Arthritis Pain: NONPILL therapies

Arthritis pain: NONPILL therapies

By Jacques Gerard Berube, MD (Laval University, Canada, 1996)

1.  Topical (local) medications: 

The best treatment I recommend for almost 25 years is Arnica Cream. Also available: gels, creams or patches of lidocaine and, creams with acetyl-salicylic content. They all have an immediate direct action.

Except Arnica, topicals, with acetyl-salicylic content, cause a lot fewer gastro-intestinal risks than oral non-steroidals (aspirin and others). Some patients may have irritation or cutaneous sensation. Arnica does not contain acetyl-salicylic acid, so no gastrointestinal side effects. Arnica cannot be used on an open wound.

2.  Transcutaneous electrical nerve stimulation (TENS):

TENS involves hook up to a pocket-sized, transportable machine that sends electrical current to painful spots, via wires connected to electrodes placed on the skin. TENS is effective in treating any kind of arthritis pains. You can’t use it if you have got a pacemaker, infection or open wounds.

Various studies report a significant effect (placebo or not) in 70% of patients.

For the price-quality ratio: Bluetens is to recommend.

3.  Physical exercises:

Exercises designed to boost posture, strength, function and to cut back pain. It boosts energy and mood still. The patient begins a program of strengthening, stretching and aerobic exercise by seeing a healer double per week for twelve weeks. Overdoing exercise is often a risk. Don’t exercise through pain. High-impact activities like running and jumping might worsen joint health and increase your risk of injury. You will be better to stay with low-impact sports like swimming, aerobic exercise and cycling. But get a move on; some may move less for fear of increasing their pain, which allows muscles to atrophy and negatively impacts mood and sleep.

4.  Heat / Cold:

You'll apply heat with heating pads, heat compresses, heat patches or heat baths. Cold can be any cold pack or ice pack. Heat works by increasing the blood flow to the painful spot. Cold reduces swelling and inflammation by constricting the blood vessels. Cold works best for inflammation caused by injuries like sprains, strains and force muscles and ligaments. Heat will worsen an acute injury sort of a muscle sprain or strain, creating the swelling and inflammation worse. And overdoing either heat or cold will cause burns; never apply to reveal skin. 

5.  Lidocaine injection:

A doctor injects lidocaine into muscle. An injection will relieve pain for weeks or months. You shouldn’t have the injections over fourfold a year. Too several produce connective tissue, which may interfere the muscle’s ability to contract, ultimately inflicting a lot of pain. This technique was taught to me 25 years ago in Honduras by a learned colleague, a doctor in Copan Ruinas.

6.  Meditation:                                                                                 Meditation is the practice of developing a deep concentration. Meditation stimulates the vagus nerve and allows a return to calm.

Stress produces chemicals within the body that increase inflammation. With relaxation techniques, you have got stress reduction and thus decreased inflammation and fewer pain. For moments of acute pain, take 10 deep breaths, very slowly, five times a day can decrease depression.

7.  Transcranial Magnetic Stimulation:

It has been proven for some pain but its cost is currently prohibitive. There are risks of addiction, currently under study.

8.  Bioelectronics medicine:

The British pharmaceutical group GlaxoSmithKline (GSK) announced, on August 1, 2016, the creation of a joint venture with Verily Life Sciences, a subsidiary of Alphabet (Google). The group plans to launch bioelectronics implants within 10 years.

Bioelectronics could be used in the treatment of several diseases: asthma (to prevent contraction of the lungs during crisis), inflammatory disorders such as arthritis (relief of inflammation) and metabolic and endocrine disorders such as diabetes.

9.   Cabbage leaves:

 Applied locally, provide a reduction of pain during application. 

10. Turmeric:

 This spice has been touted as anti-inflammatory. A study published in 2018 in BMC Complementary & Alternative Medicine found that adults with knee osteoarthritis who took 325 to 350 mg a day for 12 weeks reported less pain and stiffness. Turmeric can interact with some medications, such as blood thinners.

11. Massage:

 A 2017 review of 7 studies in the American Journal of Physical Medicine & Rehabilitation found that although massage appears to help, better research comparing it with other therapies is needed. Make sure your therapist has experience with sensitive joints. Massage improve circulation, and help relax muscles that may be putting pressure on nearby nerves.

12. Sleep:

Design strategies to sleep better, such as sleep in a dark, quiet room and limiting the use of devices. No pet in your bed. Some percale sheets are welcome. Adjustable bed frame. Pillow-top mattress with use of heat-reducing materials. If you are worried about dust-mite allergies, you can use a dustproof or allergen- impermeable cover to protect against these creepy-crawlies. Get the right mattress, depending on whether you sleep mainly on the side or on the back. Have your own pillow according to the best comfort. A stomach sleeper can convert to a side or back sleeper.

13. Cognitive behavioral therapy:

The therapist can teach a patient to identify thoughts and behaviors that worsen pain, and replace them with new thought patterns designed to calm nervous system and relieve pain.

14. Fish oil:

Fish oil has strong anti-inflammatory effects and can help reduce symptoms of inflammatory diseases. 

15. Virtual Reality:

VR causes the production of endorphins, which calm the pain even when the session is over. Compared to other techniques such as meditation, which requires a lot of training and effort, VR allows you to travel far away from it all by simply putting a VR headset on your head.

NOTES:

1) Cannabidiol (CBD):  I don’t recommend CBD.

Chemical compound that comes from marijuana or hemp, but does not get users high. Found in oils, creams, tinctures, vapes and more. Often touted as a panacea for a variety of health conditions, including chronic pain. It is just too much overstated. No good research that looks specifically at CBD. No firm evidence that using it has benefits and is safe. Herbicides? Pesticides? Heavy metals? Various chemicals?

A 2017 study in Journal of American Medical Association (JAMA) found that only 26% of CBD products purchased online contained the amount of the compound claimed on their labels.

In UK, a recent report (July 2019) by industry body the Centre for Medical Cannabis blind-tested 30 products advertising themselves as CBD, bought on the High Street and online. It found almost half (45%) had measurable levels of THC (which does have mind-altering effects).

What water is used to grow plants? Administrations themselves do not test water for ARSENIC. They rely on the results provided by the companies.

In short, our boat is adrift, as in 1960, with the cigarette. At that time, everyone, including manufacturers, did not know the deadly effects of smoking. 

2) I don’t recommend Corticosteroid injection and Hyaluronic acid injection. Long-term performance is better for manufacturers than for patients.

3) I totally disapprove of Acupuncture. It's a very dangerous Russian roulette game for the patient. We have the TENS that I call modern acupuncture.

4) I don’t recommend Peripheral nerve stimulation because of the risk of infection and nerve injury, like acupuncture. A doctor needs to implant an electrode under the skin.

5) Any opioid (synthetic origin) or opiate (natural origin) should be avoided, due to the risk of disastrous dependence.

6) Side effects for ibuprofen can include heart attack or stroke, stomach bleeding and kidney disease.

7) Stimulation of the vagus nerve is mainly intended for the symptoms of "rheumatoid arthritis", an autoimmune disease different from arthritis. See "Bioelectronics medicine" above. 

At the time of writing this blog (2019), there are 2 external stimulators on the market: Gamacore and Stimex to connect on Tens Eco2.