Pain in the joints affects millions of people worldwide. There are many different types of joint pain—pain related to osteoarthritis, pain after traumatic injury, pain after joint surgery, pain related to inflammatory joint disorders such as rheumatoid arthritis and psoriatic arthritis, and pain related to crystal deposition in the joints such as gout or chrondrocalcinosis. Depending on the individual, pain might be felt in the joint or in the muscles around the joint.
The pain may be diffuse and constant, or it may occur at rest or while moving, depending on the cause. Despite the wide range of conditions and symptoms, different types of joint pain might share similar underlying mechanisms, manifestations, and potential treatments.
Why Pain in the Joints?
The following issues may contribute joint painTreatment for joint pain is often inadequate.
- Joint pain is associated with loss of function, and treatment should focus not only on pain but also on activity and function.
- Medications are sometimes unsafe, and rehabilitation and physical therapy are essential. Chronic joint pain can be manageable, but patients might continue to suffer.
- A person's joint pain often bears little relationship to what the joint looks like on x-rays or scans, and this makes joint pain especially challenging to understand. Even when the source of the joint pain is identifiable, this might not fully explain the severity of the pain.
- In addition to the suffering and discomfort associated with joint pain, the problem can exact substantial financial and other costs. These include high medical expenses, lost work days, and diminished quality and productivity in people's work and personal lives.
- Aging populations, sedentary lifestyles, and an increasing propensity toward obesity all mean that the problem of joint pain is likely to continue unabated worldwide.
What Is Pain?
Pain is a protective mechanism that alerts the brain when damage has occurred. But pain isn't just a sensation, it is a personal experience. It has emotional effects too, making us feel upset or distressed. Pain may continue when the damage seems to have gone. This is a feature of some chronic pain
Pain may be caused by a physical injury or damage to body tissues, chemicals produced by inflammation, or damage to the nerves or nerve endings. The most common causes of chronic pain in joints are osteoarthritis, rheumatoid arthritis, spondyloarthritis and psoriatic arthritis, systemic diseases, and crystal deposition disease, also known as chondrocalcinosis or pseudogout.
Pain severity can be affected by a number of factors. For example: the extent to which one concentrates on the pain; the ability to enjoy various activities that can take one's mind off the pain and make it more manageable; unhappy feelings, anxieties, or depression, which can worsen pain; and prescription drugs, which can have a direct effect on the brain, chemically reducing the impact of pain.
How Is Joint Pain Treated?
A number of approaches are available to help manage pain, including various drug therapies, physiotherapy, and exercise.
- Painkilling drugs, ranging from paracetamol to codeine and, only in few cases, up to stronger options such as oxycodone, slow-release morphine, or patches containing fentanyl or buprenorphine.
- Non-steroidal anti-inflammatory drugs (NSAIDs) and coxibs, which are painkillers and have anti-inflammatory effects.
- Corticosteroids, often called steroids for short, given mostly by injection Drugs for nerve pain and chronic pain syndromes.
- Tricyclic antidepressants (for example, amitriptyline or dosulepin), which improve sleep and help the brain control sensations from the upper body and limbs Gabapentin, carbamazepine, and pregabalin help control some types of pain, especially when there is nerve damage.
- Transcutaneous Electrical Nerve Stimulation (TENS) can help ease pain, though evidence on its effectiveness is mixed (A TENS machine is a small electronic device that sends pulses to nerve endings via pads placed on the skin. TENS produces a tingling sensation and is thought to alter pain messages sent to the brain.)
Other pain-relief treatments and therapies include a heating pad or hot-water bottle and technologies such as ultrasound, laser, or interferential treatment In all cases, individually tailored exercise programs are essential and contribute to regained strength and function In some cases, surgery can be effective, but individuals should always discuss this option with doctors in light of the intensity of their pain and the extent of their disability.
Interventional procedures are non surgical method of pain relief. This may be useful for some of the patients with joint pain especially knee, hip& shoulder.
- Medications are injected accurately into & around the joint with the help of x Ray guided or ultra sound.
- The pain producing nerves are managed by radio frequency ablation method.
Some time the swollen joints are decompressed with X-ray or ultra sound guided aspiration of joint fluids. In some conditions there may not be adequate lubricant in the joint, in such conditions synthetic synovial fluids are accurately injected into the joint with the help of X-ray or ultra sound.This particular method is called synovial fluid replacement,especially useful for knee joint pain.
All joint pains are evaluated after careful clinical examination along with biochemical ( blood investigation) , and radiological ( X-ray,CT , MRI,Bone Scan) investigations. Then treatment is planed accordingly. Multiple methods like drugs, nutritional supplements, intervention procedures,physical exercise & rehabilitation methods, life style modifications like weight reduction & posture correction, surgery are available & chosen according to the clinical condition of the patient.Multimodal approach is choosing more than one method to handle the pain effectively.
Unfortunately, for some people pain is long lasting, doesn't respond fully to drugs or physical treatments, and cannot be cured by surgery. In such cases, multimodal method will be useful and also it is worth thinking about lifestyle changes, such as learning to rest sensibly (but not giving up all exercise), avoiding certain activities, asking for help, or using gadgets and home adaptations. A doctor, physical therapist, social worker, or occupational therapist can offer expert help and advice with these changes.
For a small minority of people, pain can be severe and disabling. This can result in a vicious cycle of pain,anxiety, depression, and deteriorating physical fitness. People affected in this way should be referred to a pain-management clinic to learn new ways to cope with pain.