Ask The Doctors: May 2011

A number of studies have found that antidepressant medications also have an analgesic (pain-relieving) effect, so your doctor may prescribe an antidepressant to help control pain. Given in doses lower than what is generally used for antidepressant effects, these drugs can improve the quality of your sleep. They also can relax painful muscles and heighten the effects of endorphin-the bodys natural painkiller.

New Guidelines Ease Treatment of Psoriatic Arthritis

The treatment of psoriatic arthritis-a chronic disease that causes a scaly, itchy skin rash on the elbows, knees, and scalp-advanced significantly late last year when experts published the Group for Research and Assessment of Psoriasis and Psoriatic Arthritis (GRAPPA) in the September 2009 issue of Annals of the Rheumatic Diseases. "This evidence-based guideline categorizes psoriatic arthritis based on the predominant symptoms, and provides a step-wise approach to treatment," says Elaine Husni, MD, MPH, vice chair of the Department of Rheumatology and director of the Arthritis and Musculoskeletal Center at Cleveland Clinic.

Alternative Therapies May Miss Key Aspects of Fibromyalgia

Due to its wide array of diverse symptoms, fibromyalgia is among the most enigmatic of medical ailments. It can be mistaken for other conditions and, as a result, may be misdiagnosed and treated incorrectly. Frustrated and desperate, many patients turn to any number of alternative therapies that promise relief. However, a Cleveland Clinic rheumatologist cautions that the evidence supporting many of these treatments is inconclusive, while research has shown no benefits for others.

Supplements: A Pain-Relief Option, But Be Cautious

When conventional treatments dont relieve your pain, it makes sense to look elsewhere for help, including among herbal and dietary supplements. However, as we point out in "8 Pain Remedy Mistakes-and How to Avoid Them" this issue, you should be careful about taking supplements while youre taking other medications for pain relief. Dietary supplements need to be approached with caution, since many of them have not been validated through clinical testing. Further, manufacturers generally do not need to register their products with the U.S. Food and Drug Administration (FDA) or get FDA approval before producing or selling dietary supplements.

Massage Offers Hands-On Relief from Arthritis Pain

You know how good a back rub feels, how it can set you at ease, relax tense muscles and relieve pain. The medical community now recognizes that those same benefits of massage extend to elsewhere in the body, and that this hands-on therapy can help alleviate symptoms of osteoarthritis and other medical conditions. "Touch is the main ingredient for massage, and if done in the correct manner, it gets the nervous system to relax," says Karen Fink, LMT, RN, BSN, CLL, a massage therapist with Cleveland Clinics Health Solutions Program. "Obviously, pain is perceived by the nervous system, and if you can get the nervous system to relax, a lot of times you get a huge pain relief." However, massage isnt as simple as a back rub. The wrong type of massage, in the wrong hands and not coordinated with your other therapies, may do more harm than good.

Antidepressants and Bone Loss: An Unhealthy Alliance

A troubling association exists between depression in older adults, a type of drug used to treat depression, and an elevated incidence of bone fractures and bone loss among those who take the drugs. "There is no definitive evidence," says Holley Thacker, MD, Director of Cleveland Clinics Center for Specialized Womens Health, "but there have been observational associations involving depression, certain medications, and low bone density." A better understanding of these three elements in this unhealthy triangle may help you to avoid future problems. The American Psychological Association (APA) says that although it is not a normal result of aging, nearly 20 percent of older adults suffer from depression. The rate escalates to 50 percent among those living in nursing homes. The APA also points out that older Americans have the highest suicide rate of any age group, and that depression is the greatest risk factor. More than 80 percent of older adults are eligible for treatment, though many do not get medical help because of insurance issues, poor diagnosis of their condition, or the dwindling number of geriatric mental health professionals.

Experimental Therapies May Hold Key to Future Pain Treatment

Because there is no cure for arthritis, the goals of controlling pain, minimizing joint damage, and improving or maintaining function have long been the main goals of treatment. But as researchers continue to seek the "holy grail" of therapy-a disease-modifying medication or surgery-they are gaining a better understanding of how arthritis develops, how to target therapies based on an individuals genes, and how to grow new cartilage in ways that may one day slow, if not reverse, the course of the disease. "Were taking strides and moving in the right direction," says Richard Parker, MD, chairman of the Department of Orthopaedic Surgery at Cleveland Clinic. For example, viscosupplementation, which involves injecting a thick fluid (hyaluronate) into the knee to help lubricate the joint, "may have the attributes of being disease-modifying," he says. Its effectiveness in treating activity-related knee pain in studies lasting six months has been found to be comparable to that of nonsteroidal anti-inflammatory drugs (NSAIDs). But it would take a study lasting at least 20 years to determine whether the intervention could actually reverse underlying disease, he explains

The Truth Behind Alternative Arthritis Treatments

Theres major buzz about so-called "super juices," particularly one product made from a Brazilian berry called aai (AH-sci-EE), which promoters say contains anti-inflammatory properties capable of easing arthritis-related pain. Such claims have made it onto TV and have spread through cyberspace. And with such heavy promotion, its tempting to give it a try. But with some retailers selling the product for $40 (32 ounces), aai juice doesnt come cheap. Its not necessarily effective or safe, either. "Youll do much better if you simply eat an apple," says William Welches, DO, PhD, a Cleveland Clinic osteopathic physician with board certification in family-practice medicine and a specialist in osteopathic manipulation. Dr. Welches says aai juice has only one-quarter of the anti-inflammatory properties found in a regular apple. He notes that the aai berry does have significant anti-inflammatory components-but the majority are in the husks, which are processed out when making juice.

6 Ways to Beat Bedtime Pain

If youre awakened most nights with severe arthritis pain and cant fall back to sleep, its tempting to blame your insomnia on your pain. But recent research suggests that, in fact, its a two-way street-not only does pain disrupt sleep, but the quality of your sleep can influence how much pain you feel, according to Judith Scheman, PhD, Program Director of the Cleveland Clinics Chronic Pain Rehabilitation Program in the Neurological Center for Pain. "You blame the arthritis pain for disrupting sleep. But thats because when you wake during the night and try to fall asleep again, youre very aware of the pain-theres often not a whole lot of other things to focus on," Dr. Scheman says. However, a study of 971 men and women published in the June issue of the journal Pain showed that experiencing bad pain does not necessarily predict having a bad nights sleep; however, not getting a good nights sleep does make it likely that youll experience bad pain the next day. So although the two are related, sleep affects pain more than pain affects sleep. The authors suggest that finding ways to improve sleep could help relieve pain.

Sprain vs. Strain: Different Injuries, Same Treatment

While sprains and strains most commonly occur in younger, athletic men and women, older people with muscle weakness, balance problems, and limited flexibility are also prone to falls and other injuries that can stretch or tear a ligament or muscle. "A sprain is the result of a specific traumatic event-such as tripping and falling on an uneven sidewalk, a stairway, or other irregular surface. Sprains are difficult to prevent," says Gary Calabrese, PT, director of Sports Health and Orthopaedic Rehabilitation at Cleveland Clinic. "Strains, on the other hand, are usually related to the overuse of a muscle. So they should be preventable with a good exercise regimen that keeps the muscles strong and flexible."

Ask The Doctors: 08/08

The diagnosis of early rheumatoid arthritis (RA) is based primarily on the presence of typical symptoms of the disease. Most commonly, these include morning stiffness in the joints lasting more than an hour and symmetrical pain and swelling in the small joints of the hands, wrists, and feet. Diagnosis of rheumatoid arthritis requires these symptoms to be present for at least six weeks or longer, since other types of arthritis, often related to viral infections, may lead to similar but more transient findings.

Electronic Therapies May Help Ease Arthritis Pain

We rely on cartilage more than we know. The amazing slick, rubbery material is the buffer that protects the ends of bones, allowing us to walk, run, bend, or flex as the internal surfaces revolve, rotate, and glide smoothly against and over each other. A repetitive cushioning cycle that is taken for granted, the need for cartilage as a self-lubricating shock absorber becomes painfully obvious to arthritis sufferers as their cartilage begins to break down. As we age, cartilages collagen framework becomes thinner and weaker. The once-powerful joint protector now is soft and prone to damage, leading to creaky, painful joints. Yet, there are ways to treat and repair injured cartilage, says Morgan Jones, MD, Department of Orthopaedic Surgery, Cleveland Clinic Sports Health. "Two of the most important factors for treating sore joints are weight loss and exercise-yet, there are many additional treatments to help you manage joint pain."