Beyond Arthritis Pills Other Therapies That Work

I’ve talked with you in the past about using supplements like glucosamine sulfate and chondroitin sulfate for the pain of osteoarthritis instead of taking traditional pain killers or anti-inflammatory drugs. But if you have arthritis there are other therapies you can, and should, use as well – no matter which form of medication you take.

Since arthritis results in pain along with limited joint function, just taking something for the pain does nothing to help your joints move.

Two doctors from Gainesville, Florida, Shahid Zeb, MD, and N. Lawrence Edwards, MD, have examined the area of non-drug therapies for people with osteoarthritis. They stress the importance of becoming more educated about your disease. The Arthritis Self-Management Program, given through the Arthritis Foundation, can provide you with a better understanding of various types of arthritis and treatment protocols. This national organization has 150 chapters throughout the country. You can find them online at http://www.arthritis.org, or look in your phone book for a local chapter.

Lose Some Weight
If you weigh more than 10 percent of your ideal weight, losing weight could decrease your risk of getting arthritis in the knee by as much as 50 percent. If you already have arthritis in your knee or hip, losing weight will reduce your pain substantially. But this is easier said than done. Weight loss combined with exercise works best, and the pain and inflammation from arthritis often don’t permit the type of exercise that would encourage weight loss.

You may need to work with a nutritionist or dietician – or use some other techniques – to successfully lose weight. One simple step is to eat smaller portions and chew them well. Then wait 15-20 minutes before asking yourself if you’re still hungry. Often, you’ll find you’ve had enough, and you can cut back on calories without feeling deprived. Emotional support helps tremendously, so team up with a friend who has similar goals and work on a program together.

Exercises That Help Range of Motion
Arthritis limits your range motion (ROM) and often leads to weak muscles that tire easily. It places restrictions on simple daily tasks like reaching for something in a cupboard or zipping up a dress. When you do regular exercises to increase ROM, you’ll have more mobility along with less pain and fatigue. Depression lessens, too, since even small improvements are encouraging. Drs. Zeb and Edwards suggest the following regime for ROM exercises:

• Exercise during the part of the day when your pain and stiffness are least.
• Use heat for mild or chronic pain.
• Use cold packs for inflammation.
• Exercise in the evening to decrease your stiffness the next morning.
• Do gentle stretching to avoid increased pain.
• When you have an inflammation, do a little less —— but do something if you can.

Strengthening Exercises
If your arthritis is moderate to severe, or if you’re not used to exercising, begin with isometric exercises to strengthen muscles around your arthritic joints. Isometric exercises use a constant tension instead of movement. Strengthening exercises help your stability and guard against injuries from falls. The exercises outlined by Robert Swezey, MD, the rheumatologist who developed the OsteoBall, are isometric (800-728-2288). Not only do they help reverse osteoporosis and frailty, they strengthen your muscles as well.

Exercises that cause joints and muscles to contract and relax are called isotonic. These may be done with elastic bands, free weights, and even machines. Even aerobic exercises are appropriate for some people. If walking is too painful, try aquatic exercises. Often, the reduction in gravity from exercises done in a pool can increase your range of motion without causing flare-ups or damaging your hips or knees. Another benefit of aerobics is increased weight loss and a cardiovascular workout.

Check with your doctor first about the appropriate type of exercises for you to do. Then make sure a physical therapist or someone who understands your needs and limitations supervises any exercise program you go on. It’s important to get this expert information since some exercises can have negative effects. For instance, Drs. Zeb and Edwards caution against doing isometric exercises if you have hypertension.

Heat or Cold? Which Is Best?

Traditionally, cold packs are used for the first day or two after an injury and heat is indicated when you have chronic pain and stiffness. But people are different. I know a woman in her 90s who swears by cold packs although she has had osteoarthritis for decades. If you’re using hot packs, understand that the heat only penetrates a few millimeters, so you need to apply heat for about 20 minutes for the best results. Ask your doctor about deep heat treatments using a diathermy machine or ultrasound. Many rheumatologists have these machines in their offices.

What’s New?

Another machine – one you can use at home – is called a TENS unit (transcuteneous electrical nerve stimulation). These machines block your low frequency chronic pain by emitting a high-frequency pain. So it works as a counter-irritant. It can relieve you of pain temporarily, but its effects are short- lived. Still, for someone in constant pain, even a short respite is welcome.

A giant step up from TENS units is a small device called the Alpha-Stim 100. Daniel L. Kirsch, PhD, developed it in the early 1980s and a colleague of mine, Fred Lerner, DC, PhD, used it in his chiropractic practice from its inception. Dr. Lerner and I worked in the same office, and I was treated successfully with this unit many times. I also saw that many of his patients were helped by it. The Alpha-Stim 100 combines microcurrent electrotherapy with a cranial stimulator. It actually treats pain in the brain, where it originates. In addition to stopping pain signals, this device treats stress, anxiety, depression, and insomnia.

You know that chronic pain affects your mood. Well, the Alpha-Stim 100 works on your mood as well as your pain – and the effects are much longer lasting than with a TENS unit. In a recent survey, Electromedical Products International, the company that makes this device, found that 94 percent of users found the Alpha-Stim 100 significantly improved their pain from arthritis, and 91.5 percent had significant improvements in their psychological outlook.

To get an Alpha-Stim 100, you need a diagnosis from your licensed health care practitioner (MD, chiropractor, osteopath, acupuncturist, etc.) and a prescription. If your prescription is from an MD you may be able to get reimbursed by your insurance company (it depends on your policy, says Dr Kirsch).

Different devices may work differently, and your doctor may already know of another one that he or she feels would be more appropriate for you. TENS units and the Alpha-Stim 100 can be expensive (the Alpha-Stim 100 is $735 —— but it works beautifully), so call and ask for information on it first and discuss it with your doctor (Electromedical Products International, 800 367-7246 or http://www.alpha-stim.com).

Topical Creams
A number of topical creams containing capsaicin, which is an ingredient in cayenne pepper, are available in over-the-counter products you can find in drugstores. These creams do help many people and are safe to use. Double-blind studies have found them to be effective in reducing the pain of arthritis. The creams act by intercepting pain signals sent to your brain when joints are inflamed.

Pain interrupts our lives. It causes fatigue and shuts down our ability to think clearly. It leads to chronic depression, lowering the quality of our lives. Everything we do becomes more of an effort, so we tend to do less, which perpetuates the cycle. You may be caught in this downward spiral, doing little or nothing to change it because your past efforts have yielded few if any results. But if you have chronic pain from arthritis, you may be able to further reduce it with some of these techniques. You’re worth the effort.

Zeb, Shahid and N. Lawrence Edwards, “Osteoarthritis: nonpharmacologic therapy,” Clin Rev, Summer 14-17, 1998.

Deal C.L., T.J. Schnitzer, E. Lipstein, et al. “Treatment of arthritis with topical capsaicin: A double blind trial.” Clin Ther. 1991;13:383––395.

McCarthy G.M., D.J. McCarty. “Effect of topical capsaicin in the therapy of painful osteoarthritis of the hands.” J Rheumatol. 1992;19:604-607.