching,” she remembers.

Right away, doctors suspected she had rheumatoid arthritis. Guillory was tenacious about finding the right doctor — one who would treat her aggressively. She knew she had to tackle this thing head-on, she says. And that she did — with disease-modifying drugs that helped curb the damaging inflammation at her joints.

That aggressive treatment, and getting it early, has made all the difference, says Guillory. “I have some deformity in my hands, but not a whole lot. It’s nothing like other people I’ve met.”

The Changing Picture of Rheumatoid Arthritis

Twenty years ago, the picture for most patients was very different. “A person in the fairly young part of life would get this disease, and within five years they would be deformed and disabled. About half the people with RA had to quit working within 10 years,” says Stephen Lindsey, MD, chairman of rheumatology at the Ochsner Clinical Foundation in Baton Rouge, La.

More than two million Americans suffer from rheumatoid arthritis, also known as RA. About 75% of them are women, according to the American College of Rheumatology. While RA can develop at any age, it often begins between ages 30 and 50. Pain, stiffness, swelling, and limited motion and function of joints — especially hand and foot joints — are the primary symptoms.

Today, doctors are better able better to diagnose the disease, determine how advanced it is – and how best to treat it, says Lindsey. New research has revealed more about the disease itself.

Rheumatoid arthritis is an autoimmune disease, which means that the body mistakenly identifies certain cells as foreign and attacks them — triggering the inflammation that damages healthy joints. Exactly what sparks this malfunction remains unclear, but research has led to important new treatments.

Some remarkable drugs have emerged to specifically short-circuit the immune system malfunction, says Lindsey, who has treated Guillory for the past eight years. “The last decade’s been amazing. It used to be that we could treat the pain but not the disability. That’s dramatically different now. The key is early diagnosis, then aggressive treatment with the right medicine.”

Newer, Better Drugs for Rheumatoid Arthritis

To protect joints from damage, doctors turn to disease-modifying antirheumatic drugs (DMARDs). These include several drugs used in the 1960s and 1970s to treat other diseases — and were discovered to also work with rheumatoid arthritis.

For example, methotrexate, a drug that Guillory took early on, was first used as a form of cancer chemotherapy. It’s still considered an important medication for slowing RA, although it is prescribed at lower doses than used for cancer treatment, Lindsey explains. “The side effects are more acceptable for methotrexate than with other cancer drugs,” he tells WebMD.

Today, DMARDs are prescribed earlier in treatment than ever before, Lindsey says. “The most joint damage and deformity occurs in the first two years and will progress over time, leading to disability. We can prevent that joint damage.”

A newer class of drugs — biological response modifiers, or biologics — is generating the most excitement. Evidence shows that biologics can actually halt the disease when used early on, he tells WebMD. “Instead of seeing the progressive deterioration and disability, we can now stop disease progression.” Biologics approved by the FDA include Enbrel, Humira, Kineret, Orencia, Remicade, Cimzia and Rituxan.

Very often, patients are switched to different drugs — and often take multiple drugs — during the course of treatment, he points out. “Each patient is different, so we have to follow them really carefully, every month. If they don’t improve, we quickly move to a different drug.”

Guillory now takes a biologic drug to better control her disease. And it has, she reports. It’s also made a huge difference in her quality of life, she tells WebMD. “Before I started taking it, I would be exhausted by midday, ready for a nap. Now I don’t have as many days that I’m tired. It’s made a tremendous difference.”

As noted above, the articles within this post have been written by writers from WebMD and reviewed by medical doctors. Even though you can trust what has been written here, please review any changes you wish to make to your treatment plan with your medical provider.

By Diane | Posted in An Inflammatory Disease, Chronic Pain, Educational Opportunity, Rheumatic Diseases, Rheumatoid Arthritis | Tagged , | Comment (1)

Therapy For Rheumatoid Arthritis

May 1, 2010

There is so much information relating to Rheumatoid Arthritis on WebMD, it is no wonder that these articles are so long. Hopefully, you are getting an excellent education. The information provided here is not a substitute for medical treatment.  Let’s continue with the next topic from the WebMD website related to the treatment for Rheumatoid Arthritis.

Physical and Occupational Therapy for Rheumatoid Arthritis

Rheumatoid arthritis treatment often includes physical therapy and/or occupational therapy.

Healthy joints are the “hinges” that let us move around and function every day. Many of us take that for granted. But if your joints are affected by rheumatoid arthritis, these simple movements aren’t always automatic or easy.

It’s possible for joints affected by rheumatoid arthritis to be too painful and damaged to use fully. Your treatment team will include a rheumatologist and others.

  • Physical therapists focus on helping you be able to keep moving around.
  • Occupational therapists help you keep doing things you are used to doing every day.

The goals and treatments used by physical therapists and occupational therapists sometimes overlap, but there are some general differences.

Physical Therapy for Rheumatoid Arthritis

Physical therapy has one simple goal: keeping you moving. It will stimulate muscles, bones, and joints through exercise or other methods. The result is more strength, tone, and overall fitness.

Physical therapists help you with joint function, muscle strength, and fitness level. They understand the mechanics of bones, joints, and muscles working together, the problems that can occur, and what to do about them.

Working with a physical therapist is a good idea at any stage or severity of rheumatoid arthritis.

  • Early in the course of rheumatoid arthritis, your physical therapist can assess and document where you are in terms of function, strength, and fitness. Your exercise plan will be designed to maximize your chances of avoiding joint problems as the disease progresses.
  • In moderate or advanced rheumatoid arthritis, a physical therapist can help you keep or increase the strength and flexibility you have.

Together, you and your physical therapist will create a road map of improvement for each muscle/joint group, and for your overall fitness. This will become part of the treatment plan for your rheumatoid arthritis. There are a number of strategies your physical therapist can use to reach your treatment goals.

  • Exercise. This is the cornerstone of any physical therapy plan. Together with you and your doctor, your physical therapist will design an exercise plan that is targeted to your ability and fitness level. A good plan will include stretching/flexibility exercises; strength exercises, and conditioning (or aerobic) exercise.
  • Heat/Ice. Treating inflamed or painful joints with heat or ice packs helps some people feel better.
  • Massage. In some patients with chronic pain, therapeutic massage reduces symptoms.
  • Motivation and encouragement. While “low-tech,” it’s hard to overestimate the value of having someone in your corner cheering you on-and pushing you to do better.

Occupational Therapy for Rheumatoid Arthritis

Occupational therapists specialize in maximizing your independence. They can assess your ability to perform the activities of daily living. If doing routine things around the house or at work has become harder, an occupational therapist can probably help. They have many tools at their disposal.

  • Efficiency analysis. Occupational therapists can see where you’re wasting energy or time in doing your daily activities, including where you’re stressing your joints unnecessarily. Then, they can teach you better or easier ways to accomplish those things.
  • Assistive devices. If activities like dressing, cooking, or bathing become difficult or painful, occupational therapists can recommend or provide solutions. Assistive devices are products or improvements that make doing what you’re used to doing easier.

When Is Surgery Right for Rheumatoid Arthritis

Drugs for rheumatoid arthritis — or simply RA — can slow down the disease. However, after joint damage has occurred, surgery may be a reasonable option. Advancements in surgical treatment are giving people with rheumatoid arthritis more chances to maintain function and keep moving.

Having surgery is never something to enter into lightly, but sometimes it can really help. When is the right time for surgery for rheumatoid arthritis, and what can you expect?

There are a couple of reasons to choose surgery for rheumatoid arthritis:

  • Relieving pain. Pain relief is the most consistent benefit of orthopedic surgery.
  • Improving function. Repair or replacement of a weakened joint may help you regain some of your previous activity level.

When Can Surgery Help Rheumatoid Arthritis?

The first question to ask your doctor is, can surgery help your rheumatoid arthritis? When there is structural damage to a joint or the tissues around it, medicines can’t fix it, and surgery may help. Determining whether surgery will fix a joint problem is complicated and requires consulting with your rheumatologist and an orthopedic surgeon.

The timing of surgery is also critical. Because any surgery is serious and can have complications, in general it’s best to delay it until really necessary. If surgery is delayed too long, though, it can be less successful. Figuring the optimal time to perform surgery requires close attention and consideration — by both your rheumatologist and orthopedic surgeon.

What Is Total Joint Replacement?

The hip and the knee are the joints most often replaced in people with rheumatoid arthritis. The damaged structures are taken out, and an artificial joint — or prosthesis – put in. The life of a replaced joint is usually 10 to 15 years, depending on factors such as the patient’s physical condition, activity level, and body weight. After that point, a second surgery is needed (revision surgery), which is more difficult and the outcome is not generally as good. Therefore, the timing of joint replacement surgery is critical.

When Is Knee Replacement Surgery Recommended?

If you have a stiff, painful knee that prevents you from performing even the simplest of activities and other treatments are no longer working, you may want to ask your doctor about knee replacement surgery.

Minimally invasive surgery for the knee joint requires a much smaller incision, three to five inches long, versus the standard approach, which typically requires an incision eight to twelve inches long. The smaller, less invasive approaches result in less tissue damage by allowing the surgeon to work between the fibers of the quadriceps muscles instead of requiring an incision through the tendon. It may lead to less pain, improved recovery time, and better motion due to less scar tissue formation.

When Is Hip Replacement Surgery Needed?

Hip replacement surgery is a procedure in which a doctor surgically removes a painful arthritic hip joint and replaces it with an artificial joint. It usually is done when all other treatment options have failed to provide adequate relief. The procedure should relieve a painful hip joint, making walking easier.

Hip replacement surgery can be performed traditionally or by using what is considered a minimally-invasive technique. The main difference between the two procedures is the size of the incision.

The small cuts are thought to lessen blood loss, ease pain following surgery, shorten hospital stays, reduce scar appearance, and speed healing.

What Other Surgeries Are Used for Rheumatoid Arthritis?

Other procedures for rheumatoid arthritis may include the following:

  • Carpal tunnel release. This can relieve the pain of carpal tunnel syndrome (compression of a nerve in the hand).
  • Synovectomy. This is the removal of the abnormal joint lining to prevent it from eroding cartilage and bone. While effective, eventually the joint lining (synovium) may grow back and the surgery may need to be repeated.
  • Bone or joint fusion surgery. Called arthrodesis, bone or joint fusion surgery is performed to relieve pain in the hips, ankles, wrists, fingers, thumbs, or spine. In arthrodesis, two bones on each end of a joint are fused, eliminating the joint itself.

What Should I Expect From RA Surgery?

If your doctor recommends surgery for joint damage due to RA, what can you expect? There are some things to think about and steps you can take to make the surgery and your recovery more successful.

  • Your doctor may temporarily stop some of your drugs, because they may lead to immune system suppression that would make infection more likely.
  • You may need to stop aspirin or other blood-thinning drugs a week or so before the operation.
  • Before knee or hip surgery, your doctor may have you practice walking on crutches to strengthen your arm muscles.
  • You may need to give blood in advance in case you need it during the surgery.

There are several things you can do to lower your risk of complications during surgery and improve your recovery.

  • If you have any tooth or gum disease, have it treated before the surgery. This helps prevent infection from bacteria in your mouth.
  • Report any discomfort with urination to your doctor. If you have a urinary infection, it should be treated before the surgery.
  • Eat a healthy, balanced diet. This will give you the energy and nutrition you need to heal faster.
  • Exercise. People with a higher fitness level do better after surgery.
  • If you smoke, quit! Stopping smoking reduces the risk of complications from surgery.
  • Lose weight. Less weight means less stress on the artificial hip or knee, making it last longer. Some surgeons will not perform joint replacement surgery on a hip or knee unless a person is less than 300 pounds.
  • Prepare your home. You will need someone to help you with cooking, cleaning, and shopping while you are recovering. Make your home fall-proof by taping down loose carpets or electrical cords.

What Should I Expect After Surgery for Rheumatoid Arthritis?

After surgery for rheumatoid arthritis:

  • You’ll be in the hospital for a few days.
  • You can expect some pain and soreness, but pain medicines will control that.
  • Learn your physical therapy plan and stick with it when you get home. Don’t lie around! Practice walking every day.
  • Within three to six weeks, you should be getting back to normal light activity.
  • Around this time, you’ll see your orthopedic surgeon again to make sure you’re healing and progressing well.
  • It’s also important to be realistic. Surgery can help, but it will rarely be a perfect fix.

Can There Be Complications From RA Surgery?

There usually aren’t any complications after RA surgery, but it’s important to watch out for them just in case. Call your surgeon if you notice any of the following:

  • The skin around the area of surgery becomes unusually red or hot.
  • The wound drains pus or thick, foul-smelling fluid.
  • A fever higher than 101 degrees.
  • Chest pain or noticeable shortness of breath.
  • Unusual pain or swelling of one leg.

Understanding Rheumatoid Arthritis — Treatment

The main treatment goals with rheumatoid arthritis are to control inflammation and slow or stop progression of RA.

Treatment is usually a multifaceted program of medications, occupational or physical therapy, and regular exercise. Sometimes surgery is used to correct joint damage. Early, aggressive treatment is key to good results. And with today’s treatments, joint damage can be slowed or stopped in many cases.

Which medications are used to treat rheumatoid arthritis?

NSAIDs

As part of your rheumatoid arthritis treatment, your doctor will probably prescribe a nonsteroidal anti-inflammatory drug (NSAID). These medications reduce pain and inflammation but do not slow progression of RA. Therefore, people with moderate to severe RA often require additional medications to prevent further joint damage.

Over-the-counter NSAIDs include ibuprofen (Advil or Motrin) and naproxen sodium (Aleve). Most people with RA require a prescription NSAID as they offer longer lasting results and require fewer doses throughout the day. There are many prescription NSAIDs to choose from.

All prescription NSAIDs carry a warning regarding the increased risk of heart attack and stroke. NSAIDs can also raise blood pressure. In addition, NSAIDs can cause stomach irritation, ulcers, and bleeding.

You and your doctor can weigh the benefits of NSAIDs against the potential risks. You may have to try a few different ones to find the one that’s right for you.

NSAIDs decrease symptoms of rheumatoid arthritis but do not slow progression of RA. Therefore, people with moderate to severe RA require additional medications to prevent further joint damage.

DMARDs

Disease-modifying antirheumatic drugs (DMARDs) help slow or stop progression of RA. The most common DMARD used to treat rheumatoid arthritis is methotrexate. Other DMARDs include Arava, Azulfidine, Cytoxan, Imuran, Neoral, and Plaquenil.

In rheumatoid arthritis, an overactive immune system targets joints and other areas of the body. DMARDs work to suppress the immune system. However, they aren’t selective in their targets. Thus, they decrease the immune system overall and increase the likelihood of catching infections.

DMARDs, particularly methotrexate, have produced dramatic improvements in severe rheumatoid arthritis and can help preserve joint function.

Biologics

The newest and most effective treatments for rheumatoid arthritis are biologics. Biologics are genetically engineered proteins. They are designed to inhibit specific components of the immune system that play a pivotal role in inflammation, a key component in rheumatoid arthritis.

Biologics are usually used when other medications have failed to stop the inflammation of rheumatoid arthritis. Biologics may slow or even stop RA progression.

TNF blockers help to reduce pain and joint damage by blocking an inflammatory protein called tumor necrosis factor (TNF). There is some evidence that TNF blockers may stop the progression of rheumatoid arthritis. Recent studies have shown benefits when they are combined with methotrexate. TNF blockers include Enbrel, Humira, Remicade, Cimzia, and Simponi.

Other biologics suppress different areas of the immune system and include Kineret, Orencia, and Rituxan.

Since biologics suppress the immune system, they also increase the risk of infection. Severe infections have been reported with biologics.

Steroids

For severe RA or when RA symptoms flare, your doctor may recommend steroids to ease the pain and stiffness of affected joints. In most cases, they can be used temporarily to calm a symptom flare. However, in certain people, steroids are needed long term to control pain and inflammation.

Steroids can be given as injections directly into an inflamed joint or can be taken as a pill. Potential side effects of long-term steroid use include high blood pressure, osteoporosis, and diabetes. But when used appropriately, steroids are often effective and quickly improve pain and inflammation.

When is surgery needed for rheumatoid arthritis?

If joint pain and inflammation become truly unbearable or joints simply refuse to function, some people choose joint replacement surgery. Today, joint replacement is commonly done on the hips and knees and sometimes the shoulders. Surgery can dramatically improve pain and mobility and is typically done only after age 50 since artificial joints tend to wear down after 15 to 20 years.

Some joints, such as the ankles, don’t respond well to artificial replacement and do better with joint fusion.

Can physical or occupational therapy help rheumatoid arthritis?

Physical and occupational therapy are key components of any rheumatoid arthritis treatment plan.

Physical therapists focus on helping you be able to keep moving around. They can help you design an exercise plan, teach you the appropriate use of heat and ice, perform therapeutic massage, and even provide motivation and encouragement.

Occupational therapists help you keep doing things you are used to doing every day. They can evaluate your daily activities, determine what you may be doing to stress your joints, and teach you easier ways to accomplish your daily activities. They can also determine which assistive devices can help you throughout your day.

What’s the best way to manage the daily pain of RA?

Because one of the most trying aspects of arthritis is learning to live with pain, many doctors recommend pain management training. Cognitive therapy for pain management combines behavior modification with relaxation techniques. These programs focus on improving your emotional and psychological well-being by teaching you how to relax and conduct your daily activities at a realistic pace.

Learning to overcome mental stress and anxiety can be the key to coping with the physical limitations that may accompany chronic arthritis. Cognitive therapy may include various techniques for activity scheduling, guided imagery, relaxation, distraction, and creative problem-solving.

Is exercise really good for joint pain from rheumatoid arthritis?

Not only can exercise help rheumatoid arthritis, it’s a vital part of your rheumatoid arthritis treatment.

When joints are stiff and painful, exercise might be the last thing on your mind. Yet when you have rheumatoid arthritis, exercising regularly is one of the best things you can do to take care of yourself and your joints.

  • People who exercise live longer, with or without rheumatoid arthritis.
  • Regular exercise can actually reduce overall pain from rheumatoid arthritis.
  • Exercise can keep your bones strong. Thinning of the bones can be a problem with rheumatoid arthritis, especially if you need to take steroids. Exercise helps bones keep their strength.
  • Exercise maintains muscle strength.
  • Regular exercise improves functional ability and lets you do more for yourself.
  • People with rheumatoid arthritis who exercise feel better about themselves and are better able to cope with problems.

What about natural treatments for rheumatoid arthritis?

There are a variety of alternative therapies for rheumatoid arthritis. Let your doctor know if you’re considering them, because they should be used in addition to conventional medicine to preserve joint function.

Heat and cold: The use of heat and cold is one of the best natural treatments to help ease rheumatoid arthritis joint pain. Cold compresses reduce joint swelling and inflammation. Heat compresses relax your muscles and stimulate blood flow.

Magnets: In people with osteoarthritis, the wear-and-tear type of arthritis, some preliminary studies have shown that magnets improved joint pain better than a placebo. However, it’s unclear if magnets might help rheumatoid arthritis.

Acupuncture: The National Institutes of Health considers acupuncture an additional alternative treatment for arthritis. Studies have shown that acupuncture helps reduce pain, may lower the need for painkillers, and can help increase flexibility in affected joints.

Mind/Body Therapy: Mind/body therapies can help with stress management and improve sleep and pain perception. Strategies include deep abdominal breathing, progressive muscle relaxation, visualization, meditation, and tai chi.

Biofeedback: With biofeedback, you work with a therapist to help you recognize feelings of increased tension and learn ways to calm yourself. This can help decrease feelings of pain.

Nutritional Supplements: Keep in mind that even natural supplements can interact with medicines. Be sure your doctor is aware of all medicines and supplements you are taking.

Research shows that omega-3 fatty acids in fish oil have an anti-inflammatory effect in the body. Several studies have shown that fish oil supplements may help reduce morning stiffness with RA.

Some studies show that borage seed oil along with anti-inflammatory painkillers can reduce RA symptoms. These studies showed reductions of tender and swollen joints of RA after six weeks.

A few studies have shown a decrease in pain and tender joints in people with RA who take thunder god vine. A larger government-funded study is under way comparing thunder god vine with traditional medicine for rheumatoid arthritis.

Aromatherapy. When you inhale oils or rub them on your skin, you’re using the scent as well as the properties of the oil (essential fatty acids) for healing. Thyme has been used to relieve joint pain.

Can I prevent rheumatoid arthritis?

Though arthritis is not preventable, many people are able to prevent disability with early treatment and a well-designed exercise program.

Preventing Joint Damage From Rheumatoid Arthritis

When rheumatoid arthritis flares up, it makes joints feel stiff and achy. That discomfort may go away at times, but there may still be permanent damage. Eventually rheumatoid arthritis can harm joints so they don’t work as well even when the disease itself is not active. How does joint damage occur, and how can it be prevented?

Doctors call the active periods of rheumatoid arthritis disease activity. During disease activity, infection-fighting cells (white blood cells) are mistakenly allowed into the joint. No one understands why this happens, but it’s clear the white blood cells don’t belong there.

Inside the joint, these white blood cells cells produce chemicals that they usually use to kill invading microorganisms — only no microorganisms are there. Instead, the chemicals damage the healthy joint tissue. During high levels of disease activity, you experience a flare — joints become swollen, stiff, and painful. You can also have low levels of disease activity that come and go without your feeling any symptoms.

There are two main ways this process can cause joint damage:

  • The infection-fighting chemicals cause cartilage to slowly weaken. Cartilage is the cushion between bones in a joint. Over time, putting stress on the joint or bearing weight on it can wear down the weak cartilage more. This is called degenerative disease, and it is similar to what happens in “regular” or “wear and tear” arthritis (osteoarthritis) — only it happens faster in people with rheumatoid arthritis.
  • The inflammation inside the joint stimulates the joint lining (synovium) to grow and spread where it doesn’t belong. If it continues long enough, it can harm healthy cartilage or bone.

The simple rule of thumb is, the “longer” and “stronger” the disease activity, the more joint damage is probably occurring.

  • A person with joint swelling and stiffness every day is more likely to have joint damage than a person with these symptoms once a month. (Longer disease activity)
  • Someone with a lot of joint swelling is more likely to have damage than a person with just a little bit. (Stronger disease activity)

How can you tell if you are having disease activity? It can sometimes be difficult.

  • You can be feeling a lot of pain, yet suffer no damage to your joints.
  • Joint damage can also occur without feeling any pain.
  • Joint swelling is a reliable sign, though. For the most part, having joint swelling is proof of having ongoing disease activity.
  • The length of morning stiffness each day is also useful. Ask yourself, after getting up, “How long does it take until I’m feeling as loose as I’ll feel for the day?” The longer you feel stiff, the more likely it is that your rheumatoid arthritis is active.
  • Another sign you can look for is a “boggy” joint. When the joint lining begins to grow abnormally, it may give a joint a mushy texture. This boggy texture may remain even when you are not having a flare. If you notice this happening, you should see your rheumatologist.

Self-Assessment: Are You Doing All You Can to Manage Your Rheumatoid Arthritis?

If you are diagnosed with rheumatoid arthritis, your doctor will do a complete joint exam and get X-rays and blood tests. At later visits, you will be checked for any changes to your tests, and your doctor will address possible joint damage with you.

Now that you know how rheumatoid arthritis causes joint damage, and what to look for, you should also know how to prevent it.

Because treatment for rheumatoid arthritis is improving, many experts believe that most people who have it today will develop less joint damage than ever before. You can gain control of rheumatoid arthritis and improve your chances.

  • Get treated early. Much of the joint damage that eventually becomes serious starts soon after rheumatoid arthritis is discovered. The earlier you are treated, the less the chance of joint damage.
  • Get treatment often. People who see their rheumatologist regularly (several times a year) have less joint damage than people who do not.
  • Exercise! You can exercise without causing joint damage. In fact, just the opposite is true — regular exercise makes joints stronger. Your doctor will help you with an exercise plan that is safe, effective, and personalized for your fitness level and condition.
  • Rest when you need to. Finding the balance between rest and exercise is important so you don’t overdo it.
  • Use a cane in the opposite hand from a painful hip or knee. This reduces wear-and-tear on the affected joint.

Treating Rheumatoid Arthritis: Questions to Ask Your Doctor

If you have rheumatoid arthritis, early and aggressive treatment can help you forestall joint damage and worsening pain. But all treatments have some side effects. To help you develop a good treatment plan for your RA, here are 10 questions to ask your doctor.

1. Is a DMARD appropriate for me?

Treatment for rheumatoid arthritis is complex — as much art as science – but certain drugs called DMARDs have the ability to change the course of this disease in many people. Methotrexate is helpful for most people, but each person’s treatment plan is unique. Make sure you feel comfortable with your treatment plan by asking questions.

2. Are the new “biologic” injectable medicines a good treatment option for me?

Biologic agents like Enbrel, Humira, Orencia, Rituxan, Kineret, Remicade, Cimzia, and Simponi have become powerful tools in the treatment of rheumatoid arthritis. People with moderate to severe RA are frequently candidates for these therapies. These drugs are genetically engineered proteins that are derived from human genes. They inhibit the immune system, which plays a key role in inflammation in RA.

3. Can we ever consider stopping treatment or taking a drug holiday?

It’s a bad idea to stop treatment for active rheumatoid arthritis. In special cases, if your disease is particularly mild or inactive, your doctor may consider pausing therapy and closely monitoring you.

4. What has been the rate of progression of my rheumatoid arthritis?

The course of rheumatoid arthritis is especially important but can be hard to predict. But looking at past progression can often help predict future progression.

5. What medication side effects have you noticed so far?

Your doctor might notice some side effects during an exam, like thinning of the skin from steroid use. Discovering others, like liver inflammation from methotrexate, requires lab testing.

6. Can you tell whether my joints have been damaged?

At each appointment, your doctor will examine your joints. You’ll also need regular tests like X-rays and labs. These are ways of checking how the disease has progressed and whether you need changes in your treatment.

7. What long-term plans should I be making for life with rheumatoid arthritis?

Sometimes medicines alone aren’t enough. Occupational therapy, assistive devices, and re-tooling the home can all be important in the treatment of advanced rheumatoid arthritis.

8. Could surgery help me?

Surgery can help correct some of the effects of joint damage from rheumatoid arthritis. The advice of orthopedic surgeons, particularly hand specialists, can often be helpful.

9. Would referral to other specialists help me?

Most people with rheumatoid arthritis should see a rheumatologist regularly. Having a relationship with a physical therapist, occupational therapist, orthopedic surgeon, pain specialist, and/or psychiatrist can often help.

10. What more could I be doing to preserve my joint function?

If you have RA, there are lots of ways to take an active and important role in your treatment. Exercise and physical therapy can have a beneficial effect on your symptoms. Learning ways to cope and manage your pain can also make life with rheumatoid arthritis easier.

The next article will continue with Home Remedies for Rheumatoid Arthritis. If you have any questions or concerns, please leave a comment with your contact information. I will be happy to respond as quickly as possible.

By Diane | Posted in An Inflammatory Disease, Chronic Pain, Educational Opportunity, Rheumatic Diseases, Rheumatoid Arthritis | Tagged , , , , | Comments (2)

More About Migraines

January 4, 2010

As identified in yesterday’s article titled, What Do You Know About Migraines?, the Mayo Clinic Staff provided a great definition of Migraines as painful headaches of unknown origin. Now you know that no one really knows where these headaches come from. The staff also went through symptoms, causes, risk factors, and complications. Today’s article begins with preparing for the appointment with your provider.

Preparing for your appointment

By Mayo Clinic staff

You’re likely to start by seeing your primary care provider first. If appropriate you may be referred to a neurologist or other physician who specializes in headache medicine.

Because appointments can be brief, and because there’s often a lot of ground to cover, it’s a good idea to be well-prepared for your appointment. Here’s some information to help you get ready for your appointment, and what to expect from your doctor.

What you can do

  • Write down symptoms you’re experiencing, even if they seem unrelated to your migraines.
  • Write down key personal information, including any major stresses or recent life changes.
  • Make a list of all medications, as well as any vitamins or supplements, that you’re taking. It is particularly important to list all medications that you have used to treat your headaches. Include the doses of the medications.
  • Take a family member or friend along, if possible. Sometimes it can be difficult to soak up all the information provided to you during an appointment. Someone who accompanies you may remember something that you missed or forgot.
  • Write down questions to ask your doctor.

Your time with your doctor is limited, so preparing a list of questions will help you make the most of your time together. List your questions from most important to least important in case time runs out. For migraines, some basic questions to ask your doctor include:

  • What is likely triggering my migraines?
  • Are there other possible causes for my symptoms?
  • What kinds of tests do I need?
  • Is my condition likely temporary or chronic?
  • What is the best course of action?
  • What are the alternatives to the primary approach that you’re suggesting?
  • What changes to my lifestyle or diet do you suggest I make?
  • I have these other health conditions. How can I best manage them together?
  • Is there a generic alternative to the medicine you’re prescribing me?
  • Are there any brochures or other printed material that I can take home with me? What Web sites do you recommend?

In addition to the questions that you’ve prepared to ask your doctor, don’t hesitate to ask questions during your appointment at any time that you don’t understand something.

What to expect from your doctor
Your doctor is likely to ask you a number of questions. Being ready to answer them may reserve time to go over any points you want to spend more time on. Your doctor may ask:

  • When did you first begin experiencing symptoms?
  • Have your symptoms been continuous or occasional?
  • How severe are your symptoms?
  • What, if anything, seems to improve your symptoms?
  • What, if anything, appears to worsen your symptoms?

What you can do in the meantime

  • Keep a headache diary. A diary can help you and your doctor determine what triggers your migraines. Note when your headaches start, how long they last and what, if anything, provides relief. Be sure to record your response to any headache medications you take. Also note the foods you ate in the 24 hours preceding attacks, any unusual stress, and how you feel and what you’re doing when headaches strike.
  • Reduce stress. Because stress triggers migraines for many people, try to avoid overly stressful situations, or use stress-reduction techniques like meditation.
  • Get enough sleep but don’t oversleep. Aim for six to eight hours of sleep a night.

Tests and diagnosis

If you have typical migraines or a family history of migraines, your doctor will likely diagnose the condition on the basis of your medical history and a physical exam. But if your headaches are unusual, severe or sudden, your doctor may recommend a variety of tests to rule out other possible causes for your pain.

  • Computerized tomography (CT). This imaging procedure uses a series of computer-directed X-rays that provides a cross-sectional view of your brain. This helps doctors diagnose tumors, infections and other possible medical problems that may be causing your headaches.
  • Magnetic resonance imaging (MRI). MRIs use radio waves and a powerful magnet to produce very detailed cross-sectional views of your brain. MRI scans help doctors diagnose tumors, strokes, aneurysms, neurological diseases and other brain abnormalities. An MRI can also be used to examine the blood vessels that supply the brain.
  • Spinal tap (lumbar puncture). If your doctor suspects an underlying condition, such as meningitis — an inflammation of the membranes (meninges) and cerebrospinal fluid surrounding your brain and spinal cord — he or she may recommend a spinal tap (lumbar puncture). In this procedure, a thin needle is inserted between two vertebrae in your lower back to extract a sample of cerebrospinal fluid (CSF) for laboratory analysis.

Treatments and drugs

A variety of drugs have been specifically designed to treat migraines. In addition, some drugs commonly used to treat other conditions also may help relieve or prevent migraines. Medications used to combat migraines fall into two broad categories:

  • Pain-relieving medications. Also known as acute or abortive treatment, these types of drugs are taken during migraine attacks and are designed to stop symptoms that have already begun.
  • Preventive medications. These types of drugs are taken regularly, often on a daily basis, to reduce the severity or frequency of migraines.

Choosing a strategy to manage your migraines depends on the frequency and severity of your headaches, the degree of disability your headaches cause, and your other medical conditions.

Some medications aren’t recommended if you’re pregnant or breast-feeding. Some aren’t used for children. Your doctor can help find the right medication for you.

Pain-relieving medications
For best results, take pain-relieving drugs as soon as you experience signs or symptoms of a migraine. It may help if you rest or sleep in a dark room after taking them:

  • Nonsteroidal anti-inflammatory drugs (NSAIDs). These medications, such as ibuprofen (Advil, Motrin, others) or aspirin, may help relieve mild migraines. Drugs marketed specifically for migraine, such as the combination of acetaminophen, aspirin and caffeine (Excedrin Migraine), also may ease moderate migraines but aren’t effective alone for severe migraines. If taken too often or for long periods of time, NSAIDs can lead to ulcers, gastrointestinal bleeding and rebound headaches.
  • Triptans. For many people with severe migraine attacks, triptans are the drug of choice. They are effective in relieving the pain, nausea and sensitivity to light and sound that are associated with migraines. Medications include sumatriptan (Imitrex), rizatriptan (Maxalt), naratriptan (Amerge), zolmitriptan (Zomig), almotriptan (Axert), frovatriptan (Frova) and eletriptan (Relpax). Side effects of triptans include nausea, dizziness and muscle weakness. They aren’t recommended for people at risk for strokes and heart attacks. A new, single-tablet combination of sumatriptan and naproxen sodium (Treximet) became available in 2008. It’s more effective in relieving migraine symptoms than either medication on its own.
  • Ergot. Ergotamine (Migergot, Cafergot) is much less expensive, but also less effective, than triptans. It seems most effective in those whose pain lasts for more than 48 hours. Dihydroergotamine (Migranal) is an ergot derivative that is more effective and has fewer side effects than ergotamine.
  • Anti-nausea medications. Because migraine attacks are often accompanied by nausea with or without vomiting, medication for nausea is appropriate and is usually combined with other medications. Frequently prescribed medications are metoclopramide (oral) or prochlorperazine (oral or suppository).
  • Butalbital combinations. Medications that combine the sedative butalbital with aspirin or acetaminophen (Butapap, Phrenlin Forte) are sometimes used to treat migraine attacks. Some combinations also include caffeine or codeine (Esgic-Plus, Fioricet). These medications, however, have a high risk of rebound headaches and withdrawal symptoms so should be used infrequently.
  • Opiates. Medications containing narcotics, particularly codeine, are sometimes used to treat migraine pain when people can’t take triptans or ergot. Narcotics are habit-forming and are usually used only as a last resort.

Preventive medications
Nearly half of those who get migraines could benefit from preventative medication, yet only about 1 in 10 people take it. You may be a candidate for preventive therapy if you have two or more debilitating attacks a month, if pain-relieving medications aren’t helping, or if your migraine signs and symptoms include a prolonged aura or numbness and weakness.

Preventive medications can reduce the frequency, severity and length of migraines and may increase the effectiveness of symptom-relieving medicines used during migraine attacks. Your doctor may recommend that you take preventive medications daily, or only when a predictable trigger, such as menstruation, is approaching.

In most cases, preventive medications don’t eliminate headaches completely, and some cause serious side effects. If you have had good results from preventative medicine and have been migraine-free for six months to a year, your doctor may recommend tapering off the medication to see if your migraines return without it.

For best results, take these medications as your doctor recommends:

  • Cardiovascular drugs. Beta blockers — commonly used to treat high blood pressure and coronary artery disease — can reduce the frequency and severity of migraines. These drugs are considered among first-line treatment agents. Calcium channel blockers, another class of cardiovascular drugs, especially verapamil (Calan, Isoptin), also may be helpful in preventing migraines and relieving symptoms from aura. In addition, the antihypertensive medications lisinopril (Prinivil, Zestril) and candesartan (Atacand) are useful in reducing the length and severity of migraines. Researchers don’t understand exactly why all of these cardiovascular drugs prevent migraines. Side effects can include dizziness, drowsiness or lightheadedness.
  • Antidepressants. Certain antidepressants are good at helping to prevent some types of headaches, including migraines. Most effective are tricyclic antidepressants, such as amitriptyline, nortriptyline (Pamelor) and protriptyline (Vivactil). These medications are considered among first-line treatment agents and may reduce migraines by affecting the level of serotonin and other brain chemicals. You don’t have to have depression to benefit from these drugs. Other classes of antidepressants called selective serotonin reuptake inhibitors (SSRIs) and serotonin and norepinephrine reuptake inhibitors (SNRIs), haven’t been proven as effective for migraine prevention. However, preliminary research suggests that one SNRI, venlafaxine (Effexor), may be helpful in preventing migraines.
  • Anti-seizure drugs. Some anti-seizure drugs, such as divalproex (Depakote) and topiramate (Topamax), and gabapentin (Neurontin), seem to reduce the frequency of migraines. In high doses, however, these anti-seizure drugs may cause side effects, such as nausea and vomiting, diarrhea, cramps, hair loss, and dizziness.
  • Cyproheptadine. This antihistamine specifically affects serotonin activity. Doctors sometimes give it to children as a preventive measure.
  • Botulinum toxin type A (Botox). Botulinum toxin type A is sometimes used for treatment of chronic migraines. Studies have had mixed results with respect to effectiveness. However, some headache specialists believe that it can be helpful for some people. Injections are made in muscles of the forehead and neck. When this is effective, the treatment typically needs to be repeated every three months.

Lifestyle and home remedies

Self-care measures can help ease the pain of a migraine.

  • Try muscle relaxation exercises. Progressive muscle relaxation, meditation and yoga don’t require any equipment. You can learn them in classes or at home using books or tapes. Or spend at least a half-hour each day doing something you find relaxing — listening to music, gardening, taking a hot bath or reading.
  • Get enough sleep but don’t oversleep. The average adult needs six to eight hours of sleep a night. It’s best to go to bed and wake up at regular times, as well.
  • Rest and relax. If possible, rest in a dark, quiet room when you feel a headache coming on. Place an ice pack wrapped in a cloth on the back of your neck and apply gentle pressure to painful areas on your scalp.
  • Keep a headache diary. Continue keeping your headache diary even after you see your doctor. It will help you learn more about what triggers your migraines and what treatment is most effective.

Alternative medicine

Nontraditional therapies may be helpful if you have chronic headache pain:

  • Acupuncture. In this treatment, a practitioner inserts many thin, disposable needles into several areas of your skin at defined points. A number of clinical trials have found that acupuncture may be helpful for headache pain.
  • Biofeedback. Biofeedback appears to be especially effective in relieving migraine pain. This relaxation technique uses special equipment to teach you how to monitor and control certain physical responses related to stress, such as muscle tension.
  • Massage. Massage may help reduce the frequency of migraines. And it can improve the quality of your sleep, which can, in turn, help prevent migraines.
  • Herbs, vitamins and minerals. There is some evidence that the herbs feverfew and butterbur may prevent migraines or reduce their severity. A high dose of riboflavin (vitamin B-2) also may prevent migraines by correcting tiny deficiencies in the brain cells. Coenzyme Q10 supplements may be helpful in some individuals. Oral magnesium sulfate supplements may reduce the frequency of headaches in some people, although studies don’t all agree on this issue. Magnesium taken intravenously seems to help some people during an acute headache, particularly people with magnesium deficiencies. Ask your doctor if these treatments are right for you. Don’t use feverfew or butterbur if you’re pregnant.

Prevention

By Mayo Clinic staff

Whether or not you take preventive medications, you may benefit from lifestyle changes that can help reduce the number and severity of migraines. One or more of these suggestions may be helpful for you:

  • Avoid triggers. If certain foods seem to have triggered your headaches in the past, avoid those foods. If certain scents are a problem, try to avoid them. In general, establish a daily routine with regular sleep patterns and regular meals. In addition, try to control stress.
  • Exercise regularly. Regular aerobic exercise reduces tension and can help prevent migraines. If your doctor agrees, choose any aerobic exercise you enjoy, including walking, swimming and cycling. Warm up slowly, however, because sudden, intense exercise can cause headaches. Obesity is also thought to be a factor in migraines, and regular exercise can help you keep your weight down.
  • Reduce the effects of estrogen. If you’re a woman with migraines and estrogen seems to trigger or make your headaches worse, you may want to avoid or reduce the amount of medications you take that contain estrogen. These medications include birth control pills and hormone replacement therapy. Talk with your doctor about the best alternatives or dosages for you.

I hope that some or all of this information will be helpful to you. If you have any questions or would like to look up other symptoms or problems, just go to The Mayo Clinic website. You can find out about any problem you may have in addition to a treatment, possibly an alternative treatment, what you can do at home for your problem, and how to prevent it. Please comment on the article if the information was useful to you.

By Diane | Posted in Chronic Pain, Chronic Pain Support, Educational Opportunity, Medication Information, Self Help Information, The Power of Education | Tagged , | Comments (2)

What Do You Know About Migraines?

January 3, 2010

The only thing I know about migraines is they hurt like “you know what.” I’ve only had a few of these headaches in my life (thank the Lord), but I have friends that have them and they cause their lives to come to a screeching halt. What can you do when your head hurts so bad you want to crawl into a dark room and pull the covers over your head?

Are you interested in the experts views on what migraine headaches are? OK! Back we go to my favorite experts, the medical staff at Mayo Clinic. I’m sure we will find some excellent information that will be helpful in understanding what migraines are, other than the obvious painful headache, and what to do about them.

Definition

By Mayo Clinic staff

Migraines are chronic headaches that can cause significant pain for hours or even days. Symptoms can be so severe that all you can think about is finding a dark, quiet place to lie down.

Some migraines are preceded or accompanied by sensory warning symptoms or signs (auras), such as flashes of light, blind spots or tingling in your arm or leg. A migraine is often accompanied by nausea, vomiting, and extreme sensitivity to light and sound.

Although there’s no cure, medications can help reduce the frequency and severity of migraines. If treatment hasn’t worked for you in the past, it’s worth talking to your doctor about trying a different migraine medication. The right medicines combined with self-help remedies and lifestyle changes may make a tremendous difference.

Symptoms

Migraines usually begin in childhood, adolescence or early adulthood. A typical migraine attack produces some or all of these signs and symptoms:

  • Moderate to severe pain, which may be confined to one side of the head or may affect both sides
  • Head pain with a pulsating or throbbing quality
  • Pain that worsens with physical activity
  • Pain that interferes with your regular activities
  • Nausea with or without vomiting
  • Sensitivity to light and sound

When untreated, a migraine typically lasts from four to 72 hours, but the frequency with which headaches occur varies from person to person. You may have migraines several times a month or much less frequently.

Not all migraines are the same. Most people experience migraines without auras, which were previously called common migraines. Some people have migraines with auras, which were previously called classic migraines. Auras can include changes to your vision, such as seeing flashes of light, and feeling pins and needles in an arm or leg.

Whether or not you have auras, you may have one or more sensations of premonition (prodrome) several hours or a day or so before your headache actually strikes, including:

  • Feelings of elation or intense energy
  • Cravings for sweets
  • Thirst
  • Drowsiness
  • Irritability or depression

When to see a doctor
Migraines are often undiagnosed and untreated. If you experience signs and symptoms of migraine, keep a record of your attacks and how you treated them. Then make an appointment with your doctor to discuss your headaches and decide on a treatment plan.

Even if you have a history of headaches, see your doctor if the pattern changes or your headaches suddenly feel different.

See your doctor immediately or go to the emergency room if you have any of the following signs and symptoms, which may indicate other, more serious medical problems:

  • An abrupt, severe headache like a thunderclap
  • Headache with fever, stiff neck, rash, mental confusion, seizures, double vision, weakness, numbness or trouble speaking
  • Headache after a head injury, especially if the headache gets worse
  • A chronic headache that is worse after coughing, exertion, straining or a sudden movement
  • New headache pain if you’re older than 50

Causes

Although much about the cause of migraines isn’t understood, genetics and environmental factors seem to both play a role.

Migraines may be caused by changes in the trigeminal nerve, a major pain pathway. Imbalances in brain chemicals, including serotonin — which helps regulate pain in your nervous system — also may be involved.

Serotonin levels drop during migraines. This may trigger your trigeminal system to release substances called neuropeptides, which travel to your brain’s outer covering (meninges). The result is headache pain.

Migraine triggers
Whatever the exact mechanism of the headaches, a number of things may trigger them. Common migraine triggers include:

  • Hormonal changes in women. Fluctuations in estrogen seem to trigger headaches in many women with known migraines. Women with a history of migraines often report headaches immediately before or during their periods, when they have a major drop in estrogen. Others have an increased tendency to develop migraines during pregnancy or menopause. Hormonal medications — such as oral contraceptives and hormone replacement therapy — also may worsen migraines, though some women find it’s beneficial to take them.
  • Foods. Some migraines appear to be triggered by certain foods. Common offenders include alcohol, especially beer and red wine; aged cheeses; chocolate; aspartame; overuse of caffeine; monosodium glutamate — a key ingredient in some Asian foods; salty foods; and processed foods. Skipping meals or fasting also can trigger migraines.
  • Stress. Stress at work or home can instigate migraines.
  • Sensory stimuli. Bright lights and sun glare can produce migraines, as can loud sounds. Unusual smells — including pleasant scents, such as perfume, and unpleasant odors, such as paint thinner and secondhand smoke, can also trigger migraines.
  • Changes in wake-sleep pattern. Either missing sleep or getting too much sleep may serve as a trigger for migraine attacks in some individuals, as can jet lag.
  • Physical factors. Intense physical exertion, including sexual activity, may provoke migraines.
  • Changes in the environment. A change of weather or barometric pressure can prompt a migraine.
  • Medications. Certain medications can aggravate migraines.

Risk factors

Several factors make you more prone to having migraines.

  • Having a family history. Many people with migraines have a family history of migraine. If one or both of your parents have migraines, there’s a good chance you will too.
  • Being younger than 40. Half the people who suffer from migraines started getting them before they were 20 and migraines are most common in people who are between 30 and 39 years old.
  • Being female. Women are three times as likely to have migraines as men are. Headaches tend to affect boys more than girls during childhood, but by the time of puberty, more girls are affected.
  • Experiencing hormonal changes. If you’re a woman with migraines, you may find that your headaches begin just before or shortly after onset of menstruation. They may also change during pregnancy or menopause. Some women report that their migraines got worse during the first trimester of a pregnancy. Though for many, the migraines improved during later stages in the pregnancy.

Complications

Sometimes your efforts to control your pain cause problems.

  • Abdominal problems. Nonsteroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen (Advil, Motrin, others) and aspirin, may cause abdominal pain, bleeding and ulcers — especially if taken in large doses or for a long period of time.
  • Rebound headaches. In addition, if you take over-the-counter or prescription headache medications more than nine days per month or in high doses, you may be setting yourself up for a serious complication known as rebound headaches. Rebound headaches occur when medications not only stop relieving pain, but actually begin to cause headaches. You then use more pain medication, which traps you in a vicious cycle.
  • Serotonin syndrome. This potentially life-threatening drug interaction can occur if you take migraine medicines called triptans, such as sumatriptan (Imitrex) or zolmitriptan (Zomig), along with antidepressants known as selective serotonin reuptake inhibitors (SSRIs) or serotonin and norepinephrine reuptake inhibitors (SNRIs). Some common SSRIs include Zoloft, Prozac and Paxil. SNRIs include Cymbalta and Effexor. Fortunately, serotonin syndrome is rare.

The Mayo Clinic Staff does a great job of explaining the information they present, don’t they? You, too, can go online and type in whatever health topic you want to learn more about. I hope this information is beneficial, especially if you have migraine headaches. Tomorrow, we will see what the Staff has to say about preparing for your provider visit, tests and diagnosis, treatment and drugs, lifestyle and home remedies, alternative medicine, and prevention. Take care and have a pleasant Sunday afternoon and evening. See You Tomorrow!

By Diane | Posted in Chronic Pain, Chronic Pain Support, Educational Opportunity, Medication Information, Self Help Information, The Power of Education | Tagged , , | Comment (1)

More About Shingles

January 1, 2010

I hope yesterday’s article was interesting, because today I’m going to tell you how to prepare for your provider’s appointment, the tests you will have to go through in order for your provider appropriately diagnose your condition, treatment and drugs, lifestyle and home remedies, and prevention. This information will help many of my readers that have had chickenpox. The varicella virus will not attack you unless you come in contact with someone with chickenpox, or if you touch the fluid from the blisters without washing your hands. Let’s go on with the Mayo Clinic’s Staff’s recommendations for preparing for your provider’s appointment.

Preparing for your appointment

By Mayo Clinic staff

Some people have such mild symptoms of shingles that they don’t seek medical treatment. Severe symptoms may result in a visit to the emergency room.

What you can do
You may want to write a list that includes:

  • A detailed description of your symptoms
  • Information about your medical problems, past and present
  • Information about the medical problems of your parents or siblings
  • All the medications and dietary supplements you take
  • Questions you want to ask the doctor

What to expect from your doctor

Your doctor will examine your rash and ask questions about your general health and when these symptoms began.

Tests and diagnosis

Shingles is usually diagnosed based on the history of pain on one side of your body, along with the telltale rash and blisters. Your doctor may also take a tissue scraping or culture of the blisters for examination in the laboratory.

Treatments and drugs

An episode of shingles usually heals on its own within a few weeks, but prompt treatment can ease pain, speed healing and reduce your risk of complications.

Antiviral drugs
For best results, start these medications within 72 hours of the first sign of the shingles rash. Oral antiviral medications include:

  • Acyclovir (Zovirax)
  • Valacyclovir (Valtrex)
  • Famciclovir (Famvir)

Drugs for the pain
Shingles can cause severe pain, so you may need prescription medications for treatment. They may include:

  • Narcotics, such as oxycodone
  • Tricyclic antidepressants, such as amitriptyline
  • Anticonvulsants, such as gabapentin (Neurontin)
  • Numbing agents, such as lidocaine, delivered via a cream, gel, spray or skin patch

Lifestyle and home remedies

Depending on your level of pain, you might not feel like doing much, and you may feel weak and tired. If this is the case, be sure to listen to your body — get plenty of rest and avoid strenuous activities while you’re recuperating.

Also, avoid stress, which can worsen pain. Relaxation techniques, including listening to music or doing tai chi, might help. To take your mind off the pain, try doing other activities, such as reading a book, watching a movie or working on a hobby.

Taking a cool bath or using cool, wet compresses on your blisters may help relieve the itch and pain.

Over-the counter medications also may help. Examples include:

  • Pain relievers such as ibuprofen (Advil, Motrin, others) or naproxen (Aleve)
  • Anti-itch cream or calamine lotion
  • Oral antihistamines, such as diphenhydramine (Benadryl, others)

Prevention

Two vaccines may help prevent shingles — the chickenpox (varicella) vaccine and the shingles (varicella-zoster) vaccine.

Chickenpox vaccine
The varicella vaccine (Varivax) has become a routine childhood immunization to prevent chickenpox. The vaccine is also recommended for adults who’ve never had chickenpox. Though the vaccine doesn’t guarantee you won’t get chickenpox or shingles, it can reduce your chances of complications and reduce the severity of the disease.

Shingles vaccine
The varicella-zoster vaccine (Zostavax) can help prevent shingles in adults age 60 and older who’ve had chickenpox. Like the chickenpox vaccine, the shingles vaccine doesn’t guarantee you won’t get shingles. But this live vaccine will likely reduce the course and severity of the disease and reduce your risk of postherpetic neuralgia.

The shingles vaccine is recommended for all adults age 60 and older, whether or not they have had shingles previously. The shingles vaccine is used only as a prevention strategy, however. It’s not intended to treat people who currently have the disease.

This shingles vaccine isn’t recommended if you:

  • Have ever had a life-threatening allergic reaction to gelatin, the antibiotic neomycin or any other component of the shingles vaccine
  • Have a weakened immune system from HIV/AIDS or another disease that affects your immune system
  • Are receiving medical treatments such as steroids, radiation and chemotherapy
  • Have a history of bone marrow or lymphatic cancer

This information is intended to educate you about a viral infection that could cause a very painful chronic condition in post herpetic neuralgia. People with this complication can be in pain every day. We need to take this information seriously. If you have symptoms of Shingles, please see your provider as soon as possible to prevent post herpetic neuralgia from setting in. Don’t be afraid to ask your provider for the Shingles vaccine unless you have any of the above conditions that would inhibit you from receiving it. If you have post herpetic neuralgia, please let your provider know so you can receive proper pain relief as identified above. Everybody’s body is different. If your pain is not relieved by the medicine prescribed by your provider, ask for a consult to the Pain Clinic. Just don’t sit home, suffer in silence, and make life difficult for yourself and your loved ones.

By Diane | Posted in Chronic Pain, Educational Opportunity, Shingles Adult Chickenpox | Tagged , | Comments (0)

A Little More Information About Gout

December 30, 2009

I hope you enjoyed yesterday’s article on gout. The information is very important because there are a lot of folks out there suffering from this disorder. Yesterday, we learned what gout actually is, risk factors, causes, complications, and preparing for the doctor’s appointment. Today, we are going to find out about tests and diagnosis, treatments and drugs, lifestyle and home remedies, alternative medicine, and last but not least, prevention. Like yesterday’s article, the information is coming from the staff at Mayo Clinic.

Tests and diagnosis

By Mayo Clinic staff

Tests to help diagnose gout may include:

  • Joint fluid test. Your doctor may use a needle to draw fluid from your affected joint. When examined under the microscope, your joint fluid may reveal urate crystals.
  • Blood test. Your doctor may recommend a blood test to measure the uric acid level in your blood. Blood test results can be misleading, though. Some people have high uric acid levels, but never experience gout. And some people have signs and symptoms of gout, but don’t have unusual levels of uric acid in their blood.

Treatments and drugs

Treatment for gout usually involves medications. What medications you and your doctor choose will be based on your current health and your own preferences.

Different medications are prescribed to:

  • Treat acute gout attacks and prevent future attacks
  • Reduce the risk of gout complications, such as the deposits of urate crystals that cause nodules to form under the skin (tophi)

Drugs used to treat acute attacks and prevent future attacks include:

  • Nonsteroidal anti-inflammatory drugs (NSAIDs). NSAIDs may control inflammation and pain in people with gout. Your doctor may prescribe a higher dose to stop an acute attack, followed by a lower daily dose to prevent future attacks.

    NSAIDs include over-the-counter options such as ibuprofen (Advil, Motrin, others) and naproxen (Aleve, others), as well as more powerful prescription NSAIDs such as indomethacin (Indocin). NSAIDs carry risks of stomach pain, bleeding and ulcers.

  • Colchicine. If you’re unable to take NSAIDs, your doctor may recommend colchicine, a type of pain reliever that effectively reduces gout pain — especially when started soon after symptoms appear. The drug’s effectiveness is offset in most cases, however, by intolerable side effects, such as nausea, vomiting and diarrhea.

    After an acute gout attack resolves, your doctor may prescribe a low daily dose of colchicine to prevent future attacks.

  • Corticosteroids. Corticosteroid medications, such as the drug prednisone, may control gout inflammation and pain. Corticosteroids may be administered in pill form, or they can be injected into your joint. Corticosteroids are generally reserved for people who can’t take either NSAIDs or colchicine.

    Side effects of corticosteroids may include thinning bones, poor wound healing and a decreased ability to fight infection. To reduce the risk of these serious side effects, your doctor will try to find the lowest dose that controls your symptoms and prescribe steroids for the shortest possible time.

Drugs used to prevent the complications associated with frequent gout attacks include:

  • Medication that blocks uric acid production. Drugs called xanthine oxidase inhibitors, including allopurinol (Zyloprim, Aloprim) and febuxostat (Uloric), limit the amount of uric acid your body makes. This may lower your blood’s uric acid level and reduce your risk of gout. Side effects of allopurinol include a rash and low blood counts. Febuxostat side effects include rash, nausea and reduced liver function.

    Xanthine oxidase inhibitors may trigger a new, acute attack if taken before a recent attack has totally resolved. Taking a short course of low-dose colchicine before starting a xanthine oxidase inhibitor has been found to significantly reduce this risk.

  • Medication that improves uric acid removal. Probenecid (Probalan) improves your kidneys’ ability to remove uric acid from your body. This may lower your uric acid levels and reduce your risk of gout, but the level of uric acid in your urine is increased. Side effects include a rash, stomach pain and kidney stones.

Lifestyle and home remedies

Medications are the most proven, effective way to treat gout symptoms. However, making certain changes to your diet also may help.

The American Dietetic Association recommends following these guidelines during a gout attack:

  • Drink 8 to 16 cups (about 2 to 4 liters) of fluid each day, including at least half water.
  • Avoid alcohol.
  • Eat a moderate amount of protein, preferably from healthy sources, such as low-fat or fat-free dairy, tofu, eggs, and nut butters.
  • Limit your daily intake of meat, fish and poultry to 4 to 6 ounces (114 to 170 grams).

Alternative medicine

If gout treatments aren’t working as well as you’d hoped, you may be interested in trying complementary and alternative treatments for your gout. Discuss these treatments with your doctor first. Your doctor can help you weigh the benefits and risks and tell you if the treatments will interfere with your gout medications.

Though you may be reluctant to discuss complementary and alternative medicine with your doctor, many mainstream doctors are becoming more open to discussing these options. But, since few of these treatments have been extensively studied in clinical trials, it’s difficult to assess whether these treatments are helpful for gout pain. In some cases, the risks of these treatments aren’t known.

Some complementary and alternative treatments that have been studied include:

  • Coffee. Studies have found an association between coffee drinking — both regular and decaffeinated coffee — and lower uric acid levels, though no study has demonstrated how or why coffee may have an influence on uric acid in your body. The available evidence isn’t enough to encourage noncoffee drinkers to start, but it may give researchers clues to new ways of treating gout in the future.
  • Vitamin C. Supplements containing vitamin C may reduce the levels of uric acid in your blood. However, vitamin C hasn’t been studied as a treatment for gout. Don’t assume that if a little vitamin C is good for you, then lots is better. Megadoses of vitamin C may increase your body’s uric acid levels. Talk to your doctor about what a reasonable dose of vitamin C may be. And don’t forget that you can increase your vitamin C intake by eating more fruits and vegetables, especially oranges.
  • Cherries. Cherries have been associated with lower levels of uric acid in studies, but it isn’t clear if they have any effect on gout signs and symptoms. Adding cherries and other dark-colored fruits, such as blackberries, blueberries, purple grapes and raspberries, to your diet may be a safe way to supplement your gout treatment, but discuss it with your doctor first.

Other complementary and alternative medicine treatments may help you cope until your gout pain subsides or your medications take effect. For instance, relaxation techniques, such as deep-breathing exercises and meditation, may help take your mind off your pain.

Prevention

Medications
If you experience several gout attacks each year or if your gout attacks are less frequent but particularly painful, your doctor may recommend medication to reduce your risk of future gout attacks and of gout-related complications.

You usually begin taking preventive medications once your acute gout attack has subsided. Options include:

  • Low-dose NSAIDs
  • Low-dose colchicine
  • Allopurinol or febuxostat
  • Probenecid

Dietary changes
During symptom-free periods, these dietary guidelines may help protect against future gout attacks:

  • Keep your fluid intake high. Aim for 8 to 16 cups (about 2 to 4 liters) of fluid each day, including at least half water.
  • Limit or avoid alcohol. Talk with your doctor about whether any amount or type of alcohol is safe for you. Recent evidence suggests that beer may be particularly likely to increase the risk of gout symptoms, especially in men.
  • Eat a balanced diet following the Dietary Guidelines for Americans. Your daily diet should emphasize fruits, vegetables, whole grains, and fat-free or low-fat milk products.
  • Get your protein from low-fat dairy products. Low-fat dairy products may actually have a protective effect against gout, so these are your best-bet protein sources.
  • Limit your intake of meat, fish and poultry. A small amount may be tolerable, but pay close attention to what types — and how much — seem to cause problems for you.
  • Maintain a desirable body weight. Choose portions that allow you to maintain a healthy weight. Losing weight may decrease uric acid levels in your body. But avoid fasting or rapid weight loss, since doing so may temporarily raise uric acid levels

I hope this information brought to you by the staff of Mayo Clinic was helpful, especially if you have gout. If you don’t have gout, maybe you know someone who does. Please share the articles on this blog with your friends and family members.

By Diane | Posted in Chronic Pain, Gout | Tagged , , , | Comment (1)

Have You Ever Had Gout?

December 29, 2009

The term “gout” has always made me think of people who eat rich food. I’m not sure why that is, only that when I was a child, I knew some family members who complained of “the gout.” In order to educate people about what gout is, the symptoms, treatment, and other information; I’ve turned to my favorite medical website, The Mayo Clinic. The first item to explain is what gout actually is.

According to the staff of The Mayo Clinic, Gout is a complex form of arthritis characterized by sudden, severe attacks of pain, redness and tenderness in joints, often the joint at the base of the big toe. Gout can affect anyone. Men are more likely to get gout, but women become increasingly susceptible to gout after menopause. An acute attack of gout can wake you up in the middle of the night feeling like your big toe is on fire. The affected joint is hot, swollen and so tender that even the weight of the sheet on it seems intolerable. Fortunately, gout is treatable, and there are ways to reduce the risk that gout will recur.

The signs and symptoms of gout are almost always acute, occurring suddenly — often at night — and without warning. They include:

  • Intense joint pain. Gout usually affects the large joint of your big toe, but it can occur in your feet, ankles, knees, hands and wrists. The pain is likely to be most severe within the first 12 to 24 hours after it begins.
  • Lingering discomfort. After the most severe pain subsides, some joint discomfort may last from a few days to a few weeks. Later attacks are likely to last longer and affect more joints.
  • Inflammation and redness. The affected joint or joints become swollen, tender and red.

When to see a doctor
If you experience sudden, intense pain in a joint, call your doctor. Gout that goes untreated can lead to worsening pain and joint damage.

Seek medical care immediately if you have a fever and a joint is hot and inflamed, which can be a sign of infection.

According to The Mayo Clinic Staff, gout occurs when urate crystals accumulate around your joint, causing the inflammation and intense pain of a gout attack. Urate crystals can form when you have high levels of uric acid in your blood. Your body produces uric acid when it breaks down purines — substances that are found naturally in your body — as well as in certain foods, such as organ meats, anchovies, herring, asparagus and mushrooms.

Normally, uric acid dissolves in your blood and passes through your kidneys into your urine. But sometimes your body either produces too much uric acid or your kidneys excrete too little uric acid. When this happens, uric acid can build up, forming sharp, needle-like urate crystals in a joint or surrounding tissue that cause pain, inflammation and swelling.

You’re more likely to develop gout if you have high levels of uric acid in your body. Factors that increase the uric acid level in your body include:

  • Lifestyle factors. Choices you make in your everyday life may increase your risk of gout. Excessive alcohol use — generally more than two drinks a day for men and more than one for women — increases the risk of gout.
  • Medical conditions. Certain diseases and conditions make it more likely that you’ll develop gout. These include untreated high blood pressure (hypertension) and chronic conditions such as diabetes, high levels of fat and cholesterol in the blood (hyperlipidemia), and narrowing of the arteries (arteriosclerosis).
  • Certain medications. The use of thiazide diuretics — commonly used to treat hypertension — and low-dose aspirin also can increase uric acid levels. So can the use of anti-rejection drugs prescribed for people who have undergone an organ transplant.
  • Family history of gout. If other members of your family have had gout, you’re more likely to develop the disease.
  • Age and sex. Gout occurs more often in men than it does in women, primarily because women tend to have lower uric acid levels than men do. After menopause, however, women’s uric acid levels approach those of men. Men also are more likely to develop gout earlier — usually between the ages of 40 and 50 — whereas women generally develop signs and symptoms after menopause.

The Mayo Clinic Staff go on to say that people with gout can develop more-severe conditions, such as:

  • Recurrent gout. Some people may never experience gout signs and symptoms again. But others may experience gout several times each year. Medications may help prevent gout attacks in people with recurrent gout.
  • Advanced gout. Untreated gout may cause deposits of urate crystals to form under the skin in nodules called tophi (TOE-fi). Tophi usually aren’t painful, but they can become swollen and tender during gout attacks.
  • Kidney stones. Urate crystals may collect in the urinary tract of people with gout, causing kidney stones. Medications can help reduce the risk of kidney stones.

Make an appointment with your doctor if you have symptoms that are common to gout. After an initial examination, your doctor may refer you to a specialist in the diagnosis and treatment of arthritis and other inflammatory joint conditions (rheumatologist).

Here’s some information to help you get ready for your appointment, and what to expect from your doctor.

What you can do

  • Write down your symptoms, including when they started and how often they occur.
  • Write down key personal information, including any recent changes or major stressors in your life.
  • Make a list of your key medical information, including any other conditions for which you’re being treated and the names of any medications, vitamins or supplements you’re taking. Your doctor will also want to know if you have any family history of gout.
  • Take a family member or friend along, if possible. Sometimes it can be difficult to soak up all the information provided to you during an appointment. Someone who accompanies you may remember something that you missed or forgot.
  • Write down questions to ask your doctor. Creating your list of questions in advance can help you make the most of your time with your doctor.

Questions to ask the doctor at the initial appointment include:

  • What are the possible causes of my symptoms or condition?
  • What tests do you recommend?
  • If these tests don’t pinpoint the cause of my symptoms, what additional tests might I need?
  • Are there any treatments or lifestyle changes that might help my symptoms now?
  • Do I need to follow any restrictions while we’re seeking a diagnosis?
  • Should I see a specialist?

Questions to ask if you are referred to a rheumatologist include:

  • Do I have gout?
  • What treatments are most likely to help me feel better?
  • What are the possible side effects of the drugs you’re prescribing?
  • If these drugs don’t work or cause serious side effects, what will we try next?
  • How soon after beginning treatment should my symptoms start to improve?
  • Do I need to take medications long term?
  • I have these other health conditions. How can I best manage them together?
  • Do you recommend any changes to my diet?
  • Is it safe for me to drink alcohol?
  • Are there any handouts or Web sites that you’d recommend for me to learn more about my condition?

If any additional questions occur to you during your medical appointments, don’t hesitate to ask.

What to expect from your doctor
Your doctor is likely to ask you a number of questions. Being ready to answer them may reserve time to go over any points you want to talk about in-depth. Your doctor may ask:

  • What are your symptoms?
  • In what part of your body do your symptoms occur?
  • When did you first experience these symptoms?
  • Do your symptoms come and go? How often?
  • Does anything in particular seem to trigger your symptoms, such as certain foods or physical or emotional stress?
  • Are you being treated for any other medical conditions?
  • What medications are you currently taking, including over-the-counter and prescription drugs as well as vitamins and supplements?
  • Do any of your first-degree relatives — such as a parent or sibling — have a history of gout?
  • What do you eat in a typical day?
  • Do you drink alcohol? If so, how much and how often?
  • What else concerns you?

This is very helpful information presented by the Mayo Clinic Staff from their website. You can read all of this information there; however, I will continue this article on Gout tomorrow explaining more about the tests you will need for diagnosis; treatments, drugs, and home remedies; alternative medicine; and prevention. I hope this information will help you diagnose and treat an extremely painful condition especially if you do not know what it is. Until tomorrow, then.

By Diane | Posted in An Inflammatory Disease, Chronic Pain, Gout, Keeping Healthy | Tagged , | Comment (1)

I Have This Back Pain That Doesn’t Go Away

November 28, 2009

You wake up in the morning after sleeping only a few hours, again. The muscles in your back are burning as if on fire. That’s when you start thinking, “How am I going to get through the day like this?”

Believe me when I say that you are not the only one thinking like this daily. There are millions of people all around the world thinking the very same thing as they get up in the morning. Chronic back pain is a very prevalent problem. Both men and women suffer with this type of pain.

We are a society that doesn’t know how to deal with diseases that cannot be cut out or cured with medicine. What we don’t want to hear is that the pain will likely never go away. When a medical provider says, “You will have to learn to live with it,” we walk away not knowing what to do.

If a medical provider is in the know, he or she will send you to a pain clinic. The providers in a pain clinic specialize in helping people cope with chronic pain. If the medical provider is honest with you, he or she will tell you that the procedures are basically “bandaids.” If anything, the injections will give you a few months of relief before the pain comes back. Even though the injections do not take the pain away, the other treatments provided could possibly help you cope with the pain.

The other treatments that pain clinics offer could be physical therapy to include massage, physical therapy-exercise (which is very important to maintain muscle mass and movement), pharmacy-medicines, psychotherapy-coping strategies and medications, occupational therapy (retraining to other occupations), vocational rehabilitation (vocational training and job relocation), etc.

You see, a chronic pain condition affects your entire body not just your back. Coping with chronic pain requires the help of a wide range of specialty people working together to care for your every need.

When I hurt my back, I thought the pain would go away. That is what I expected, but it didn’t happen. Back in the 1970s, the neurologist put me in the hospital for 10 days in pelvic traction and physical therapy (water therapy). The medicine he gave me made me feel very drowsy and weak. One of the problems that developed in coping with this pain was the inability to sleep. Muscle relaxants made me drowsy and pain medicine helped me sleep a little bit, but for the most part, I was awake every 3 to 4 hours.

After a few years of conservative therapy, I was tired of dealing with daily pain with no end in site. Finally, I consulted a surgeon, a neurosurgeon. He warned me that the pain may not go away completely even if they found what was causing it. I was willing to take that chance. No more of this conservative stuff, I was tired of it. So, off to surgery I went.

Enough of this story for now! I will go on with my story tomorrow. Stay tuned, because what I learned in the years following my back surgery will be very revealing reading.

By Diane | Posted in Chronic Pain Support, The Power of Education | Tagged , , | Comments (0)

Fibromyalgia and Coping Strategies

November 15, 2009

Fibromyalgia is the new word that describes a condition that used to be called “rheumatism.” This condition like rheumatism  has similar symptoms, i.e., muscle pain, body aches,  fatigue, sleep disturbances, chronic facial muscles pain or aching, and reduced exercise tolerance, etc.. There are specific sites, called tender points, on the back of the neck, the lower back, sternum or breast bone, hip, shin, elbows, and kneResearchers believe repeated nerve stimulation causes the brains of people with fibromyalgia to change. This change involves an abnormal increase in levels of certain chemicals in the brain that signal pain (neurotransmitters). In addition, the brain’s pain receptors seem to develop a sort of memory of the pain and become more sensitive, meaning they can overreact to pain signals.es. For the most part, the incidence of fibromyalgia happens in women between the ages of 20 and 50. The prevalence of this chronic pain disorder is between 0.7% and 13% for women and 0.2% and 3.9% for men.

Researchers believe repeated nerve stimulation causes the brains of people with fibromyalgia to change. This change involves an abnormal increase in levels of certain chemicals in the brain that signal pain (neurotransmitters). In addition, the brain’s pain receptors seem to develop a sort of memory of the pain and become more sensitive, meaning they can overreact to pain signals.

According to an article on fibromyalgia on the Mayo Clinic website, doctors don’t know what causes fibromyalgia, but it most likely involves a variety of  factors working together. These may include:

  • Genetics. Because fibromyalgia tends to run in families, there may be certain genetic mutations that may make you more susceptible to developing the disorder.
  • Infections. Some illnesses appear to trigger or aggravate fibromyalgia.
  • Physical or emotional trauma. Post-traumatic stress disorder has been linked to fibromyalgia.

Why does it hurt?
Current thinking centers around a theory called central sensitization. This theory states that people with fibromyalgia have a lower threshold for pain because of increased sensitivity in the brain to pain signals.

Treatments and drugs

In general, treatments for fibromyalgia include both medication and self-care. The emphasis is on minimizing symptoms and improving general health.

Medications
Medications can help reduce the pain of fibromyalgia and improve sleep. Common choices include:

  • Analgesics. Acetaminophen (Tylenol, others) may ease the pain and stiffness caused by fibromyalgia. However, its effectiveness varies. Tramadol (Ultram) is a prescription pain reliever that may be taken with or without acetaminophen. Your doctor may recommend nonsteroidal anti-inflammatory drugs (NSAIDs) — such as aspirin, ibuprofen (Advil, Motrin, others) or naproxen sodium (Aleve, others) — in conjunction with other medications. NSAIDs haven’t proved to be as effective in managing the pain in fibromyalgia when taken by themselves.
  • Antidepressants. Your doctor may prescribe amitriptyline to help promote sleep. Fluoxetine (Prozac) in combination with amitriptyline is effective in some people. Duloxetine (Cymbalta) may help ease the pain and fatigue associated with fibromyalgia. And milnacipran (Savella) was recently approved by the Food and Drug Administration for the treatment of fibromyalgia symptoms.
  • Anti-seizure drugs. Medications designed to treat epilepsy are often useful in reducing certain types of pain. Gabapentin (Neurontin) is sometimes helpful in reducing fibromyalgia symptoms, while pregabalin (Lyrica) is the first drug approved by the Food and Drug Administration to treat fibromyalgia.

Therapy

  • Physical therapy. Specific exercises can help restore muscle balance and may reduce pain. Stretching techniques and the application of hot or cold also may help.
  • Counseling. Cognitive behavioral therapy seeks to strengthen your belief in your abilities and teaches you methods for dealing with stressful situations. Therapy is provided through individual counseling, classes, and with tapes, CDs or DVDs, and may help you manage your fibromyalgia.

Lifestyle and home remedies

Self-care is critical in the management of fibromyalgia.

  • Reduce stress. Develop a plan to avoid or limit overexertion and emotional stress. Allow yourself time each day to relax. That may mean learning how to say no without guilt. But try not to change your routine completely. People who quit work or drop all activity tend to do worse than those who remain active. Try stress management techniques, such as deep-breathing exercises or meditation.
  • Get enough sleep. Because fatigue is one of the main characteristics of fibromyalgia, getting sufficient sleep is essential. In addition to allotting enough time for sleep, practice good sleep habits, such as going to bed and getting up at the same time each day and limiting daytime napping.
  • Exercise regularly. At first, exercise may increase your pain. But doing it regularly often decreases symptoms. Appropriate exercises may include walking, swimming, biking and water aerobics. A physical therapist can help you develop a home exercise program. Stretching, good posture and relaxation exercises also are helpful.
  • Pace yourself. Keep your activity on an even level. If you do too much on your good days, you may have more bad days.
  • Maintain a healthy lifestyle. Eat healthy foods. Limit your caffeine intake. Do something that you find enjoyable and fulfilling every day.

Alternative medicine

Complementary and alternative therapies for pain and stress management aren’t new. Some, such as meditation and yoga, have been practiced for thousands of years. But their use has become more popular in recent years, especially with people who have chronic illnesses, such as fibromyalgia.

Several of these treatments do appear to safely relieve stress and reduce pain, and some are gaining acceptance in mainstream medicine. But many practices remain unproved because they haven’t been adequately studied. Some of the more common complementary and alternative treatments promoted for pain management include:

  • Acupuncture. Acupuncture is a Chinese medical system based on restoring normal balance of life forces by inserting very fine needles through the skin to various depths. According to Western theories of acupuncture, the needles cause changes in blood flow and levels of neurotransmitters in the brain and spinal cord. Some studies indicate that acupuncture helps relieve fibromyalgia symptoms, while others show no benefit.
  • Chiropractic care. This treatment is based on the philosophy that restricted movement in the spine may lead to pain and reduced function. Spinal adjustment (manipulation) is one form of therapy chiropractors use to treat restricted spinal mobility. The goal is to restore spinal movement and, as a result, improve function and decrease pain. Chiropractors manipulate the spine from different positions using varying degrees of force. Manipulation doesn’t need to be forceful to be effective. Chiropractors may also use massage and stretching to relax muscles that are shortened or in spasm. Because manipulation has risks, always go to properly trained and licensed practitioners.
  • Massage therapy. This is one of the oldest methods of health care still in practice. It involves use of different manipulative techniques to move your body’s muscles and soft tissues. The therapy aims to improve blood circulation in the muscle, increasing the flow of nutrients and eliminating waste products. Massage can reduce your heart rate, relax your muscles, improve range of motion in your joints and increase production of your body’s natural painkillers. It often helps relieve stress and anxiety. Although massage is almost always safe, avoid it if you have open sores, acute inflammation or circulatory problems.

Coping and support

Besides dealing with the pain and fatigue of fibromyalgia, you may also have to deal with the frustration of having a condition that’s often misunderstood. In addition to educating yourself about fibromyalgia, you may find it helpful to provide your family, friends and co-workers with information.

It’s also helpful to know that you’re not alone. Organizations such as the Arthritis Foundation and the American Chronic Pain Association provide educational classes and support groups. These groups can often provide a level of help and advice that you might not find anywhere else. They can also help put you in touch with others who have had similar experiences and can understand what you’re going through.

Most of the information above comes from an article written by staff of the Mayo Clinic. As a fibromyalgia sufferer myself, I have to tell you that the information written above is very helpful. Sleep is a very important treatment. Exercise will actually help decrease the pain you feel, contrary to what you are thinking as you read this. Another thing that will help you to live with your fibromyalgia is to decrease the amount of stress you take on. Relaxation and breathing exercises will help you decrease the stress and relax your muscles. Warm baths or a Jacuzzi will help you relax as well.

I’ve given you the medical information available on the Mayo Clinic website as well as my personal recommendations as to what worked for me. My fibromyalgia came about as the result of an accident in which I broke my neck, hurt my right shoulder, and suffered a closed head injury all at one time. I’m sure every fibromyalgia sufferer out there can tell a similar story. As stated above, if you are having difficulty coping with this painful condition, don’t hesitate to find a chronic pain support group in your area or go to the American Chronic Pain Association online. You will read a lot of great information that will help you cope with fibromyalgia. Whatever you do to help yourself will be the first step in coping with this condition. If you have questions or concerns about fibromyalgia, please leave a comment. I will get back with you as soon as possible.

By Diane | Posted in Chronic Pain Support | Tagged | Comments (4)

Stress and How it Affects Your Pain!

November 3, 2009

Oh my gosh! I’m so upset! Everything is so tense at work. My boss is constantly watching my work. I feel like I can’t make a mistake or I’ll lose my job!

Have you ever been under a lot of stress? If you have, your pain level probably goes from tolerable to off the charts in response to your stress level, doesn’t it? In my own experience, my back and neck pain seems twice as severe when I’m under a lot of stress. Do you have some coping mechanisms to decrease your stress levels or your increased pain levels, or do you just take a pill? Let me tell you about some coping mechanisms that have helped me deal with stress; which, in turn, has helped decrease my pain.

First of all, slow deep breathing or mindful deep breathing helps tremendously to decrease stress. Sitting quietly at your desk or in a comfortable chair, take in a very slow deep breath through your nose, counting to 10. Upon exhaling, blow the air out slowly counting to 10. Each time you take in a breath fill your lungs as completely as you can. When you exhale, blow the air out slowly through your mouth. Close your eyes and do this deep breathing technique for at least 10 to 15 minutes.

Another stress and pain relieving technique is progressive muscle relaxation. This type of relaxation begins at the toes. Tense your toes on both feet as hard as you can and then release them. Then, tense your calf muscles, on both legs, count to three and release. Tense your thigh muscles front and back on both legs, count to three and release. Tense your abdominal muscles, count to three, and release. Tense your back muscles, count to three and release. Tense your fingers or make a fist with both hands, count to three and release. Tense both arm muscles for three seconds and release. By the time you finish tensing and releasing all of your muscles, you should feel less tense and hopefully less pain. If you haven’t relieved your stress or your pain, do this technique again starting at the toes.

Imagery or visualization is another way of relieving stress and pain. Sit quietly in a comfortable chair, close your eyes, and think about a place you would like to be. As you are thinking, create a perfect place in your mind. Put yourself in the mountains in a cabin by a lake, in a sail boat on a beautiful sunny day, a cruise ship with your significant other, or wherever your favorite place is.

As long as you are in your favorite place,  your stress will be gone as well. As you are creating your favorite place, create a total scenario. Bring your significant other into your image. If you don’t have a significant other create the perfect person and bring him or her into your favorite place. You can sit quietly in your favorite place or you can create a dialogue between yourself and the person you are with. What is most important is that you use your imagination and create a beautiful place that you can take yourself whenever you want to relax, de-stress, or take your mind off your pain.

These are just a few of the techniques you can use to decrease your stress. Stress can hurt you psychologically as well as physically, especially if you have a chronic pain condition. Try any or all of these techniques to decrease your stress or to take your mind off your pain. You will be surprised how well they work. If you have any questions about these techniques or you would like additional information, please comment on this article. I will be happy to respond to your questions personally.

Take care and continue to read the articles. See you tomorrow!

By Diane | Posted in Chronic Pain Support | Tagged , | Comments (0)