and NSAIDs (non-steroidal anti-inflammatory drugs) are typically a first line of defense against the hallmark symptoms of arthritis: inflammation and the dull, persistent ache of damaged joint tissue. Fortunately, medications have gotten better over the past decade. That’s thanks largely to the debut of biologic response modifiers (often called biologics) like Humira (adali- mumab) and Enbrel (etanercept), which treat dif- ferent types of arthritis and work by blocking the chemicals that trigger inflammation. Also, new sur- gical techniques and materials are part of physicians’ arsenal, like meniscus transplants used in knee ar- throscopy to slow the progress of OA, and new ma- terials such as highly cross-linked polyethylene, a long-wearing, flexible polymer used to replace dam- aged joints. This all makes for a much brighter picture for those hoping to ease their arthritis pain and slow the condition’s progress and damage. Even better, there’s a lot you can do on your own
to take control, says Dennis Boulware, M.D., a rheu- matologist in Honolulu, and a member of the board of the American College of Rheumatologists. “Pa- tients often have more power than they think they do to change the way they feel.” Relief from arthritis shouldn’t be all about medical treatment, not by a long shot: A December 2009 study published in the journal Arthritis & Rheumatism suggests that a com- bination of medication and lifestyle changes could significantly reduce the annual cost of treating OA alone. Here are five proactive ways you can start eas- ing your aches—and protect yourself against more pain in the future.
talk about it.
Even when you don’t have anything nice to say about how you’re feeling, speak up anyway. In a 2006 study, fewer than half of participants with osteoarthritis said they had talked to their rheumatologist about pain-relief options during their last visit. “Your rheu- matologist won’t know your medication isn’t working or your pain regimen isn’t giving you the relief you need unless you tell him,” says Carmen R. Green, M.D., a pain specialist at the University of Michigan Health System’s Center for Interventional Pain Med- icine, in Ann Arbor, Michigan. The “best” way to treat your arthritis symptoms isn’t written in stone; it changes over time and better relief may be as simple as switching from one analgesic to a different one, or trying a new exercise plan. Holly Roberts, who was diagnosed with rheumatoid arthritis (RA) in 2004, remembers feeling so caught up in trying to find a reason for her pain (it took four years to get an accurate diagnosis) that she didn’t look for a solu-
36 PAIN RESOURCE FALL 2012
Every 10 pounds of excess weight you lose takes 30 to 60 pounds of pressure off your knee joints.
tion to it. Finding relief got a lot easier when she described her symptoms to her physician in detail. “I finally mentioned to my doctor that I had trouble driving in the morning and he recommended a seat pad and a change in the time I took my morning pain pill,” says Roberts, 40, a graphic designer living in Branson, Missouri. “It took five months for me to mention the problem, and five minutes to solve it.” In short, the more information you can give your doctor and other healthcare providers, the more likely it is they’ll be able to work with you on a pain- care plan that successfully manages most or all of your joint pain and inflammation. So start, and keep, the conversation going with your doctor.
pay attention to posture.
“People have to accommodate their arthritis, and sometimes they make accommodations in ways that make the problem worse,” says Dina L. Jones, as- sistant professor in orthopaedics and physical ther- apy and director of clinical research in the department of orthopaedics at the Robert C. Byrd School of Medicine at West Virginia University, in Morgantown, West Virginia. Someone with OA in their right knee, for example, may compensate by putting pressure on the joints of the left leg, which can eventually cause those joints to deteriorate. Allen Baird kept his hip OA under control with COX-2 inhibitors, a type of NSAID, and occasional cortisone shots dur- ing severe flares. But the 60-year-old salesman from Hoboken, New Jersey, couldn’t understand why his back hurt constantly. A physical therapist quickly spotted the problem: Baird had developed a habit of shifting pressure to his left hip in order to protect the joint in his right hip, twisting his spine in the process. “I had to learn how to stand and sit and move in a completely different way—and my back stopped hurting,” he says. “Now when I have back pain, I know how to solve the problem.”
keep costs under control.
Simply put, treating arthritis has never been more expensive. The CDC estimates the average annual cost of medical treatment alone for U.S. arthritis patients is more than $80 billion, and spending on drugs to treat it more than doubled between 1997 and 2003, according to a 2007 study in Arthritis and Rheumatism. In terms of the hit to your own bank account, a lot depends on the medication(s) you’re on. If, for example, you take Celebrex (celecoxib), an NSAID for OA pain, the annual average cost is $1,584 a year. On the other hand, Enbrel, which has shown incredible success in treating RA, costs $1,521