Osteoarthritis of The Feet: An Overview

Arthritis is a general term used for more than hundred group diseases involving the joints; it typically refers to degeneration or inflammation of the cartilage, bones and other structures which make up the joint itself, and has many possible causes.

Osteoarthritis is the most common, and usually is described as ‘wear and tear’ arthritis of the cartilage lining or attached to the ends of the bones in the joint. It usually progresses over the years due to gradual thinning and cracking of cartilage tissue. Most commonly the three joints that are most affected by osteoarthritis of the feet are the joints involving the ankle and heel bone, the bones of the arch in the middle foot, and the joint of the big toe.

The symptoms are typically aching pain and tenderness in the affected areas, with localized stiffness and sometimes bony swelling around the joints. The pain is better at rest, but will tend to become stiff and feels most uncomfortable with the first few steps before easing up. Usually there is minimal redness, warmth or swelling of the tissues with osteoarthritis of the feet.

Treatment of osteoarthritis of the feet is similar to the treatment of osteoarthritis in other joints. This includes Tylenol, NSAID medications (such as ibuprofen, diclofenac and naproxen). Various creams or ointments may provide temporary comfort as well. For severe discomfort, sometimes the painful joint is injected with cortisone-like medication. Podiatrists may assist with arch support braces called orthotics.

Inflammation in the joints in the feet also may be caused by diseases such as gout or rheumatoid arthritis which cause severe inflammation of the ankle, middle foot or toe joints. It is very important to have these diseases diagnosed correctly and not confuse them with osteoarthritis, as untreated they may permanently damage the joints and cause disability.

The course of treatment of depends upon the type of arthritis, the severity of the pain other conditions of the individual. Specialists in arthritis called rheumatologists are trained to diagnose the type of arthritis which is present. Specialized foot doctors called podiatrists, also specialize in treatment, and if necessary, surgery of the feet.

Suffering from pain in the feet? Evaluate your symptoms by taking the foot pain quiz at PainSpot.com, and have yourself checked for osteoarthritis of the feet and start treatment immediately!

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Pinched Nerve Sciatica: Prognosis and Treatment

The sciatic nerve is the nerve branching from the lower back right through the hips and buttocks towards the lower part of the leg. When this nerve is pinched due to a bone spur or a herniated disk, it results in numbness, inflammation and pain extending down the affected leg and is consequently called sciatica.  The medical term is ‘lumbar radiculopathy’.

In most cases, sciatica can be resolved using conservative treatment. However sciatica pain may be severe in certain cases and not respond to other treatment where the condition is sustained for over a period of weeks of treatment surgery may be required to relieve compression of the nerve.

Sciatica (Pinched Nerve) Treatment

Treatment should be sought for sciatica pain when symptoms persist for several days, and may include one or more of the following treatments:

  • Medicines: A physician may prescribe anti-inflammatory medicines, muscle relaxants, short acting narcotic medicines and for burning pain, anti-seizure medications such as gabapentin or Lyrica are particularly helpful.
  • Therapy: Physical therapy is generally prescribed; to  reduce muscular tightness, improve flexibility, correct posture and help prevent further injury.
  • Injections: Steroid injections (‘epidural injections’) may help suppress swelling around the nerve due to inflammation and thereby reduce pain.
  • Surgery: Surgery is the last resort which is again a rarely necessary. However, when pain progressively worsens despite physical therapy, or if there is weakness or loss of reflexes, surgery to relieve the nerve compression caused by a bone spur or herniated disk is usually very effective.

Are you suffering from pain due to a pinched nerve causing Sciatica? Feel free to share your thoughts and experiences with us.

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Non-Surgical And Surgical Treatment Of Osteoarthritis

Osteoarthritis occurs when the cartilage in a joint becomes worn or thin. Cartilage is the shiny smooth connective tissue present on the joints on the ends of bones, protecting and aiding in smooth gliding movement of the joints. The deterioration of cartilage causes increased friction within the joint and results in arthritic pain and stiffness.

Osteoarthritis is also known as degenerative arthritis or ‘wear-and-tear’ arthritis and is the most common form of arthritis, affecting millions of people around the world.

While it can occur in number of joints throughout the body, the most commonly affected areas are feet, hands, spine, knees and hips. Osteoarthritis of the Feet is the most common among them all, usually affecting the mid-foot, ankle and big toe.

Treatment of Osteoarthritis

  • Non-Surgical

Non-surgical arthritis treatments involve prescribing:

  • Oral medicines such as non-steroidal anti inflammatory drugs to reduce inflammation and pain.
  • Orthotic devices such as shoe inserts for cushioning and to improve mechanics.
  • Bracing which is done to support the joints and reduce pain by restricting motion and providing support.
  • Steroid (‘cortisone’) injections for reducing inflammation and pain.
  • Therapy which involves exercising to strengthen muscles and enhance stability and flexibility.
  • Surgery

Arthritis can progress, and after non-surgical treatments fail, surgery may be considered an option. The surgery aims to reduce pain, but often results in decreased joint mobility.

Are you suffering from osteoarthritis? What were the biggest challenges you witnessed when it was discovered? Feel free to share your thoughts and experiences with us.

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Simponi Aria Effectiveness And Safety

How effective is SIMPONI ARIA for Rheumatoid Arthritis?

SIMPONI ARIA is a new medicine used to treat rheumatoid arthritis.

It is given into an arm vein, every two months over about thirty minutes. In a 14 week study of adults with moderately to severely active rheumatoid arthritis, when used in combination with the first line drug methotrexate, almost 60% of patients receiving SIMPONI ARIA were at least 20% better as compared with 25% of patients receiving only methotrexate and no SIMPONI ARIA.hand picture

Not only were people better using clinical measurements, there was much less joint damage; after 6 months there was a 97% reduction in the damage seen in joints. This was seen in the ‘GO-FURTHER’ study*;  a global, multicenter, randomized, double-blind, placebo-controlled study in nearly 600 adult patients who had active rheumatoid arthritis despite taking methotrexate for at least 3 months and who had not been previously treated with an anti-TNF agent (such as Enbrel or Humira). Moderately to severely active RA was defined as at least 6 swollen and tender joints. They had positive tests for rheumatoid factor and/or anti-CCP antibody, and an increased level of an inflammatory marker called C-reactive protein (CRP). For an explanation of these tests click here.

How Safe is SIMPONI ARIA?

Is there more cancer in patients treated with this drug? In clinical trials, there was about 1 case of cancer (not including lymphoma and non-melanoma skin cancer) for every 200 years of patient use. More lymphomas have been seen in children and adolescent patients receiving this medicine.

Patients with a history of untreated tuberculosis, Hepatitis B, multiple sclerosis or severe congestive heart failure should not receive TNF inhibitors such as SIMPONI ARIA.

The immune system’s ability to ward off infections is diminished in patients receiving SIMPONI ARIA, or other medicines in this class of TNF blocker drugs (includes Enbrel, Cimzia and Remicade). Using patient years,  if 100 patients took Simponi for a year for rheumatoid arthritis, there would be predicted 5.7 serious infections, versus 4.2 infections in patients not receiving the medication.

In all the the TNF blockers, patients at higher risk (elderly or those with diminished immune systems or a tendency for infections) are at higher risk for infections they normally would not have to worry as much about (such as tuberculosis or other tuberculosis-like bacteria, fungus, virus, parasitic, valley fever, certain molds and yeast-like diseases). These are usually less than 0.1% however, and low risk.

*Weinblatt ME, Bingham CO III, Mendelsohn AM, et al. Intravenous golimumab is effective in patients with active rheumatoid arthritis despite methotrexate therapy with responses as early as week 2: results of the phase 3, randomised, multicentre, double-blind, placebo-controlled GO-FURTHER trial. Ann Rheum Dis. 2013;72:381-389
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Ankylosing Spondylitis: Causes And Symptoms

Ankylosing spondylitis is a kind of arthritis that occurs in the spine. About 0.1% – 0.5% adults are affected by this condition and it is characterized by neck or back stiffness and pain. Ankylosing spondylitis can affect any gender and at just about any age. However, it’s mostly seen in men in their teenage or twenties. In women though, it’s generally mild.

The Causes

The real cause of ankylosing spondylitis is unknown. However, research has revealed that there is a particular gene associated with this condition called HLA-B27. Most but not all people with ankylosing spondylitis are carriers of the HLA-B27 gene, but most people with this gene do not develop ankylosing spondylitis. The events or conditions which trigger ankylosing spondylitis to start are still not entirely understood, though certain types of infections seem to be linked.

The Symptoms

The early and most common symptoms of ankylosing spondylitis include:

  • Stiffness And Pain: Constant pain is experienced in the hips, buttocks and lower hips for over 3 months. It usually starts from around the sacroiliac joints, where the lowest portion of the spine fuses with the pelvis bone.
  • Fusion of Bones: Bony fusion, as it is called, refers to the abnormal fusion of the back bones leading to the inability of performing day to day activities. The spine may also become fused with the rib cage at time leading to the inability in expanding the chest while taking deep breaths.
  • Pain in Tendons And Ligaments: Ankylosing spondylitis may affect ligaments and tendons attached to the bones as well. Its termed as tendonitis or enthesitis and it refers to the inflammation of the tendons causing stiffness and pain in the adjoining area of the affected bones.

Ankylosing spondylitis is more of a systemic disease which implies that the symptoms are never really limited to the joints. Associated conditions such as loss of appetite, fatigue, fever, eye inflammation and even heart and lung problems may develop.

Have you been affected by ankylosing spondylitis? What symptoms did you experience? Which was your pain spot? Share your thoughts and experiences with us.

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Wrist Pain – Associated Conditions

Wrist pain is one of the most common problems that individuals experience. Whether in the left or right hand, wrist or on top of the wrist, there are multiple reasons that could trigger wrist pain. Persistent wrist pain should be diagnosed and treated, as it may be due to serious conditions such as fractures or dislocation of the wrist bones.

Associated conditions of wrist pain include:

  • Arthritis: Arthritis can not only happen in your bigger joints but also your wrists. It is characterized by swelling in and around the joint, pain and difficulty in getting a grip of objects. More serious arthritis such as rheumatoid arthritis, gout or pseudogout may cause warmth and redness over the wrist. There are a number of ways wrist arthritis can be treated.
  • Tendonitis: This occurs due to the inflammation in the tendon sheath leading to swelling around the wrist and pain. Tendonitis usually does not require surgery.
  • Carpal Tunnel Syndrome: When a median nerve passing through the bottom of the wrist is pinched or compressed it leads to pain in the fingers, sometimes weaknees and dysfunction due to carpal tunnel syndrome.
  • Sprain: Injuries to ligaments in the wrist usually lead to sprain in the region. It can be characterized by chronic pain and swelling.
  • Ganglion Cyst: Ganglion cysts are benign, fluid filled sacs that grow in size leading to this condition, often over the top of the wrist. Individuals affected by it can experience pain and swelling in the region. These cysts are however not cancerous and do not necessarily require treatment unless they are unusually large or painful.
  • Fractures: Common orthopedic injuries due to forceful impact in the region may crack or fracture the small bones in the wrist. In severe cases, surgery may be required. Fractures should not be ignored as long term pain, chronic weakness and instability are possible complications.

Have you had your wrist pain diagnosed yet? Which of the above condition has been the cause of your wrist pain? How was it treated? Share your thoughts and experiences with us below.

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The American Chronic Pain Association

What is the American Chronic Pain Association?

The following information is from the American Chronic Pain Association’s website. Since 1980, the ACPA has offered peer support and education in pain management skills to people with pain, family and friends, and healthcare professionals. The information and tools on their site can help you to better understand your pain and work more effectively with your healthcare team toward a higher quality of life.

What Does the ACPA do?

The American Chronic Pain Association has been helping people live fuller lives in spite of their pain for 34 years.  Their goal is to provide you with the tools you need, in addition to what your healthcare provider offers, so that you can improve your skills in the self-management of your chronic pain.  They focus on helping you become an active partner on your health care team.

The Mission of the ACPA is Patient Oriented

The mission of the ACPA is to facilitate peer support and education for you if you suffer with chronic pain, as well as your families so that you may live more fully in spite of your pain. In addition, they strive to raise awareness among the healthcare community, policy makers, and the public at large about issues of living with chronic pain.

Who Started the ACPA, and How Did it Become So Successful?

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from myfbsearch.com, page by P. Pandey

The American Chronic Pain Association was founded in 1980 by Penney Cowan in her home in Pittsburgh, Pennsylvania.  After many years of living with chronic pain, Penney had taken part in the pain management program at the Cleveland Clinic and was eager to maintain the skills she had learned there when she returned to her daily life. Penney placed a notice in her church bulletin and soon found others whose lives were compromised by ongoing pain.  They began meeting as the first ACPA support group.  This one small group quickly became many.  Unable to be personally involved with every group, Penney developed the first of the ACPA’s manuals and other materials so that others could learn and maintain the skills that had been so important to maintaining her wellness.

Support Groups are the Cornerstone of the ACPA

Today several hundred ACPA support groups meet across the US and in Canada, Great Britain, and many other countries.  The ACPA’s unique materials are a primary resource for individuals seeking to improve the quality of their lives and for the professionals who help them. The website is theacpa.org.

Multiple Resources on the ACPA Website

The well-organized website has multiple resources which are simple to navigate. Diseases can be researched (‘Conditions A to Z), information on medications and treatments is provided, as well as patient tools to research the particular type of pain you are experiencing. Pain awareness is fostered through links such as Partners for Understanding Pain which represents a comprehensive network of resources and knowledge about issues in pain management. They are a loose consortium of organizations with an interest in the personal, economic, and social impact of pain on our society. Members include health-condition-specific groups as well as those with broader mandates that touch the lives of people with chronic, acute, and cancer pain.

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What is Ankylosing Spondylitis?

Ankylosing spondylitis (AS) is one of the forms of arthritis that affects spinal joints. The name is derived from Greek words ankylos and spondylo, which mean “stiffening of a joint” and “vertebra” respectively. It is an immune disease that causes inflammatory problems such as swelling, redness, and pain in the vertebrae which comprises of numerous discs that make up the spine. Generally, AS involves an inflamed sacroiliac (SI) joint, which is the meeting point of the spine and pelvis.

The early symptoms of Ankylosing spondylitis are back pain, sometimes coupled with neck stiffness. The disease often affects ribs, knees, hips, feet, and areas where the ligaments and tendons are attached to the bones. Bowel, eyes, heart and lungs may also be affected.

According to the National Institute of Arthritis and Musculoskeletal and Skin Diseases (NIAMS), AS affects twice as many men as women. It may run in families beginning as early as in the teen years. The majority of people begin to exhibit disease symptoms before they turn 30 and only five percent show symptoms after 45.

The definite causes of AS are still unknown. It is believed that the genes and the environment both play a role in causing AS. Normally, a rheumatologist diagnoses and treats Ankylosing Spondylitis.

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Low Back Pain: Cause and Prevention

It is estimated that around 2% to 10% of the people in the US who suffer from low back pain go on to develop chronic pain condition which in turn affects their daily living for almost 3 months. By and large, the middle and lower back is quite vulnerable to mechanical stresses – like the upper body weight – which always puts a lot of strain on the lower back.

The various conditions that cause middle and lower back pain include:

  • Degenerative disc disease
  • Herniated disc disease
  • Spondylolisthesis
  • Vertebral fractures caused by osteoporosis
  • Spinal stenosis
  • Scoliosis

Here are a few tips to get you started on easing out your lower back pain.

  • If you are a heavy smoker, it’s time to give up the habit. According to a study, smokers are at least one-third more likely to suffer from lower back pain than non-smokers.
  • Whenever you stand or sit, try your level best to maintain good posture. And when lifting things, bend your knees. You need to lift the things with your knees and not with your back.
  • Perform exercises to strengthen the support muscles around your back. These include the abdominals, back, hips and pelvic area. Develop and strengthen your core muscles and you will begin to feel more energetic and healthy.
  • Don’t let the pain go untreated. See your doctor at the very onset of symptoms. Getting treated for lower back pain in time can help prevent further damage and keep you stay active.

To detect your back pain symptoms, use the diagnostic tool at Painspot. Locate the exact spot of your pain, identify the symptoms and become more cautious with regard to your condition.

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Neck Pain Relief Without Pills

Four ways to reduce and manage your neck pain.

posture 2My approach to helping people with chronic neck pain – daily neck pain that is not due to a recent injury surgery etc. – involves doing a number of things and NOT doing a number of things. Each change will help perhaps 5-10% over time (yes, it takes time), doing the steps below could add up to 50% improvement or more, and often help basic neck aching and stiffness related to day-to-day muscular strain, and perhaps a bit of disc arthritis (called degenerative cervical disc disease). You might also use medications sometimes, but they are only one part of treatment and may not be necessary (especially daily) if you keep in mind some general principles. If would like to explore possible causes of your neck pain, go to PainSpot.com. (The principles below are general educational advice, and not meant to be specific or individual medical advice, so of course please review them with your health provider before starting them or any physical therapy program.)

1. The proper position of your head and neck on your shoulders in the day is crucial to relieving pain.

When you are sitting especially, it’s important to picture the idea of your head balancing over your tailbone; if it is in a forward position (I call it first gear position) then the head holder-upper muscles have to work overtime to keep your head up! Your ear lobes should be centered over the middle of your shoulders, where the crease in a shirt usually is. These muscles behind your neck and over the tops of your shoulders are the ones that often hurt and feel stiff. If you allow your shoulders to settle back, and pretend you have a puppet string attached to the top of your head pulling up and back, these muscles will relax.

(picture, courtesy dreamwellnesspacificbeach.com)

(courtesy dream wellness pacific beach.com)

Picture a twelve pound ball balancing on a stick, where the ball is your head and the stick is your spine. If you lean the ball forward, your head feels almost four times heavier with poor neck posture.

When you slouch forward your spine becomes “C-shaped”. This is guaranteed to cause pain over time; your head-ball is not balanced. Because we can’t actually straighten the spine, a useful mental picture is to make your C-shape spine into an “S-shape” with the lower part of your back going in as though you had a pillow behind your back. If you correct your head posture over your shoulders and lower spine, you should feel the upper shoulder muscles relax immediately.

2. At night, your neck and head position are just as important!

Never sleep this way

Wrong way to use a neck pillow!

Never sleep on your stomach! Your neck should be straight, and your head not turned at all. Most neck pain sufferers already know this, but it is worth repeating. Even for 10 minutes, which can cause the neck muscles to go into spasm. Throw out any foam pillows. They don’t allow your neck to be in the right position. If you can sleep on your back, a thin towel folded up behind your neck will feel good. Side sleepers will often bunch up their pillows which is the right idea, but it never lasts – better to use a cervical roll BUT the position is key. It should angle down under your chin so you can feel it on the front of your chest. Remember this neck roll/pillow secret: tilt the pillow down so it lies along your chest.

3. Stretch and strengthen

Right before going to sleep, lie on your back and lift your head off the pillow like you are doing sit ups with your head. Don’t do this if it’s too painful. Strengthening the core muscles in the front of your neck is the same idea as strengthening your low back core muscles for back pain. Then stretch the neck from side to side. A brisk walk or jog may loosen up your neck and shoulder muscles, and a massage from time to time will do the same.

4. Things not to do.

napping on couch

Guaranteed neck pain

No TV in bed. No napping on the couch. No cradling the phone. If you fall asleep sitting up, put on a soft foam collar, or better yet just go to bed! If you have a couch with deep cushions, it is almost impossible not to slouch, and putting an extra pillow behind your low back will help to regain the ‘S-shape’ in your lower spine, and position your head over your tailbone.

Remember to run these ideas by your health provider. Don’t do anything that is too painful, and if you’ve had neck surgery only follow the advice of your surgeon and therapist.

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