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Joint Pain

Dr. HelloDox Care #
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Joint pain can occur for a number of reasons. For many people, it is due to arthritis (joint inflammation), of which there are several types. For others, such as those with fibromyalgia or an underactive thyroid, pain occurs with no underlying inflammation at all. Joint pain may range from a mild ache to a severe, burning or sharp sensation in one or several joints. In some instances, joint pain is associated with other symptoms, like joint swelling and stiffness, overlying red and warm skin, and whole-body symptoms like fatigue, weight loss, or fever
Causes
Due to the multiple causes of joint pain, it is perhaps best to separate them into two classes— joint pain from arthritis versus joint pain unrelated to arthritis.

Arthritis-Related
Joint pain related to arthritis indicates that inflammation is occurring within the joint space. There are several types of arthritis and their causes differ.

Osteoarthritis

Osteoarthritis (OA) is the most common form of arthritis. OA develops as a result of age-related breakdown of cartilage, which serves as a cushion between the bones of a joint. This type of arthritis tends to affect the knees, hips, neck, lower back, and fingers.

The pain of OA, which often progresses from a sharp, intermittent pain to a constant aching, worsens with movement and eases with rest. Joint stiffness and a restricted range of motion are also characteristic of OA joint pain.

While classic OA is actually a non-inflammatory arthritis (even though it is still classified as an arthritis), an aggressive subtype of OA, called erosive osteoarthritis, is inflammatory. Erosive OA is most common in postmenopausal women and causes a gradual onset of joint aches, stiffness, and swelling in multiple finger joints.

Gout


Gout is a type of inflammatory arthritis that occurs in some people with high levels of uric acid in their blood. As the uric acid builds up, it may form crystals in certain joint spaces, like the big toe, ankle, or knee.

A classic gout attack refers to a sudden episode of severe, often burning joint pain that usually occurs in one joint (for example, the big toe). The joint pain of a gout attack is often extreme and associated with redness, swelling, and warmth of the joint. Without treatment, the episode will remit on its own, often within a week's time.

The "why" behind gout joint pain is attributed to the rapid, inflammatory response of the body's immune system to digest the unwanted and foreign crystals.


Pseudogout

Pseudogout, also known as calcium pyrophosphate deposition disease (CPPD), is a type of inflammatory arthritis that occurs as a result of calcium crystal buildup in certain joints, most commonly the knee, wrists, shoulders, ankles, feet, and elbows. Like gout, the pain of an acute pseudogout joint attack is sudden, severe, and associated with other symptoms like joint swelling and warmth. Unlike gout, the attacks of pseudogout may last longer before remitting.

Septic Arthritis

With septic arthritis, a joint becomes infected, most commonly with a bacteria and rarely with a fungus (for example, Candida) or mycobacteria (for example, tuberculosis).

Septic arthritis tends to affect a single joint, usually the knee, ankle, wrist, or hip. The affected joint is swollen, warm, and stiff, and a fever is also present. In most cases, septic arthritis is caused by a bacterial infection in the blood that then travels to the joint space. Less commonly, joint surgery or trauma (for example, a tick bite) may be the culprit.

Viral Arthritis

Several different viruses may cause arthritis. The most common ones include hepatitis B and C, parvovirus B19, and alphavirus (viruses transmitted by mosquitoes), such as the Chikungunya virus (CHIKV) found in the Caribbean.

Rheumatoid Arthritis

Rheumatoid arthritis (RA) is a chronic, autoimmune disease that develops gradually over a period of weeks to months. While the disease predominantly affects the joints, early symptoms may not involve them, but instead include fatigue, muscle pain, low-grade fever, weight loss, and numbness and tingling in the hands.

When the joints become affected, which is a gradual process, small joints on the same side of the body—such as the joints in the fingers and toes—tend to be affected first. Eventually, other joints follow suit like the wrists, elbows, hips, and spine.

In addition to joint pain, stiffness, warmth, redness, and swelling occur. Unlike osteoarthritis, the stiffness of joint pain in RA tends to be worse in the morning (lasting for more than an hour) and improve with movement.

Spondyloarthritis

Spondyloarthritis is a family of inflammatory rheumatic diseases that includes the following four conditions:

Ankylosing spondylitis (AS): AS is an axial spondyloarthropathy because it affects mainly the back and neck (i.e. spine) and the sacroiliac joints (which connect the spine to the pelvis). The joint pain of AS tends to begin in early adulthood before the age of 45, come on gradually, and improve with activity (similar to rheumatoid arthritis, but the opposite of osteoarthritis). Morning stiffness that lasts longer than 30 minutes is also common in AS.
Psoriatic arthritis: Up to 30 percent of people with psoriasis—a chronic skin condition characterized by patches of thickened skin covered by silvery scales—have psoriatic arthritis. It most commonly affects the end joints of the fingers and toes, causing a throbbing pain, along with stiffness and swelling. Other symptoms may include swollen fingers and toes that look like sausages and nail problems (for example, pitted nail beds). Interestingly, the severity of a person's psoriasis does not correlate with the severity of their arthritis—and in about 15 percent of people, joint pain shows up before the psoriasis appears.
Reactive arthritis: This type is characterized by the development of joint pain and swelling one to four weeks after an infection in the urinary tract, genitals, or intestines. Specific bacterial organisms linked to the development of reactive arthritis include Salmonella, Campylobacter, Shigella, Yersinia, and Chlamydia. Typical joints involved in reactive arthritis are the knee, ankle, and foot.
Arthritis associated with inflammatory bowel disease (IBD): Throbbing joint pain and swelling, especially in larger joints like the knees and hips, may occur in people with inflammatory bowel disease (Crohn's disease or ulcerative colitis). The arthritis tends to be more active when bowel symptoms are flaring.
Systemic Lupus Erythematosus

Joint inflammation, especially of the knees, wrists, and finger joints, is common in systemic lupus erythematosus (SLE)—a chronic, autoimmune disease that may affect nearly every organ in the body.

Like RA, the same joints on the same side of the body tend to be affected in SLE. However, unlike RA, the morning stiffness does not last as long (minutes for SLE versus over an hour for RA), and the joint pain tends to be short-lived and migratory, moving from one joint to another within a 24-hour period.

Polymyalgia Rheumatica

Polymyalgia rheumatica (PMR) is an inflammatory joint disease that causes significant muscle and joints aches and stiffness in the shoulders, neck, and hips. Joint swelling and tenderness may also occur in the wrists and fingers, although it is usually mild. The feet and ankles are never affected, and the disease almost only affects people over the age of 50.

Interestingly, PMR is associated with another rheumatic condition called giant cell (temporal) arteritis, which is an inflammatory blood vessel disease that causes inflammation in the arteries of the head and scalp.

Other Systemic Rheumatic Diseases

Though it may be hard to believe, the above list is not exhaustive of all the different causes of arthritis. Other less common systemic (whole-body) illnesses may cause arthritis, a few examples being:

Systemic sclerosis
Sarcoidosis
Familial Mediterranea fever

Unrelated to Arthritis
These conditions may cause joint pain but are not related to an underlying disease or inflammatory process within the joint.

Fibromyalgia

The predominant symptom of fibromyalgia, a chronic pain condition, is widespread muscle tenderness, along with crippling fatigue. In addition to muscle pain, people often note joint aches and sometimes joint swelling, despite the lack of inflammation on physical exam.

Hemarthrosis

Hemarthrosis, when bleeding into a joint occurs, may occur for a number of reasons including trauma, a bleeding disorder like hemophilia, a postsurgical complication, or tumor growth, like a synovial hemangioma.

Hypothyroidism

The most common cause of hypothyroidism—an underactive thyroid gland—is Hashimoto's thyroiditis, which is when your body's immune system launches an attack on your thyroid. Hypothyroidism may cause numerous symptoms, including fatigue, weight gain, constipation, cold intolerance, and joint aches and stiffness.

Depression

You may be surprised to learn that a primary physical manifestation of depression is joint pain, and sometimes this is a person's only reported symptom. That said, other common symptoms of depression include a loss of interest in pleasurable activities, a change in appetite, sleep disturbances, difficulty concentrating, and feelings of hopelessness and/or guilt.

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How To Cope With Shoulder Pain?

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The shoulders are the strongest and the most often used areas of the body as they are connected to the neck, chest, hands and elbows. Therefore, it should not come as a surprise that shoulder pain and wear and tear of this area, including the rotor cuff and bursa, is also quite common. The shoulders may face plenty of wear and tear when it comes to the ligaments, tissue and other such elements. The shoulder joint may also get injured with repetitive actions that are involved in the life of a sportsperson, a carpenter, a painter and other such professionals.

There are a number of ways in which one can deal with shoulder pain. Here are the best measures that you can take in order to deal with the same.

Increase the range of motion: One should increase the range and variety of motions so that the stiffness and soreness that primarily comes from repetitive actions, may be avoided. If you are only lifting materials, then you may also want to swing the arm at regular intervals to increase the blood flow and exercise the various nerves. Also, this will help in giving rest to the affected region of the shoulder. Rehabilitation therapy can help in introducing one to a range of motions that will give rest to the affected area and bring in new positions.

Perform strengthening exercises: One of the best ways to keep pain and stiffness at bay is to create plenty of core strength in the muscles and joints of the area. You can try out various exercises as per the physiotherapist and the physical therapy exercises so that you can build strength. This will also help in keeping the pressure off of the affected area. You can add some weights to the exercise routine so that there is extra strength built up in the process.

Do aerobic exercises: Aerobic exercises are known to increase the blood circulation to the area. The tendon and the bursa in particular benefit substantially from this kind of exercise. This will also bring the soreness down so that the pain and stiffness do not affect you.

Try heat and ice therapy: You can use ice packs to soothe the inflammation in the affected area. This is usually recommended for acute pain and new injuries. Similarly, you can use heat packs and hot showers to soothe chronic pain as and when the same returns. However, you should be careful so that the scalding temperature does not leave burns and marks.

Medication: You can also have painkillers as well as gels and ointments that can be used for topical relief. These must be taken with a doctor’s prescription.

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Joint Pain - How Panchkarma Therapies Can Help You?

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Joint pain is considered to be one of the first few signs of aging. According to the science of Ayurveda, joint pain is triggered mainly by an accumulation of toxins in the body. These toxins can create an imbalance in the doshas which in turn can cause pain and inflammation on the joints. Along with joint pain, a person is likely to experience a loss of flexibility, weakness, tenderness and enlargement of the joints.

Unlike some popular forms of medication that focus on relieving the pain, Ayurveda addresses the root cause of the issue. Panchkarma aims at cleansing the body of toxins and clearing blockages in the body’s digestive and circulatory system. This helps the vatta dosha flow easily through the body and reduces pain associated with arthritis etc. Panchkarma can be defined as a collection of five ayurvedic techniques. These are:

Vasti or Medicated Enema: Vasti aims at removing toxins and waste products from the body through the colon. In doing this, it cleanses the digestive channels and improves circulation of air or the vatta dosha in the body. With better circulation, joint pain is effectively reduced. An enema also nourishes the body and gives it the strength to rebuild tissues while boosting the immune system.

Abhyanga or Full Body Massage: This technique helps I the removal of toxins from deep tissues within the body. It pacifies the vatta and nourishes the body while simultaneously reducing stress and enabling better quality sleep. A full body massage also helps calm the body both physically and mentally.

Potli or Poultice Massage: As the name suggests, a potli involves massaging the body with medicated herbs tied together in a tiny bundle that has been warmed with medicated oils. This potli is then used to massage the entire body. This technique helps relax the muscles of the body and soothes the aggravated vatta dosha. It is very effective when it comes to providing relief from joint pains caused by arthritis, spondylitis, muscle cramps etc.

Pizhichil or Rich Oil Massage: A rich oil massage involves subjecting the body to streams of lukewarm oil that has medicinal properties while simultaneously softly massaging the body. This type of massage helps relieve tension and stress and is a very effective remedy against joint pains. It is highly recommended in the case of rheumatic diseases.

Svedana or Steam Bath: A steam bath helps cleanse the body both physically and mentally by aiding in the removal of toxins through sweat and calming the mind. It also helps soften the muscles and tissues and dilates the channels in the body.

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Joint Pain and Women

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Everyone gets the occasional ache or pain — a little soreness in the shoulder, a twinge in the knee — but research shows that women are more frequently and often more severely affected than men. The CDC estimates that from arthritis or chronic joint symptoms affect more than 70 million Americans, 41 million of whom are women. A number of factors contribute to this disparity: Women are more apt than men to have conditions that cause joint pain, experience hormone fluctuations that affect their vulnerability, and may not be physiologically equipped to deal with pain.

Causes of Joint Pain in Women

Of the nearly 27 million Americans with osteoarthritis (AO), 60 percent are women. Rheumatoid arthritis (RA), an autoimmune disease, strikes approximately three times more women than men. Other autoimmune conditions that cause joint pain, such as lupus, scleroderma, and multiple sclerosis (MS), also hit women harder than men: Women are nine times more likely to develop lupus, three times more likely to have scleroderma, and twice as likely to suffer from MS. And fibromyalgia, a little understood condition that can cause joint pain, affects women eight times more frequently than men.

The Estrogen-Joint Pain Connection

"Women typically feel pain more intensively, more often, and in more parts of the body than men," says Tarvez Tucker, MD, a pain specialist and director of the Pain Clinic at the University of Kentucky Medical Center, in Lexington. Female hormones are believed to play a role in women's high vulnerability to pain. Many women with OA, RA, lupus, and fibromyalgia report an increase in joint pain just before or during their periods. This is likely because estrogen levels plummet right before menstruation and rise again after a woman's period is over. "Estrogen is believed to be protective against pain," says Dr. Tucker. "It peaks during pregnancy, probably to protect women from the pain of childbirth." Some research shows that 80 percent of women with RA experience a remission of symptoms during pregnancy and a flare-up when estrogen dips during the postpartum period. Additionally, reproductive hormones are suspected as factors in the high incidence of autoimmune diseases in women since conditions such as RA and lupus are most common during the childbearing years.

Women's Bodies and Joint Pain

Hormones are only part of the picture, however. Female brains may be wired for pain. It's thought that endorphins, the body's natural painkillers, work more effectively in men than in women. "Studies have found that females release less of the brain chemical dopamine in response to painful stimulation. Without dopamine, endorphins can't function effectively," says Patrick Wood, MD, a pain researcher at Louisiana State University, in Shreveport, and medical advisor to the National Fibromyalgia Association.

Female structural differences may contribute to some kinds of joint pain, too. For example, women are more prone to osteoarthritis of the knee. One possible explanation: "Women tend to be more limber and loose-jointed than men, so there's more movement in that area, increasing the risk that the kneecap will rub on the bones below it," notes Bruce Solitar, MD, a rheumatologist at the NYU Hospital for Joint Diseases, in New York City. This may lead to osteoarthritis symptoms in the knee area.

Joint Pain Medication and Women

Women react differently than men to some medications for relieving joint pain. For example, fluctuating hormone levels can reduce the amount of medicine circulating in the bloodstream, which means that women may need more of the standard dose. Plus, female digestive systems are slower, causing certain medications (like pain relievers) to take more time to pass through the digestive tract where they're absorbed more fully. And because pain sensitivity increases right before a woman's period, more pain-relieving medicine may be required at this time of the month. "Women need to be aware of these factors, ask the right questions, and be persistent about getting an accurate diagnosis and proper treatment," says Dr. Tucker. By becoming educated about how joint pain affects them, women can increase the odds of finding relief and getting the best health care possible.

Published  

Joint Pain - How Panchkarma Therapies Can Help You?

Dr. HelloDox Care #
HelloDox Care
Consult

Joint pain is considered to be one of the first few signs of aging. According to the science of Ayurveda, joint pain is triggered mainly by an accumulation of toxins in the body. These toxins can create an imbalance in the doshas which in turn can cause pain and inflammation on the joints. Along with joint pain, a person is likely to experience a loss of flexibility, weakness, tenderness and enlargement of the joints.

Unlike some popular forms of medication that focus on relieving the pain, Ayurveda addresses the root cause of the issue. Panchkarma aims at cleansing the body of toxins and clearing blockages in the body’s digestive and circulatory system. This helps the vatta dosha flow easily through the body and reduces pain associated with arthritis etc. Panchkarma can be defined as a collection of five ayurvedic techniques. These are:

Vasti or Medicated Enema: Vasti aims at removing toxins and waste products from the body through the colon. In doing this, it cleanses the digestive channels and improves circulation of air or the vatta dosha in the body. With better circulation, joint pain is effectively reduced. An enema also nourishes the body and gives it the strength to rebuild tissues while boosting the immune system.

Abhyanga or Full Body Massage: This technique helps I the removal of toxins from deep tissues within the body. It pacifies the vatta and nourishes the body while simultaneously reducing stress and enabling better quality sleep. A full body massage also helps calm the body both physically and mentally.

Potli or Poultice Massage: As the name suggests, a potli involves massaging the body with medicated herbs tied together in a tiny bundle that has been warmed with medicated oils. This potli is then used to massage the entire body. This technique helps relax the muscles of the body and soothes the aggravated vatta dosha. It is very effective when it comes to providing relief from joint pains caused by arthritis, spondylitis, muscle cramps etc.

Pizhichil or Rich Oil Massage: A rich oil massage involves subjecting the body to streams of lukewarm oil that has medicinal properties while simultaneously softly massaging the body. This type of massage helps relieve tension and stress and is a very effective remedy against joint pains. It is highly recommended in the case of rheumatic diseases.

Svedana or Steam Bath: A steam bath helps cleanse the body both physically and mentally by aiding in the removal of toxins through sweat and calming the mind. It also helps soften the muscles and tissues and dilates the channels in the body. If you wish to discuss about any specific problem, you can consult an ayurveda.

Dr. Dhananjay Ostawal
Dr. Dhananjay Ostawal
BHMS, General Physician, 34 yrs, Pune
Dr. Abhijit Kamble
Dr. Abhijit Kamble
BAMS, Family Physician General Surgeon, 14 yrs, Pune
Dr. Vishwajeet Desai
Dr. Vishwajeet Desai
BAMS, Ayurveda Infertility Specialist, 8 yrs, Pune
Dr. Aarti Vyas
Dr. Aarti Vyas
BAMS, Ayurveda Panchakarma, Pune
Dr. Vijay U. Jadhav
Dr. Vijay U. Jadhav
BAMS, Ayurveda Family Physician, 15 yrs, Pune
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