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Arthritis: Treatment, Pain Management & More

March 16, 2015 12:59 PM with Dr. Victoria Brander

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The pain of arthritis can be debilitating but there are treatments that can help manage pain. Victoria Brander, MD, Physical Medicine and Rehabilitation, will answer questions on non-surgical arthritis treatments and pain management, from physical therapy and diet, to medications and integrative therapies. She will also take questions on when surgery might be indicated. Submit questions early.

Brenna (Moderator) - 12:32 PM:
Our chat is scheduled to begin at 1 PM. You can submit questions in advance or at any point during the chat. Before the chat begins, you can find out more about the NorthShore Arthritis Center here

  Sandie (Evanston, IL) - 1:01 PM:
On October 18, 2014, I participated in a charity walk (3.5 mi). I made it through the walk with no problems but within 2-hours afterwards, I was having extreme pain in my (L) knee. Since then, I have pain daily. I've tried ice and a medicated cream. What else can I try? I have pain EVERYDAY!
Dr. Victoria Brander (NorthShore)
First, its important to get a diagnosis. Knee pain can be from arthritis, from inflammation of soft tissues, or even from hip or spine problems. It seems as though you tried the right approach to begin with - ice, rest and an antiinflammatory cream. If you can tolerate these, the next steps are to start an antiinflammatory (such as ibuprofen or naproxen over the counter), see a physician (and probably get an XRay) and then, based on the diagnosis, do physical therapy, start a customized exercise program or try other interventions if needed (like injections). But, since the pain has been going on since October, you should see a physician for an an accurate diagnosis.

  Shelley (Lakemoor, il) - 1:16 PM:
Hi Dr. brander, Pain management question. Re: arthritis, fibromyalgia, sjogrens. What is left to some patients that have tried all the prescriptions, physical therapy, chiropractic, accupuncture and supplements that we know of and still have debilitating pain? Is there something we might have missed? Thank you for your time:). Shelley
Dr. Victoria Brander (NorthShore)
Chronic pain, including fibromyalgia, is very difficult. It usually takes a combination of interventions - medication to restore sleep, some pain medication or intervention, structured exercise/physical therapy, centrally acting medication to reduce brain "hypersensitivity" to pain, pain osychologist for biofeedback, stress management etc. Very important are techniques to foster the patient's trust in the physician and clinicians, which then lead to better patient compliance, lessening of fear and better outcomes. Many of these patients are "kinesthesiophobic" (have fear of movement) -- so need to trust that we are not going to hurt them with exercise and mobility instructions. But the single best predictor of outcome is patient's SELF-EFFICACY - and we train this through verbal persuasion (education, classes); improving "physiology" (eg exercise); having patients see other patients going through the same problems; and activity repetition - 1:1 with a PT who inspires & motivates

  Martha (Evanston) - 1:24 PM:
Could exercise make arthritis worse? If so, are there specific exercises to avoid?
Dr. Victoria Brander (NorthShore)
Exercise is the single best treatment for arthritis. Its the only treatment ever shown to change the "natural history" (deterioration) of arthritis. The type of exercise depends on teh joint. For knee arthritis, exercises should focus on strengthening the quadriceps, glut muscles and abdominal muscles; working on flexibility of the hips and the knees and normalize the pattern of walking. A bicycle is a great exercise for hip and knee OA. I strongly believe that Yoga is the best choice for exercise classes for almost all patients with arthritis

  Jen (Lake Bluff, IL) - 1:31 PM:
Diagnosed with arthritis in thumb joint. 3 steroid injections, no relief. Had accupunctur still no relief. Sever pain, starting to interfer with daily activites. What can you suggest?
Dr. Victoria Brander (NorthShore)
Many people with arthritis of the thumb (including ME!) seem to benefit from getting a customized thumb splint; seeing an occupational therapist for exercises; trying a topical anti-inflammatory (such as diclofenac gel); and if necessary modifying some activities (such as typing) that aggravate the pain. I like to use a paraffin (hot wax bath) unit to heat the joint and tissues and then following that with aggressive stretching and strengthening. The more you stretch out the joints the better they feel. Surgery is a very last resort

  sarah (wilmette il) - 1:33 PM:
If you may eventually need knee replacement, should you wait until the pain really restricts your daily activities or do it proactively?
Dr. Victoria Brander (NorthShore)
That's a great question. You want to wait until pain is bad enough that it starts to limit your activities, but not so long that you are very disabled. People who are more disabled going into surgery have a more difficult time recovering. It is very important to reduce your joint pain before surgery (medications, injections) so that you can EXERCISE (stationary bike is great) preoperatively. I like to send my pre-operative hip and knee surgery patients to physical therapy for customized exercise. Most people know deep down inside of them when the "time is right" for surgery. Along with Ron Allen (a patient who is a law professor and writer), Dr David Stulberg and I wrote a book for patients/consumers who have arthritis that is bad enough to start considering surgery. We have a whole chapter dedicated to "knowing when the time is right". The book is >10 years old (I think its less than $5 on Amazon now) -- the surgery detail is outdated but the other concepts, such as this one, apply.

  Sophia (Glencoe, Il) - 1:38 PM:
How can you manage debilitating knee pain when over the counter anti-inflammatory agents such as Motrin don't work and ingections seem to excacerbate the pain?
Dr. Victoria Brander (NorthShore)
First, if your doctor approves, take full dose anti-inflammatory - such as ibuprofen 600mg (3 Advils) four times a day or naproxen 440mg (2 Aleve) twice a day. Most people don't take the full antiinflammatory dose and so the medications don't work well. There are other medications we often add to the antiinflammatories- such as tramadol (a simple pain killer) or cymbalta (to dampen the nerve component of pain). Exercise is critical -- very important to strengthen the quadriceps, glut muscles, abdominal muscles. Injections include steroids ("cortisone shots"), hyaluronic acid (such as Synvisc or Euflexxa), and fairly soon an injectable stem cell treatment (for early arthritis). Sometimes orthotics (knee "unloader" brace or even foot orthotics) can help unload pressure on the knee and reduce pain. Last, if the diagnosis is advanced arthritis and all the nonsurgical interventions dont work, knee replacement surgery may be indicated

  Grace (desplaiens,ill) - 1:45 PM:
2 months ago i revecived an injection to both my kmnees for arthritis. It is lot better now . I am getting pain almost like pricking with pins and needles. This is kind of intermittent. so i take an aleeve and do some streching along with. Is this going to be my life or is there something that you can do so I can be a normal personi cna s.
Dr. Victoria Brander (NorthShore)
Unfortunately, it's almost impossible to answer your question accurately without having specific clinical information - about how bad your arthritis is, if you also have arthritis in the hip or back, what else you have tried and what your physical exam and XRay findings are. Because I am not your doctor and have not examined you, I can give you general information about arthritis but not specific recommendations about you...sorry. But, in general, people with arthritis of the knees find that if they exercise 4 days a week (focusing on STRENGTH of the hips, knees and abdominal muscles), take a medication to reduce pain or inflammation consistently, wear supportive shoes, try a knee brace, and intermittently get injections if these help, often find their arthritis can quiet down significantly. Your most important choice is exercise.

Brenna (Moderator) - 1:48 PM:
There are 15 minutes left in this chat. Please submit your final questions. This has been a very popular chat so we apologize in advance that we will not be able to address all your questions.

  Claudia (Evanston, IL) - 1:50 PM:
How can I decrease advancement of arthritis in my hands, especially the thumbs. I unable to hold many things or open jars, bottles, etc.
Dr. Victoria Brander (NorthShore)
There is no known treatment that slows the "natural history" of arthritis of the hands, unfortunately. (I sympathize with you - I have arthritis in my hands too!). We think the best strategies are: keep your hands strong and knuckles flexible; use a brace for the thumb (especially at night to reduce movement & inflammation); try a topical antiinflammatory cream (such as diclofenac cream up to 4 x a day); take adequate Vitamin D (2000 international units a day); eat an antiinflammatory diet (avoid sugars, alcohol and carbohydrates); keep your hands warm in the winter (I use a paraffin - hot wax - bath for my hands and then follow that with stretching); and, you can use modified/built up handles on your kitchen tools, use a jar opener etc

  sarah (wilmette il) - 1:54 PM:
Is long term use of an OTC anti-inflammitory OK?
Dr. Victoria Brander (NorthShore)
For many people, yes. I suggest to my patients that if they are taking an antiinflammatory every day, they need to come in for a visit every 6 months so we can monitor their blood pressure, look for leg edema, question them about heartburn and get blood tests (looking at kidney, liver function and urine for protein). Patients who have diabetes, disorders of the kidney or liver, heart disease, reflux, stomach ulcers, who are very frail or elderly, those on blood thinners, and those on multiple medications are at high risk of complications and need to re-consider taking daily antiinflammatories (I am reluctant to prescribe them in these situations).

  Marsha (chesterfield i) - 1:58 PM:
I was just diagnosed with arthris of back but I do not want to take another pill. Can you give me another type of treatment?
Dr. Victoria Brander (NorthShore)
Its hard to answer that question too specifically because I dont know the details of your condition. However, in general, the most important strategy is EXERCISE -- and seeing a very good physical therapist with a specialty in spine is critical. With arthritis of the spine, treadmill or long walking is usually too painful. Instead exercsing in flexion (such as a stationary bike) is better. And, need to work on strength of the abdominal muscles -- pilates, yoga for scoliosis, Tai Chi are all great. Sometimes patients use a corset/abdominal binder when they are active (eg "quick draw corset"). Transcutaneous electrical stimulation (TENS unit) is a topical device that sends very brief light electrical impulses into the muscles/spine, "confusing" the pain nerve endings and in many patients reduces pain. There are a variety of injections into the spine that sometimes help - eg epidural steroid injections, ablation of pain nerves.

Brenna (Moderator) - 2:06 PM:
Thank you everyone for your participation in our chat today. Thank you Dr. Brander for your time.

Brenna (Moderator) - 2:06 PM:
A transcript of the chat will be made available today.
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