JOINT PAIN

Joint pain can range from mild to severe, and it can make moving the joint impossible. A joint is anywhere two bones or more connect together.

Joint pain may be acute, sharp or sudden, and arise from an injury or trauma. It can, also, be chronic, coming on gradually, and related to an underlying condition. An injury or trauma may turn into a chronic pain condition as well, however. If pain starts as an injury and doesn’t begin to alleviate within 48 hours to a few weeks, there may be an underlying condition.

There are different types of joints, and most are related to movement. The back and neck have spinal bones (vertebra), and each vertebra has two facet joints, which connect the vertebrae together. They allow for limited spine movement. The majority of joints in the human body are synovial joints, meaning that they are filled with synovial fluid.

Acute joint pain often occurs in the synovial joints, such as the knees, hips, shoulders and hands, because these joints allow for the most movement. Back and neck pain are, also, a common source of joint pain.

Most acute joint pain, occurring from injuries, can be treated at home with anti-inflammatory drugs (Ibuprofen) and by applying ice, periodically, to the injured joint.

Joint pain occurring from an injury or trauma that results in intense pain, excessive swelling, joint deformity, or inability to use the joint, needs immediate medical attention.

There are many causes of joint pain. Some Common Causes include:

Osteoarthritis
Rheumatoid Arthritis
bursitis
gout
Sacroiliac joint disease
Injury or trauma

Pathology

Osteoarthritis

Osteoarthritis is most common cause of joint pain in the United States. Known as the “wear and tear” arthritis, it occurs over time and is often attributed to the aging process. It is a chronic and progressive condition caused by the thinning of bone cartilage and the formation of bony spurs (osteophyte) in the joint spaces. Most individuals have some level of osteoarthritis by the age of 70 (Brasington). The specific cause of Osteoarthritis is unknown, and it is not just a disease of aging. It is, instead, the result of a combination of factors including genetics, joint degeneration, and other mechanical processes (Kalunian).

Rheumatoid Arthritis

Rheumatoid Arthritis (RA) is a form of arthritis caused by an auto-immune disorder that causes the body to attack its own joint tissues. The subsequent continuous attack causes joint degeneration and pain. This disease can be severe, but there are many treatments today.

Bursitis

Bursitis is related to the bursa. These are the small sacs of fluid that cushion the area between a tendon and a bone. The most common places where bursitis is felt, are in the elbow, shoulder, and hip. Bursitis can, also, appear in the knee, heel and the base of the big toe, but the aforementioned locations are the most common. Bursitis occurs in joints that perform frequent repetitive motion.

Gout

Gout is characterized by sudden, severe pain (usually experienced at night), redness and tenderness in joints of the knees, legs, or the base of the big toe. This condition occurs when urate crystals build up in a joint, causing the inflammation and intense pain of a gout attack.

Sacroiliac Joint Disease

Lower back pain often is related to the Sacroiliac joint, which links the lower spine and the pelvis together. There are several ligaments and muscles that support these joints, and they are located on both sides of the lower back. As we age, the joint will sometimes fuse together, and in some cases, arthritis develops in the joint.

Injury or Trauma

Injuries from sports, falls, and auto accidents are common causes of joint pain and/or injury. An acute injury may occur during the activity; or it may build gradually after the injury worsens over time. This turns the initial injury into a common condition.

Diagnosis

If you have any of the following, seek medical attention:

Severe pain
Redness, swelling and tenderness
Heat in the joint area
Any Pain that doesn’t resolve or alleviate in 48 hours to four weeks.

At the time of the appointment, your physician will take a medical history and perform a physical assessment of the painful joint. Additional questions about when the pain started, where it is located, and what, if any, injuries have occurred, will all be valuable information f or an accurate diagnosis. After the initial visit, your doctor may order one or more visual tests. These may include an X-ray, Computerized tomography (CT) scan, Magnetic resonance imaging (MRI) or a Bone scan. MRIs are especially useful before any procedures are performed.

Treatments

Please see a physician before beginning any treatment plan.

Medications

Medications are the recommended and first treatment choice for managing most joint pain. Over-the-counter non-steroidal anti-inflammatory medications, known as NSAIDs, (Ibuprofen, and Aleve) are tried first. Prescription NSAIDs, like Celebrex, ma, also, help arthritis-related joint pain. Anti-inflammatory medications reduce the inflammation, which is often the root cause of pain in joint injuries.

“NSAIDs are effective against mild to moderate pain, and are important for the Management of both acute and chronic pain” (Brennan).

Exercise

Some exercises can be beneficial for those with joint pain. Swimming, walking, and yoga are all examples of exercises that are low-impact, and that add minimal stress on the joints and help maintain motion.

Physical Therapy

A course of physical therapy may help with joint pain by improving, and sustaining, range of motion. A physical therapist can create an exercise program catered to an individual patient’s abilities, limitations, and goals.

Joint Injections

There are many types of joint injection procedures. Some are common and minimally invasive non-surgical procedures used to treat joint pain, in many joints in the body. They are, especially, effective in the hips, knees, shoulder, back, and neck.

Joint injections are sometimes useful as a diagnostic tool. If an injection produces pain reduction, then the location and source of the pain can be more easily deduced.

Many patients with joint pain experience relief through these injections. Injections are combined with cortisone (steroid) and a short-term local anesthetic (lidocaine, bupivacaine). The local anesthetic works to interrupt the pain cycle, and the corticosteroid reduces inflammation in the joint and is more long term. Multiple joint injections may be ordered to improve a patient’s range of motion and quality of life.

Medial Branch Blocks (MBBs) are a type of joint injection for chronic neck and back pain. Radiofrequency ablation (deadening the nerve) may be part of the procedure. The process is an injection of medications that reduce inflammation and irritation of the facet joint and the related nerves.

Evidence suggests that therapeutic lumbar MBBs with local anesthetic and steroids, may be effective in the treatment of chronic low back pain within the facet joints (Manchikanti 2007).

Replacement Surgery

Joint replacement surgery is considered the last option and used when other treatment options have failed. The most common kinds of replacements are for the hips and knees. The replacement may be total or partial replacement and is aimed at relieving severe and painful joints. The recovery time after surgery is often long, and there is a higher potential for complications and risks than with less invasive treatment options.

For more information about joint pain or other items mentioned, please see your pain physician.