Understanding Rheumatoid Arthritis – Dealing With Chronic Pain Associated With RA Part II

A Review

As discussed in “Understanding Rheumatoid Arthritis – Dealing With Chronic Pain Associated With RA Part I,” rheumatoid arthritis or RA is a disease affecting millions of individuals around the world every year. RA leads to a constellation of symptoms including but not limited to small joint pain, neck pain, back pain, hip pain, knee pain, and leg pain, also known as sciatica. Approximately one per cent of the world’s population, one in ten thousand individuals, are affected by rheumatoid arthritis. There appears to be a significant, gender-based difference, with three to five times as many women as men presenting with symptoms. Significantly, Native Americans present with as high as six percent of the population affected with the disorder. This author found RA present in high numbers in skeletal samples of pre-Columbian, Native American populations at the William S. Webb Museum of Anthropology, University of Kentucky, Lexington. It is this author’s experience, based on extensive research, that this condition dates back to pre-historic times, yet an explanation for the high prevalence in Native Americans remains elusive. The greater incidence among smokers was also discussed and is noted once again. Although the link between smokers and RA appears robust, causality remains problematic.

Understanding Symptoms

Rheumatoid arthritis remains something of a conundrum with more questions unanswered than answered. One thing is certain, chronic pain associated with RA is very real and often leads to total disability, particularly as the disease progresses. Additionally, as areas beyond the smaller joints become involved, and neck pain, back pain, hip and knee pain, and even sciatica advance, the quality of life can and often does suffer, particularly in the latter stages of RA. As noted in Part I, RA is characterized by small joint involvement, usually involving the hands and feet in early stages, becoming widespread and affecting the larger joints and other organ systems as the disease progresses. RA is an inflammatory disease both chronic and systemic (widespread) in nature. The disease may express with a myriad of symptoms, and they may range from mild stiffness and discomfort, to chronic, systemic and even acute pain. It is not unusual in the latter stages of the disease for RA patients to be completely disabled.

Inflammation and the Synovial Membrane

As noted above and previously, rheumatoid arthritis is systemic and is a form of auto-immunity. RA is characterized by an inflammatory process affecting the synovial membrane, known as synovitis. The synovial membrane lubricates the joints and makes it possible for the cartilaginous surface of one bone to “glide” across the surface of another. Synovial fluid is the medium responsible for the effortlessness of this function, reducing friction as it lubricates the joint. Imagine placing a penny on your kitchen counter and sliding it with a little push; it would slide until friction slowed and eventually stopped it. Now, with synovial fluid present the penny would continue on and on as friction is reduced to almost zero. Synovial fluid is truly one of the body’s miracles, allowing joints to function in a virtually frictionless environment. However, when RA is present, the synovial fluid and consequently the synovial membrane becomes inflamed, causing friction. The friction leads to joint erosion, and the joint erosion leads to a breakdown of the joint capsule, leading to chronic pain, and deformity. The breakdown in the joint capsule, and the joint itself, exacerbates the deformity compounding the pain; and, thus we have a feedback look, constantly feeding upon itself as the pain grows more intense with each progression over time.

Morning Stiffness and Inactivity

Rheumatoid arthritis may present with symptoms to include inflamed and swollen joints, slight fever and pain affected areas warm to the touch, stiffness, particularly upon arising in the morning, and soreness, stiffness, and pain after long periods of inactivity. I will repeat the latter portion of that last sentence because it is worth repeating:

“…stiffness, particularly upon arising in the morning, and soreness, stiffness, and pain after long periods of inactivity.”

Why would I repeat that sentence? Prolonged inactivity of any kind, whether extended periods of bed rest, self-imposed inactivity, or inactivity as habit, the result of a sedentary lifestyle, will only lead to heightened stiffness, soreness, and chronic pain, particularly as they relate to pain in the hands and feet, neck and shoulders, back, hips and leg pain, and sciatica. With inactivity, whether as the result of a sedentary lifestyle or as an adaptive and protective mechanism due to acute and chronic pain, deformity, further erosion, loss of function, and finally disability often result.

Treatment Strategies for Swelling and Stiffness

Stiffness in the morning or after periods of moderate to prolonged inactivity is a telling characteristic of RA, distinguishing it from osteoarthritis. Morning stiffness may last as long as one to two hours in advanced cases. Failure to integrate a proper stretching and exercise program, particularly when stiff, may result in heightened stiffness, soreness, and chronic pain. Small joint pain, particularly in the neck, hands and feet, can be dealt with by engaging in a simple but effective stretching and exercise program. Stiffness and soreness in the larger joints, those of the shoulders, back, hips, and knees, can and should be attended to through a comprehensive stretching and exercise program, preferably one designed by someone knowledgeable when it comes to RA. Of course an individualized, medically-supervised program is always best. Additionally, ice is always indicated when soreness, swelling, and stiffness is present and/or ongoing. When pain is acute, whether hand, neck, shoulder, back, hip, knee, or leg pain (sciatica), ice should always be the first step in any inflammation pain reduction strategy, not heat!

A Two-Pronged Approach to Treatment

Ultimately, while we understand quite a bit about RA, there is no cure. However, as noted above, there are methods to alleviate the inflammation, stiffness and soreness, chronic pain, and many of the other symptoms associated with the disorder. The primary treatment strategy should be a two-pronged treatment approach designed to alleviate chronic joint pain symptoms, to include neck pain, back pain, hip and leg pain, and sciatica, and to offset, as much as possible, and prevent any further deterioration of the joints. The strategy must include medication, prescribed my your RA specialist, usually a specific anti-rheumatic medicine or medicines combined with anti-inflammatories, weight loss, podiatry for the feet, physiotherapy or physical therapy, various injections, again as prescribed, fish oil and certain natural bone and joint medications, ice, and exercise.

Prognosis and Lifestyle Change

While statistics are not encouraging, particularly as they relate to treatment and prognosis, the debilitating and disabling effects of RA may be delayed and, in many instances alleviated, through an intelligent, holistic treatment strategy including medication, alternative medicine treatment methods, lifestyle changes, to include weight loss and diet considerations, and, above all, exercise. The concert of treatment strategies, with its holistic approach, will aid in alleviating and in some cases eliminating, at least short-term, the debilitating impact of RA. Rheumatoid arthritis, with its chronic, inflammatory, and systemic pain expressions, to include neck pain, back pain, hip pain, and sciatica, is not the disabling diagnosis it once was, provided a holistic, individually-designed treatment strategy is engaged early on and followed conscientiously. In Part III we will explore deeper into the various aspects of rheumatoid arthritis, including some of the specific treatment strategies available for individuals suffering from this debilitating and disabling condition.

Rheumatoid Arthritis Treatment Strategies and Solutions Part II & Part III (continued tomorrow)!

These are some of the programs I recommend. I hope they help you as much as they helped me!

Article Source: http://EzineArticles.com/?expert=John_Zajaros

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Welcome Back to Ultimate Bad Back Strategies!

I am constantly amazed by the number of people, even medical practitioners, still advising and using heat! Where have they been over the last decade…Mars?

I have suffered from neck pain, back pain, and sciatica for 30 years now. It has only been in the last few months that I have achieved anything close to complete and lasting pain relief! For years I struggled with operation after operation until I’d lost all hope of ever waking up in the morning without some sort of neck pain, back pain and/or sciatica.

By the end of most days?

Well, if we could have put a cherry picker, one of those machines they use to lift engines out of the engine compartment, in the living room to get me up out of the recliner and into bed, we would have had the super deluxe model! Needless to say, I was in bad shape just before the dawn. Having overcome an advanced case of osteomyelitis, with a myriad of associated health consequences, I was still in very bad shape a year ago now. In fact, they really weren’t too sure I was going to make it. I was in dire straits and in more pain than any human being should ever have to endure. If you have ever had spine surgery? Imagine the pain when you first woke up in the recovery room and multiply it exponentially! I am not being melodramatic, I’m attempting to give you a real sense of the incredible pain I was in 24/7. I was depressed, addicted, and without hope. In other words, I was at the end of my rope…literally and figuratively! And, as time goes on, I will share a bit more of that story. However, for now I want to talk about something that helped me in a way few other bad back strategies have:

ICE!

That’s right! Ice! Many medical practitioners have come to understand that ice, not heat, is the proper response in 95% of all instances of neck pain, back pain and/or sciatica. You see, when you are experiencing neck pain, back pain and/or sciatica, in fact any kind of pain, acute or chronic, it is usually due to inflammation or swelling. The inflammation and/or swelling may be affecting many areas or it may be limited to one specific area. Pain may have a single cause or it may be the result of a myriad of factors working in concert. For example, a herniated disc may cause nerve impingement, the nerve impingement causes inflammation, the inflammation causes swelling, the swelling causes muscle spasms, and the muscles spasms, as anyone who has had back pain can tell you, can be extremely painful. Trace the pain back and it may be possible to interrupt the pain continuum, the back pain complex, at any point along the continuum of cascading reactions leading to the ultimate expression of pain, and in this case neck pain, back pain and/or sciatica.

But they’ve been using heat for years!

Exactly, and it doesn’t work! You see, when you use heat, you allow increased blood flow, leading to increased swelling, which leads to increased pain levels. Instead of interrupting the continuum, by introducing heat you actually enhance the ultimate expression and contribute to more inflammation, swelling, muscle cramps and spasms, and ultimately, pain. While the use of heat may be psychologically soothing, allowing for a temporary feeling of relief, as a long term, efficient and effective back pain complex strategy, it is ineffective and may actually exacerbate the problem. Unless the pain is psychosomatic or psychogenic in origin, by using heat you may be making the problem worse, the reaction of the body may be an intense re-action, intensifying the pain instead of allowing for much needed relief.

Ultimately, the decision to use heat or ice is a personal one. However, if you want real and lasting relief, relief that will allow you to function all day and sleep at night, ice is the best neck pain, back pain, and sciatica treatment strategy. For relief in minutes, place an ice compress, either a brace or a plastic bag wrapped in a thin towel over the affected area and keep it in place for at least 30 minutes. Once removed, allow 30 minutes and then repeat making sure that with each application you are exposing the entire area to ice, as well as an area on all sides wide enough to ensure adequate coverage. By making sure you cover the entire area, and a significant portion of the non-affected area, you will achieve optimal results. I can’t tell you how many times I have fallen asleep with my brace still on, the relief can be that quick and complete. So, as a bad back strategy, heat should be avoided in almost every case. Ice is the best strategy for quick and complete relief from neck pain, back pain, and sciatica.

These are some of the programs I recommend. I hope they help you as much as they helped me!

Article Source: http://EzineArticles.com/?expert=John_Zajaros

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