Pain Management: Osteoarthritis
Doctors make a diagnosis of OA based on a physical exam and history of symptoms. The diagnosis of osteoarthritis is based on a combination of the following factors:
- A description of symptoms
- The location and pattern of pain
- Certain findings in a physical examination
X-rays may be used to confirm a diagnosis and to make sure that no other type of arthritis is present.
Sometimes, blood tests are done. While blood tests cannot point to anything in particular that can help a doctor confirm the presence of OA, the tests can help the doctor determine the presence of a different type of arthritis.
If fluid has accumulated in the body's joints, the doctor may remove some of the fluid with a process called joint aspiration and may examine the fluid under a microscope to rule out other diseases.
Treatment Options for Osteoarthritis
The treatment of OA focuses on decreasing pain and improving joint movement. The following treatments are available:
- Over-the-counter pain-relieving, anti-inflammatory medications: These include acetaminophen (Tylenol, for example), aspirin, ibuprofen (Advil and Motrin), or naproxen (Aleve).
- Topical treatments. Some medications in the form of creams, rubs, or sprays may be applied to the skin of affected areas to relieve pain and inflammation.
- Exercise: Physical activity can improve joint movement and strengthen the muscles that surround the joints. Gentle exercises, such as swimming or walking on flat surfaces, are recommended because they create less stress on joints. Activities that increase joint pain (jogging, high-impact aerobics, etc.) should be avoided. If you have arthritis, talk to your doctor to find out the best exercise routine for you.
- Weight control: Losing weight can prevent extra stress on weight-bearing joints.
- Prescription anti-inflammatory pain relievers: These help reduce pain and swelling in the joints.
- Hyaluronic Acid Injections: These medications can be given as injections to relieve pain in some people with osteoarthritis. Medications include Euflexxa, Hyalgan, Orthovisc, Supartz, Synvisc, and Synvisc-One.
- Cymbalta (duloxetine): Originally approved as an antidepressant, Cymbalta is also used to fight various forms of pain, including osteoarthritis pain.
- Hot or cold compresses: These treatments may be given in the form of a hot shower or bath, or by applying heating pads or cold compresses.
- Joint protection devices: These can prevent strain or stress on painful joints.
- Integrative therapy: Acupuncture has been shown to help relieve pain. While research is conflicting, there is some evidence that the supplements glucosamine and chondroitin may relieve some pain in some people with osteoarthritis, especially in the knee. Several studies have shown that SAMe may work better than prescription anti-inflammatory pain relievers in some people. Several other dietary supplements (including herbals) sometimes help OA pain.
- Steroid injections. Your doctor can inject these potent medicines directly into your joint to help relieve pain. Using them too frequently can cause joint damage.
- Narcotics: Stronger pain pills, such as narcotics, may be prescribed when osteoarthritis pain is severe and other treatments are not working.
- Surgery: When other treatment options have failed, some people may need surgery to relieve chronic pain in damaged joints.