Joint Pain

WHEN TO SEE YOUR DOCTOR

* Your joint pain is severe or unexplained.

* The pain lasts more than one week.

* The joint is hot, red or swollen as well as painful.

* You get no relief from the use of aspirin, ice packs or heat.

* You have recently injured the joint, particularly with a sharp blow.

What Your Symptom Is Telling You

Your joints usually serve you effortlessly—they glide like the parts of a miraculous machine through all the movements of your day. Then, one of these vital parts starts to hurt. What's going on?

It could be any one of a hundred things, says Robert Thoburn, M.D., a clinical associate professor of rheumatology at the University of Florida in Gainesville. But though joint pain has many possible causes, the major contenders are arthritis, rheumatism or an injury.

There are over 100 types of arthritis, including gout and rheumatoid arthritis. But the type that most commonly causes joint pain is osteoarthritis, sometimes called the wear-and-tear disease.

Osteoarthritis is the result of a series of small injuries that occur over a long period of time. Years of hard work and overuse (like constant typing or incessant use of one motion in a sport, such as a golf swing or tennis serve) cause tiny fractures in the joint's cartilage and underlying bone, and the joint begins to deteriorate. (Oddly enough, underuse through lack of exercise can also cause the problem.)

Rheumatism is the medical term for inflammations of the muscles, tendons, ligaments and bursae (tiny, pillowing sacs) that surround the bony part of the joint. This kind of pain—better known as bursitis or tendinitis—also results from the wear and tear of aging, or from overuse.

A single injury to a joint—such as a sharp blow or strain—can also cause joint pain, as can a torn cartilage or ligament. And sometimes the pain you feel may actually originate somewhere else. A healthy knee might hurt because of arthritis in the hip, for example. Or inflammation in the wrist from carpal tunnel syndrome might cause pain in the shoulder.

Arthritis can snake like ivy through your family tree. Can you bend your hand down and touch your thumb to your wrist like Uncle Edward? If you can, you may have inherited unusually mobile joints. While they come in handy in yoga class, hypermobile joints tend to wear out and become arthritic earlier because your extra-stretchy ligaments and tendons have trouble holding the joints stable.

Other causes of joint pain may include a viral or bacterial infection, a hormonal or nervous system problem or—rarely—certain types of cancer.

Symptom Relief

The most important approach to joint pain is to work with your doctor for the right diagnosis, ruling out any serious medical problems or infections, says Bill Arnold, M.D., a rheumatologist and chairman of the Department of Medicine at Lutheran General Hospital in Park Ridge, Illinois.

If your pain results from osteoarthritis, the most common cause of joint pain, your doctor will prescribe specific medications, injections or exercise.

If your doctor says you have gout or rheumatoid arthritis, you will be treated for inflammation (heat and swelling) in the joints as well as pain.

But no matter what the cause of your pain, there's a lot you can do on your own to relieve it.

Turn up the heat. "The more chronic your pain, the better heat is," says Dr. Arnold. "Heat helps to relax muscles around the joint." Moist heat is particularly effective, he says. Take a wet towel, put it in the dryer but remove it while the towel is still wet and hot. Then place it against the joint, putting a dry towel on top to keep the heat in. Or you can use a moist heating pad, wrapping it around the painful joint for 20 to 30 minutes.

Ice it. If you are suffering from a recent injury or from pain that has recently appeared, use cold instead of heat, says Dr. Arnold. "The sooner you put ice on, the better off you are. That's why baseball pitchers slap it on in the dugout," he says. Here's Dr. Arnold's recommendation for an ice pack: "Buy a one-to-five-pound bag of frozen peas or kernel corn and wrap it around the painful joint. You've got yourself an ice wrap. And then you can eat it for dinner." You can leave the ice pack on for 20 minutes at a time.

Rest what hurts. If you have pain in just one joint or area, like the knee or neck, use a brace or support to rest it, says Dr. Arnold. If many of your joints are involved, plan for 15 minutes of rest for every hour that you're awake. For ten hours of activity, you'll need one to two hours of rest. "Just put your feet up and relax," he says. (See specific joint pain entries for more information on dealing with pain.)

Mix your OTCs. Over-the-counter or nonprescription painkillers will ease arthritis pain, says Dr. Arnold. But be aware that steady use of anti-inflammatory drugs like aspirin and ibuprofen can increase your risk of an ulcer. Dr. Arnold suggests this solution: Say you find that if you take four aspirin tablets daily, your joint pain is relieved. Instead of taking four aspirin daily, take two aspirin and two acetaminophen tablets. This will reduce the quantity of anti-inflammatory medicines entering (and irritating) your stomach. Acetaminophen will not help with inflammation, but it is an effective painkiller that is easy for the stomach to tolerate, explains Dr. Arnold.

Explore your range of motion. For problems of the soft tissue around the joint, like bursitis and tendinitis, staying limber and flexible will prevent those tissues from tightening up and hurting even more, says physical therapist Kathleen Haralson of Washington University School of Medicine in St. Louis.

Each joint has its own natural range of movement, she explains, and each individual has to find the fine line between overuse and keeping it limber. "Listen to your body," she says. "Don't overstretch, just try to exercise in your normal range of motion several times a day, depending on how painful it is." For example, if you have a painful shoulder, raise your arm over your head until it hurts just a little bit. "You need to move the painful body part as far as you can, but do not force it," she says. "This is what a physical therapist would do with you."

Get your whole body moving. People have less pain in their joints when they exercise regularly at low to moderate intensity, says Haralson. Her top pick is swimming or walking in water. "Getting into hip-deep water and fast-walking to your capacity is wonderful," she says. Stationary bicycles, treadmills and low-impact aerobic dance are also good choices.

If your condition keeps you chairbound, you can still get a good workout, Haralson says. Sit in a chair, put on some moderate to fast-paced music and march with your arms until you work up a good sweat, she suggests.

Get a little assistance. "For people with arthritis or rheumatism, there's a device out there that can make your life a little less painful, especially for dressing, hygiene and kitchen activities," says Haralson. "These devices include zipper pulls, buttoners, long-handled shoehorns, long-handled combs, elastic shoelaces or Velcro fasteners. She also suggests using something to get your weight off the painful joint, like a cane, crutch or walker.

Try the antidepressants for anti-pain. Your doctor may prescribe tricyclic analgesics, also known as tricylic antidepressants, for musculoskeletal pain. These medicines may be very helpful for the insomnia and fatigue that often accompany rheumatism, says Sidney Block, M.D., a rheumatologist in private practice in Bangor, Maine. They're prescribed in smaller doses than those used for depression, and they are not addicting. "They relieve pain, help promote a good sleep pattern and can be used for long-term pain problems," says Dr. Block.

Get physical with a therapist. Ask your doctor about a prescription for physical therapy, suggests William Loomis, D.O., an osteopathic physician in Spokane, Washington, who also serves as president of the American Association of Orthopedic Medicine. Physical therapists treat the muscles and underlying ligaments around the joint by improving the joint's blood supply, which promotes healing. They can help you with range-of-motion exercises and also apply healing techniques such as ultrasound waves, which go deeper into the injured tissues than any at-home, self-help techniques, says Dr. Loomis.

See also Joint Inflammation; Joint Swelling