Interesting information regarding Chronic Pain experienced with the onset of Osteoarthritis. My research on this topic can be found at Arthritis-Health.com website. Numerous video clips on this subject matter are also available for viewing.
The most commonly reported symptoms of osteoarthritis include chronic pain and stiffness in affected joints, as well as limited mobility.
However, there is truly a wide range of osteoarthritis symptoms among patients, and the severity of symptoms does not necessarily correlate with the degree of joint damage. For example, a patient with a significantly degenerated joint may have fewer symptoms than a patient with only mild joint degeneration. For many, the symptoms come and go, often with long periods between flare ups. Note: I experience arthritic chronic pain in my shoulders when there’s a change in barometric pressure. These changes normally occur when the barometric pressure drops during hurricane or tornadic activity and when a cold front moves in.
Typical Signs and Symptoms of Osteoarthritis
For many, osteoarthritis pain may become markedly worse over time or with specific activities. Characteristic signs and symptoms of osteoarthritis include:
- Stiffness. A common marker of osteoarthritis is stiffness in the joint that is most pronounced first thing in the morning, or after a prolonged period of inactivity (such as sitting in a car or airplane). The stiffness usually resolves within 30 minutes of light activity, as the joints “warm up” through gentle movement.
- Pain. Another common symptom is pain in the joint that worsens during or after too much movement. The pain may be experienced as dull and aching, or sharp and piercing. In the most severe cases of osteoarthritis, patients may also feel pain when the joints are at rest or only moving slightly.
- Soreness. The joint may feel tender to touch or with slight pressure.
- Inflexibility. Patients may experience loss of full range of motion in the affected joint.
- Swelling. The joint may swell due to excess fluid buildup. This type of swelling is clinically referred to as effusion. If the swelling is severe, the joint may also feel warm to touch.
- Grating or creaking. There might be a sensation of grating or slight grinding when moving the joint, as the surfaces of the articulating points of the joint no longer move smoothly against each other.
- Is the grating or grinding sensation harmful? See What Is Crepitus?
- Bone spurs. Sometimes, bone bumps – which are points of the bone that grow outward as a result of the joint friction and dysfunction – can be felt under the skin. Bone spurs may also be referred to as osteophytes.
- Deformity. In some types of osteoarthritis, physical deformity may be noticeable. For example, enlarged finger joints may result from the friction causes bony enlargements of the finger joints, or advanced degeneration of knee cartilage can lead to an outward, or bowlegged, curvature of the knee.
While osteoarthritis pain is usually felt in the affected joint, for some patients the pain may be referred to other areas of the body. For example, hip osteoarthritis may lead to knee pain, or spinal osteoarthritis may affect nerves that cause pain, numbness or other symptoms in the part of the body that the nerve leads to.
When the hips or knees are affected, walking can be a significant source of pain, and accommodating pain may induce a limp. Pain can be felt in areas outside the damaged joints, including the buttocks, groin, or thigh and may vary in severity from a dull ache to a sharp pain.
Osteoarthritis pain is caused by a wearing down of the cartilage that serves as a protective shock absorber between the joints. Cartilage is important for minimizing the impact of everyday activities on the joints, but the intensive use also means that it is subject to high levels of wear and tear.
There is no single known cause of osteoarthritis, but several risk factors can serve as strong indicators for the disease when present. Patients are at greater risk of developing osteoarthritis if they have one or more of the following factors.
- Age. The single most common cause of osteoarthritis is aging, as use of the joint over many years is likely to lead to breakdown of cartilage. Osteoarthritis develops most often in people over age 50.
- Family history. Genetics can play a role in bone abnormalities that result in distorted shape and problems with joint alignment. This is apparent in cases of bowed legs or double-jointed abilities, both of which are more likely to lead to development of osteoarthritis.
- Obesity or excess weight. Weight-bearing joints are at risk for osteoarthritis in people who are significantly overweight. It is estimated that every extra pound of weight adds three pounds of pressure on the knees, and increases the pressure on the hips as much as six times. Because weight gain gradually increases stress on the joints, the onset of osteoarthritis symptoms may take many years to develop.
- Injury or overuse of the joint. Occupations or sports that require repetitive motion over a long period of time increase one’s risk of developing osteoarthritis due to increased stress on specific joints. Old injuries can develop into osteoarthritis, especially where a fracture or surgery has occurred. Overcompensation for injuries can also cause osteoarthritis to develop due to a modified gait or other activities.
Having a risk factor for osteoarthritis does not guarantee that the condition will develop. But the presence of a combination of risk factors produces the highest likelihood that a given person will develop the disease.
Osteoarthritis of the major joints is most effectively diagnosed through a combination of medical history, physical examination, and various lab tests including imaging studies such as X-ray. A primary care physician can diagnose most cases, but depending on perceived severity a patient may be referred to a specialist, such as a physiatrist or orthopedic surgeon, for further evaluation.
Medical histories can often be the most useful tool for physicians in diagnosing osteoarthritis. Practitioners will look for family history of the disease as well as the presence of various risk factors to indicate the need for further testing. A careful review of the patient’s symptoms is important to obtaining an accurate diagnosis.
A physical examination will usually follow the medical history as the physician looks for physical signs of the disease. These include swelling and tenderness of the joints, loss of movement in specific joints, or visible joint damage such as bony growths in the surrounding area. The patient may also be asked to perform a variety of physical tasks so the physician can evaluate range of motion and general joint mobility.
Laboratory tests are used to help confirm a suspected diagnosis of osteoarthritis if the diagnosis is otherwise in doubt.
- Joint aspiration or arthrocentesis. This diagnostic tool involves removing a sample of fluid from the joint for further examination, and can be used to rule out other conditions. Further testing can reveal the presence of crystals and also rule out infection.
- X-ray. An X-ray is used to provide a picture of potential joint damage, but is not the most reliable tool. Most patients over the age of 60 display joint degeneration associated with osteoarthritis, but only a third or this population report actual symptoms. For this reason, an X-ray is usually used to confirm a suspected diagnosis made through a physical examination and medical history.
- MRI. Magnetic resonance imaging techniques can be used to provide a more accurate picture of damage to the joint and remaining cartilage.
The above combination of medical history, physical exam, and possibly diagnostic testing, all inform the diagnosis of osteoarthritis.
The most effective step toward controlling the symptoms of osteoarthritis is obtaining an early diagnosis and starting treatment as soon as possible. Non-surgical treatments are often sufficient for the management of physical symptoms and the preservation of daily functioning.
Osteoarthritis treatment programs typically include a combination of medication and exercise therapy. I’ve found that a supplement Glucosamine Chondroitin to be beneficial in reducing joint pain and assist in regaining flexibility. Click here for recommended product selection. Our veterinarian recommended this product for our aging dogs. We have seen remarkable improvement in the mobility in our dogs daily life.
Drug therapy is used to manage physical symptoms, with a focus on relieving pain and slowing progression of the disease. Some commonly used medications include:
- Analgesics. Pain relievers, or analgesics, such as acetaminophen (e.g. Tylenol), or tramadol (e.g. Ultram) are used to relieve pain, but do not alleviate inflammation or swelling. Because they have few side effects, analgesics are recommended for patients experiencing mild to moderate pain.
- Topical analgesics. Topical analgesics are creams that can be applied directly to the skin over the affected area. The primary ingredients in these creams are usually counterirritants, such as wintergreen and eucalyptus, which stimulate the nerve endings and distract the brain from joint pain. Topical analgesics are available in most drug stores, and can be used in combination with most oral pain medications.
Physical therapy provides targeted exercises that help maintain the ability to perform everyday tasks such as walking, bathing, and dressing. Although rest is an important part of the healing process, it is important to keep up with moderate levels of activity to strengthen the muscles surrounding the damaged joint. Stronger muscles provide greater stability for the joint, which in turn helps reduce stress on the joint.
Occupational therapy may also be recommended to demonstrate appropriate modifications for everyday activities that may be causing pain.
Steroid injections are often performed if pain is moderate to severe and especially if the pain symptoms limit the patient’s ability to participate with exercises. When combined with physical therapy, steroid injections can offer a very important “window of opportunity” during which the patient may more fully participate with therapy because the pain is resolved or at least better controlled. By allowing the patient to participate with therapy, the patient may stretch and strengthen important muscles around the affected joint(s) and thereby decrease the load experienced by the joint(s) so that the inflammation and pain do not return.
Hyaluronic acid injections are another injection modality designed to help lubricate the joint and reduce the pain and inflammation of the joint. These injections attempt to help replace the joint’s natural fluid and are sometimes described as “paving the pot holes in the joint.” By reducing the inflammation and pain in the joint, as with steroid injections, a “window of opportunity” is opened up for the patient to stretch and strengthen the appropriate muscles. If the patient does not use this window, then often symptoms recur in 6-12 months at which point the injections can be repeated if necessary.
For most patients, osteoarthritis symptoms can be successfully managed through non-surgical care. For some, however, if they are experiencing severe joint damage, extreme pain, or very restricted mobility, surgery may be a viable option. Common types of surgery for osteoarthritis of the hip or osteoarthritis of the knee include arthroscopic surgery, osteotomy, and arthroplasty (total joint replacement).
While the potential benefits of surgery, such as improved movement and pain relief, can be enticing, it is important to remember that any surgery comes with risks. These risks are higher for patients who are overweight or have other co-morbidities, which is a concern for many osteoarthritis sufferers.