Joint pain

• Pain and tenderness around the joint
• Redness, warmth, or swelling around the joint
• Joint stiffness
• Reduced range of motion of the joint
• Feeling of locking sensation, where the joint feels locked in a particular position
• Severe pain that may radiate to surrounding body parts
• Weakness of the muscles surrounding the joint

There are various causes of joint pain, such as:

• Injuries: Injuries to the joint, such as contusions, ligament sprains or tears, fractures, joint dislocations, and soft tissue injuries, that occur due to trauma can cause acute joint pain.
• Infections: Infections can occur in the joint as a complication of injury or internal infection, such as septic arthritis and osteomyelitis. This may lead to redness, swelling, warmth, tenderness, and acute pain in the affected joint. Infections may also be chronic, such as tuberculosis infection of the joints.
• Degenerative changes: Degenerative changes occur due to age-related wear and tear of the joint surface, cartilage, and surrounding soft tissues. Degenerative changes of the joint, known as osteoarthritis, are the most common cause of joint pain. Osteoarthritis most commonly affects the knees, hips, spine, and hands.
• Chronic inflammation: Repetitive mild trauma to the joint and surrounding structures can cause chronic inflammatory changes, such as tendinitis and bursitis. Certain diseases also cause chronic inflammation in the joints, which is an important cause of joint pain, like gout.
• Systemic Diseases: Systemic and genetic diseases associated with involvement of the bones and joints that cause joint pain include:
  • Ankylosing spondylitis: A disease with a genetic predisposition that affects the spine.
  • Fibromyalgia: A chronic condition characterized by widespread musculoskeletal pain.
  • Avascular Necrosis: A condition in which blood supply to the joints is affected, leading to the death of bone tissue. This commonly affects the hip joints.
  • Bone Cancer: Osteosarcoma, leukemia, and other types of bone cancers that spread to bones and joints can cause severe joint pain.
  • Paget’s Disease: In this disease, the bones become abnormally shaped and brittle, which can cause severe joint pain.
  • Rickets: A deficiency of vitamin D that causes the bones to weaken and may lead to joint pain.
• Autoimmune disorders: Certain autoimmune diseases can involve joints and cause joint pain, including:
  • Rheumatoid Arthritis: A condition characterized by chronic inflammation, stiffness, and deformity of the joints. It commonly affects the small joints of the hands in the initial phase of the disease.
  • Systemic Lupus Erythematosus: An autoimmune disease that causes inflammation and pain in multiple joints, along with involvement of other organ systems of the body.
• Miscellaneous causes: Other causes of joint pain include viral fever, Lyme disease, sarcoidosis, and juvenile idiopathic arthritis.

• Previous injury to a joint
• Repeated use and/or overuse of a joint and muscle
• Chronic medical conditions associated with arthritis
• Old age
• Depression, anxiety, or stress
• Overweight
• Poor nutritional health
• Immunocompromising diseases

The following evaluations are performed by the doctor to evaluate joint pain and establish a cause:

• History and Physical Examination: The doctor will take a detailed history of the onset of symptoms, perform a thorough physical examination, and check for joint stiffness, inflammation around the joint, joint mobility, muscle spasms, muscle strength, etc., to evaluate the affected joints.
• Imaging Studies:
  • X-Rays: X-Ray studies of the affected joint are performed to evaluate the bony changes in and around the affected joint. Based on the location of the pain, your doctor may advise you to go for:
    • X-Ray Both Knee Standing AP & Lateral Views
    • X-Ray Hip Joint AP View
    • X-Ray Cervical Spine AP & Lateral
    • X-Ray Lumbar Spine AP & Lateral
    • X-Ray Right Ankle AP & Lat View
    • X-Ray Right Wrist AP & Lat View
  • MRI: MRI scans of the affected joints are performed to conduct an in-depth study of the bony and soft tissue changes occurring in the affected joint. These include:
    • MRI Both Knee Joints
    • MRI Both Hip Joint
    • MRI Screening of Whole Spine
    • MRI Ankle Joint
    • MRI Shoulder Joint
  • Other Imaging Studies: Bone Densitometry Whole Body - to check for concomitant osteoporosis, a condition where the bones lack calcium and become brittle and weak.
• Laboratory Tests:
  • Complete Blood Count (CBC), Erythrocyte Sedimentation Rate, C-Reactive Protein Quantitative to detect any ongoing infection or inflammation in the body.
  • Serum Uric Acid in suspected Gout.
  • Anti Nuclear Antibody to check for auto-immune diseases.
  • Rheumatoid Arthritis Panel in cases of suspected Rheumatoid Arthritis. It consists of three tests - antinuclear antibody, anti-cyclic citrullinated peptide antibody, and rheumatoid factor.
  • HLA-B27, PCR in case of suspected ankylosing spondylitis.
  • Serum Calcium - to check for calcium deficiency which plays an important role in bone and joint pains.
  • Vitamin D (25 - OH) - to check for Vitamin D deficiency which is crucial for absorbing calcium into the body.
  • Other tests like synovial fluid analysis, tissue biopsy, etc., may be performed for certain conditions.

Certain conditions that cause joint pain cannot be prevented. However, several strategies can help prevent the occurrence of severe joint pains and maintain overall joint health:

• Follow a healthy diet rich in calcium and other essential minerals.
• Ensure adequate exposure to morning sunlight for sufficient Vitamin D levels in the body.
• Engage in regular exercise to maintain strength and mobility in the joints.
• Practice correct ergonomics while lifting weights and exercising.
• Avoid sudden, jerky, and twisting movements of the joints.
• Weight loss can reduce strain on the joints.

Depending on the cause and severity of the joint pain, your doctor may advise you to take medications to relieve the pain or consider surgery.

Medical Management

This involves the use of medications to relieve symptoms and treat the underlying cause of joint pain, such as arthritis or gout. In some cases, medications to improve overall bone and joint health can be prescribed.

Symptom Relief

• NSAID Analgesics: Help relieve pain and inflammation. These medicines must always be consumed with meals, as taking them on an empty stomach can irritate the gastric lining. Common drugs include Ibuprofen, Diclofenac, and Paracetamol.
• Narcotics (Opioids): Tramadol and morphine may be required for severe pain not relieved by first-line medications. These tablets must be used only as prescribed by the physician, as they are potentially habit-forming.
• Muscle Relaxants: Help relieve painful spasms and stiffness associated with osteoarthritis of the spine. Examples include Cyclobenzaprine.
• Corticosteroids: May be prescribed for a short duration or as an injection to address resistant pain. These include drugs containing prednisolone.
• Topical Applications: Analgesic ointments (e.g., diclofenac), sprays, and rubefacients can help with symptomatic pain relief.
• Dietary Supplements: Glucosamine, calcium, and vitamin D3 may aid in improvement.
• Intra-articular Injections: For severe pain unresponsive to medications, a hydrocortisone injection may be administered in the joint for quick relief. In some cases, hyaluronic acid injections are also given to aid joint lubrication.

Treatment of Underlying Cause

• Rheumatoid Arthritis: Disease-modifying anti-rheumatic drugs (DMARDs), such as Methotrexate and Leflunomide, are used to treat rheumatoid arthritis.
• Gout: Allopurinol and colchicine formulations are used to treat gout.
• Arthritis: Antibiotics are used to treat septic arthritis.

Surgical Management and Other Invasive Procedures

This may include the use of injections to relieve pain or corrective surgeries to improve the condition. Joint replacement surgery is another common procedure used to treat joint pain.

Corrective Surgery

Corrective surgeries, such as synovectomy, osteotomy, laminectomy, spinal fusion, and fracture reduction, are performed in cases of severe joint deformities that limit function and cause pain.

Joint Replacement Surgery

For severely damaged knees and hips, a prosthesis may be fitted, replacing worn-out joints with mechanical joints. This can be done for hip, knee, and shoulder joints. The surgeon removes parts of the patient’s bone and implants an artificial joint made from metal or plastic. This procedure has shown excellent results, and the majority of patients experience long-lasting pain relief afterwards.

Along with medications, the following home care tips can help manage symptoms and lead to the best possible disease outcomes:

• Take a wholesome, balanced diet rich in calcium and other minerals.
• Follow the exercise routine suggested by the doctor or physiotherapist.
• Hot fomentation or icing (as applicable) and application of topical analgesic preparations help relieve pain and stiffness.
• Gentle massage performed by a massage therapist can aid relaxation and promote pain relief.
• Use joint supports, such as knee caps, cervical collar, lumbosacral belt, wrist cuffs, etc., to help support the frail joints.
• The use of walking aids, such as a cane or walker, may help offload the diseased joints, promote safer walking, and offer pain relief.
• Avoid lifting heavy weights. When weight training is a part of an exercise program, it must be done with extreme caution and correct ergonomic posture.
• Change the mattress and sleeping pillow if they do not provide proper support, and use those that stabilize the spine.

If joint pain is left untreated, the following complications can occur:

• Complete loss of mobility and extreme stiffness in the joints, rendering a patient bed-ridden or causing severe walking issues.
• Deformities in the hands can hinder skillful activities, such as writing and sewing.
• Chronic debilitating pain may hamper a patient’s quality of life, interfere with sleep, and contribute to anxiety or depression.
• Infection in the joints may spread to surrounding areas and could lead to septicemia.

Along with medicines and topical analgesic preparations, various other treatment options help manage joint pains:

• Exercise and yoga: Regular exercises and yoga focused on strengthening the joints and surrounding musculature, and improving mobility help manage the pain and stiffness caused by arthritis and other joint conditions.
• Massage: Gentle massage improves blood flow to the affected areas, promotes relaxation, and aids in pain relief. Massage should only be performed by a qualified massage therapist.
• Physiotherapy: Physiotherapeutic modalities, such as Interferential Therapy (IFT) and Transcutaneous Electrical Nerve Stimulation (TENS), are effective in providing pain relief, including from nerve pain. IFT and TENS use electric currents applied via electrodes directly over the joint to stimulate the surrounding nerves and muscles, leading to muscle relaxation and inhibition of painful sensations. Rehabilitation exercises focus on strengthening and correcting weight-bearing of the joint and surrounding muscles, improving overall strength and mobility.
• Acupressure and acupuncture: Chronic joint pain may respond to acupuncture or acupressure therapy, which involves applying pressure or noxious stimuli on peripheral trigger points. These therapies should be performed by a qualified therapist or under their supervision.
• Ayurveda: Various Ayurvedic preparations, including oils and liniments such as menthol and camphor oil, sesame oil, etc., can be applied locally at the site of pain. They provide good relief from symptoms and promote joint health.
• Homeopathy: Homeopathic preparations, available in the form of injections or oral drops/pills, such as Rhus Toxicodendron, Arnica Montana, and Solanum Dulcamara, are known to improve pain and other troublesome symptoms associated with joint pain.
• External orthoses support: Using knee caps, cervical collars, lumbosacral belts, and walking aids like sticks or walkers offers essential support to degenerative joints and can alleviate joint pain. Use them only if advised by your doctor and exactly as instructed, as misuse may cause more harm to the joints.

Chronic joint pains and aches can be quite disabling. In addition to conventional treatment, consider trying some excellent essential oils to relieve chronic joint pains.

Joint pain has a significant impact on an individual’s quality of life. Severe, chronic, and debilitating pain may interfere with basic activities, such as walking, leading to restrictions in movement and travel. Often, chronic pain is a source of anxiety and depression in patients with osteoarthritis, rheumatoid arthritis, and other joint diseases. They may find themselves withdrawn from society and the community at large. Joining knee care, spine care, and other musculoskeletal health clubs may help these patients address joint issues and bond with others suffering from similar pain.

Winters are particularly challenging for people with joint pain, as changes in weather can cause fluctuations in atmospheric pressure, resulting in more inflamed tissue and increased swelling and pain. Here are a few lifestyle changes one can incorporate into their daily routine to alleviate joint pain, especially during winter.

• Supplement bone and joint healthy foods: Stock up on dairy products and spend at least 15 minutes in sunlight daily to increase vitamin D intake. Include foods rich in omega-3 fats, such as salmon, nuts, and fish oil in your diet, as these help ease inflammation. Foods rich in vitamin K, such as spinach, fenugreek (methi), cabbage, and kale, are beneficial due to their pain-soothing properties. Additionally, foods rich in vitamin C, like oranges, sweet red peppers, tomatoes, and amla, help halt cartilage loss associated with arthritis.
• Exercise regularly: Aim for a 30-minute walk daily. If cold weather discourages morning walks, consider an afternoon stroll. Stretching your muscles can also help maintain mobility.
• Stay hydrated: Drink plenty of water in winter, as dehydration can reduce flexibility and increase stiffness.
• Get a massage: Professional massage therapy can help relax the muscles around painful joints, reducing pain and improving mobility.
• Cover up: Keep painful joints covered with a sleeve or wrap. Keeping them warm can help reduce pain and increase mobility. Using a muscle relaxant gel on aching joints before covering them can be very helpful.
• Use hot packs: Hot packs, baths, or steam can soothe painful joints. Heat stimulates blood flow, bringing healing nutrients to the affected area and inhibiting pain signals sent to the brain.
• Take medication on time: Remember to take your medications as prescribed by your doctor. If you suffer from chronic joint pain, consult your doctor for pain relief options. Avoid self-medication and seek regular consultations, especially if symptoms recur or worsen.
• Watch your weight: Major joints like the hips, knees, and back bear body weight during daily activities. Increased pressure can lead to more wear and tear on the joints, so maintaining a healthy weight is essential.
• Improve your posture: Consciously maintaining a correct upright posture is crucial. While standing, keep your spine straight, buttocks pressed together, belly in, and chest out. When sitting, ensure your core rests firmly against the chair’s backrest, and it is advisable to sleep on a firm mattress facing upwards. Avoid slouching while watching TV or using a laptop.
• Get enough sleep: The saying "sleep is the best healer" is especially true for our joints. Our bones, muscles, and tendons are active throughout the day, so allowing them to recover is essential. Tired tissues are more susceptible to injury.