A 5-Point Plan for Arthritis Pain Relief

Pain is a common symptom arthritis, and we have a culture that promotes medicine for pain — but we can do much better. Here are steps for easing pain while avoiding pills.

 

By Lillie Rosenthal, DO

Published: May 16, 2018
Last updated: May 16, 2018

 

Pain is a common symptom associated with rheumatoid arthritis (RA) and osteoarthritis (OA). We have a culture that promotes pills for pain — but we can do much better. Pain medications are “chemical band-aids” that should never be the first line of treatment. We should instead be investing our time and energy in non-pharmacological alternatives that not only treat pain more effectively, but spare the potential for serious side effects. 

The 5-point plan below offers pain relief and increased function as well as better health and well-being for the arthritis patient.

1. Fight Pain with Food

Inflammation is what causes the muscle pain from arthritis. What you eat makes a big difference! The best choice to limit inflammation and the pain it causes is a whole-food, plant-based diet consisting of vegetables, fruits, nuts, berries and whole grains. If you want to include animal products in your diet, keep them to a minimum and be mindful of the quality. Avoid processed foods and those with added sugar.

This diet will not only support a healthy gut microbiome to reduce pain and inflammation and boost your immune system, but will support a healthy body weight to maintain joint health. (Extra weight means extra pressure on your joints.)

2. Push Yourself to Exercise

When we have pain, the last thing we feel like doing is exercising! Yet exercise is critical for the arthritis patient as it increases musculoskeletal strength and flexibility as well as reducing joint pain. Strong muscles that support already vulnerable joints reduce the torque and stress at the joint lines. Non-weight-bearing exercise such as isometrics, biking and swimming can be especially effective. Remember to stay hydrated and use heat before exercise (warm up) and ice after (cool down) as needed.

3. Mindfulness Meditation

Mindfulness meditation can be a valuable tool in the management of arthritis pain. Remarkably, after only 4 days of mindfulness meditation training, pain unpleasantness and intensity were reduced by 57% and 40% respectively, according to one study. My patients’ favorite meditation apps are Calm and Headspace. Deep breathing exercises can also help manage pain –- inhale for 4 counts, hold for 4 counts, exhale for 4 counts. These techniques are quite effective in reframing the pain from something to fight into something to acknowledge and accept (in small amounts).

4. Osteopathic Manipulation

Osteopathic manipulation is a manual therapy that can often provide immediate pain relief. These gentle, hands-on techniques involve stretching, mobilization and traction, which improves circulation and joint function as well as reducing muscle spasm, pain and swelling, without side effects. Osteopathic manipulation assists the body in healing itself on a cellular level to optimize function.

Find this type of care by seeking out a DO (Doctor of Osteopathy) near you. DOs have the same level of training that MDs do, with the same ability to write prescriptions. But don’t expect your DO to encourage medical intervention. Philosophically, DOs focus on whole-person care -— rather than treat the symptom, the DO will more likely encourage you to make lifestyle changes to eliminate the cause of the problem. Most, but not all, insurance programs will pay for osteopathic care.

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5. Sleep – Rest and Repair:

Pain can be exhausting during the day and may keep you up at night. Sleep is when the body repairs and rebalances. Sleep deprivation decreases our threshold for pain and impairs healing. We should aim for 7 to 9 hours of sleep nightly.

To support your sleep success, have a regular bedtime, limit or refrain from alcohol use, shut off all devices with screens at least 1 hour before bedtime and keep the bedroom dark and cool. Valerian herbal tea is a safe and helpful sleep aid.

We all want to feel and function optimally, and we all have important choices in our healthcare. The best choices offer high rewards and low risks. The lifestyle modification program outlined above can safely reduce the pain of RA and OA along with improving health and well-being without side effects. The choice is yours!

 

Lillie Rosenthal, DO

An expert in lifestyle management with a focus on injury prevention, pain management and biomechanics, Lillie Rosenthal, DO, is a board-certified physical medicine and rehabilitation physician in New York City.

Dr. Rosenthal sees a variety of patients in her Manhattan practice, including world-renowned musicians, dancers, choreographers, and writers, as well as marathon runners and other athletes, and treats such conditions as back pain, tendonitis and repetitive stress disorders. She is also a consulting physician for the New York City Ballet, American Ballet Theatre, Metropolitan Opera, MTV Video Music Awards and several Broadway productions and is, herself, a dancer and a marathon runner.

Dr. Rosenthal’s media experience includes national television appearances on “The Dr. Oz Show” and she has been featured as an author and expert source in a number of publications, including U.S. News & World Report, the New York Times, The Huffington Post and Consumer Reports.

Osteopathy can be used to treat mental health issues related to back pain – new study →

Millions worldwide suffer from chronic musculoskeletal back pain (lasting more than three months). The problem is so big that in the UK alone, it is estimated that 116m days of work are lost, a million hospital appointments are made and five million GP visits are scheduled – just for low back pain. 

The physical agony is often not a standalone problem, however. 35% of people who suffer with low back pain are also diagnosed with depression, anxiety and social isolation.

NICE guidelines suggest that chronic back pain sufferers should have physical therapy as part of a broader package of treatment which includes psychological help. But we have been exploring how one single type of osteopathic treatment can be used to treat both the physical and mental conditions.

Osteopathic manipulative therapy is a drug-free medical approach which uses touch-based massage, manipulation of soft tissue and joints, and spine mobilisation procedures, to diagnose and treat pain related conditions. Practitioners use a structured evaluation to identify dysfunction relating to the skull, spine, pelvis and abdomen, as well as upper and lower limbs, and target treatment.

OMT has already been found to be effective for several types of muscoskeletal pain, such as chronic neck pain. In addition, it has been proven to be more effective than the standard primary care options – such as exercise and painkillers – at improving quality of life for those with persistent low back pain three and 12 months into treatment. 

Researchers have also shown that OMT can reduce subacute (between acute and chronic) low back pain. Accordingly, spinal mobilisation and manipulation alone have been found to be effective for acute, subacute and chronic low back pain. 

While this is all very positive, there is a pattern here. The limited OMT research has focused mostly on physical problems, not the associated mental health issues. 

Treating mental health issues

To find out more about how osteopathy could potentially affect mental health, at our university health and well-being academy, we have recently conducted one of the first studies on the psychological impact of OMT – with positive results. 

 

Spine mobilisation. Photographee.eu/Shutterstock

For the last five years, therapists at the academy have been using OMT to treat members of the public who suffer from a variety of musculoskeletal disorders which have led to chronic pain. To find out more about the mental health impacts of the treatment, we looked at three points in time – before OMT treatment, after the first week of treatment, and after the second week of treatment – and asked patients how they felt using mental health questionnaires.

This data has shown that OMT is effective for reducing anxiety and psychological distress, as well as improving patient self-care. But it may not be suitable for all mental illnesses associated with chronic pain. For instance, we found that OMT was less effective for depression and fear avoidance. 

All is not lost, though. Our results also suggested that the positive psychological effects of OMT could be further optimised by combining it with therapy approaches like acceptance and commitment therapy (ACT). Some research indicates that psychological problems such as anxiety and depression are associated with inflexibility, and lead to experiential avoidance. ACT has a positive effect at reducing experiential avoidance, so may be useful with reducing the fear avoidance and depression (which OMT did not significantly reduce). 

Other researchers have also suggested that this combined approach may be useful for some subgroups receiving OMT where they may accept this treatment. And, further backing this idea up, there has already been at least one pilot clinical trial and a feasibility study which have used ACT and OMT with some success.

Looking to build on our positive results, we have now begun to develop our ACT treatment in the academy, to be combined with the osteopathic therapy already on offer. Though there will be a different range of options, one of these ACT therapies is psychoeducational in nature. It does not require an active therapist to work with the patient, and can be delivered through internet instruction videos and homework exercises, for example. 

Looking to the future, this kind of low cost, broad healthcare could not only save the health service money if rolled out nationwide but would also mean that patients only have to undergo one treatment.

Neck pain: A problem of posture, tension or medical issues

Neck pain requires your attention.

Most neck pains are caused by tension and posture issues, but when present, medical problems must be ruled out.

Daily life stressors and anxiety are perhaps the most frequent cause of neck pain, as stress increases the muscle tone in structures of the body that require frequent muscle activation to stabilize, the neck is the primary victim of your stress.

If frequent, there could be association with migraines and headaches, which is called cervicogenic headache. According to research carried out on this type of headache, 70 percent of cervicogenic headaches are caused by a problem with the C2-C3 bones and their joints and soft tissues of the neck submitted to tension that put pressure on vascular structures that irrigate the brain. 

With regards to posture, a slouched posture that constantly places the head or the shoulder in a forward position, will shorten the suboccipital muscle groups (a series of short/strong muscles that connect the back of the neck to the skull) and these willbackward bend the skull on the neck vertebrae, placing tension on the muscles, and restrictions to the blood flow of the vertebral artery, or the Greater Occipital Nerve that innervates the back of the head, and thus create neck pain, headaches, and migraines. Maintaining this posture of backward bending or extension over time, will also put much pressure on the facet joints, in the back of the cervical spine, and will translate onto osteoarthritis of the neck that will also cause chronic pain.

 

Similarly, a posture of a flat neck, as this is a loss of the normal curvature of the cervical spine, will place constant pressure on the discs in between the vertebrae of the neck, the disc will lose content of water, the normal height of the neck will be lost as the vertebrae approach each other, and there will be pinching of the nerve root that exit through the side of the spine, referring pain to the arms, a condition named radiculopathy.

To reduce forward head/shoulders posture, for most of the cases and regardless of age, it is advisable to activate the “upper thoracic axial extension”. This means to pick the chest up and maintaining, in a progressive way. This will fatigue the muscles not used to maintain the corrected position, that’s way it must be performed progressively, within a range of comfort. It is proven that people in the military and police forces have less incidence of neck pain and less need of spinal surgery because they keep the chest up, to manifest their authority, and to look better. 

For a posture of a flat neck, specific exercises under the direction of a qualified Physical Therapist is recommended to increase the normal curvatures of the cervical spine.  

Treating the conditions above with pain medicines will provide pain relief for as long the medication takes effect. An examination by a Physical Therapist is valuable to determine if the neck pain is related to a true muscle-skeletal dysfunction or if the pain is caused by a medical problem or disease that will prompt referral to the proper specialty. 

If treatment options are suggested for a solution to the neck pain, a qualified Physical Therapist can offer Manual Therapy, distraction, and postural corrective approaches to treat the specific restrictions in the neck joints and restrictions of the neck muscles and their fascia (connective tissue that envelops the muscles), in order to put bone structures in place, reduce the muscle tension, reduce nerve entrapments, and help restore blood flow through the vertebral arteries to reduce or eliminate neck pain and cervicogenic headaches or migraines. 

Additionally, a qualified Physical Therapist can offer and recommend specific relaxation techniques, traction, customized and modified Yoga, modified Pilates, or Dry Needling (a technique like acupuncture), among other holistic techniques to address the neck pain and headaches. 

Ergonomics are also important in address neck pain. Among many aspects of ergonomics and neck pain, a proper pillow is important to start reducing and preventing neck pain. A proper pillow is one that keeps the neck neutral (without any side bending) in the side lying position. If the neck is bent to the bed, the pillow is flat; if the neck is bent to the ceiling, the pillow is thick. If the pillow in side lying maintains the neck neutral for 5 minutes, that’s a good pillow to use either in side lying or back positions in bed. 

Once the pain has been reduced and the posture has been improved, the qualified Physical Therapist will have to customize specific exercises for neck strengthening, to maintain and improve the gains, and prevent further development of reoccurrence of neck pain. This is called, cervical stabilization. 

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