Relieving Arthritis Pain

Therapists may choose from a variety of physical agents to relieve Arthritis Pain. These provide superficial and deep heat, as well as superficial cold, to affected joints. The primary purpose of using any of these modalities is to suppress and to control the symptoms of inflammation.

Superficial heat is used to produce localized analgesia and increase local circulation in the area to which it is applied. It penetrates only a few millimeters, however, and does not enter the depth of the synovial cavity.

Superficial heat can be delivered through a number of means such as moist hot pack, dry heating pads and lamps, paraffin, and hydrotherapy. There is no conclusive evidence that any method of application achieves a significantly better therapeutic effect, but patients often report clinically a greater tolerance for and comfort derived from moist heat.

Paraffin is particularly useful in delivering superficial heat to irregularly shaped joints or to individuals who cannot tolerate the weight of a moist hot pack. Although the patient can concoct paraffin mixtures at home, instructions for its use should be provided cautiously because of the high flammability of the wax.

Although hydrotherapy is one of the most expensive and time-consuming methods for delivering superficial heat, it does have the added advantage that the therapist can combine heat with exercise. It may also orient the patient to the value of a therapeutic swimming program that can be undertaken in conjunction with, or following treatment.

Deep heating modalities may affect the viscoeleastic properties of collagen and increase the plastic stretch of ligaments. Their use in treating individuals with arthritis during the acute stage of inflammation is contraindicated in that they may stimulate collagenase activity within the joint and further its destruction.

Local applications of cold will also produce local analgesia and increase superficial circulation at the site of application following an initial period of vasoconstriction. It is particularly useful around joints that are swollen, a condition that usually worsens with the application of superficial heat modalities.

Therapists may use either wet or dry application techniques. Superficial cold is contraindicated in patients with Raynaud's phenomenon or cryoglobulinemia, the presence of an abnormal protein in the blood that forms gels at low temperatures. Both may be associated with arthritis.

Therapists may also wish to consider using their modalities for pain relief in treating the patient with arthritis, including relaxation training and tanscutaneous electrical nerve stimulation also known as TENS, although the value of the latter as reported in the literature is controversial.

Splints may be used to immobilize specific joints and help reduce pain and swelling by providing local rest. They may also negatively affect function during the times they are worn and should be used judiciously for this purpose.

Complete bed rest may similarly be beneficial but should be weighed against the deleterious systemic effects on the musculoskeletal and cardiopulmonary systems its overuse can produce.