The word arthritis literally means joint inflammation, but is
often used to refer to a group of more than 100 rheumatic diseases
that can cause pain, stiffness, and swelling in the joints. These
diseases may affect not only the joints but also other parts of the
body, including important supporting structures such as muscles,
bones, tendons, and ligaments, as well as some internal organs.
This fact sheet focuses on pain caused by two of the most common
forms of arthritis-osteoarthritis and rheumatoid arthritis.
Pain is the body's warning system, alerting you that something
is wrong. The International Association for the Study of Pain
defines it as an unpleasant experience associated with actual or
potential tissue damage to a person's body. Specialized nervous
system cells (neurons) that transmit pain signals are found
throughout the skin and other body tissues. These cells respond to
things such as injury or tissue damage. For example, when a harmful
agent such as a sharp knife comes in contact with your skin,
chemical signals travel from neurons in the skin through nerves in
the spinal cord to your brain, where they are interpreted as
Most forms of arthritis are associated with pain that can be
divided into two general categories: acute and chronic. Acute pain
is temporary. It can last a few seconds or longer but wanes as
healing occurs. Some examples of things that cause acute pain
include burns, cuts, and fractures. Chronic pain, such as that seen
in people with osteoarthritis and rheumatoid arthritis, ranges from
mild to severe and can last a lifetime.
The pain of arthritis may come from different sources. These may
include inflammation of the synovial membrane (tissue that lines
the joints), the tendons, or the ligaments; muscle strain; and
fatigue. A combination of these factors contributes to the
intensity of the pain.
The pain of arthritis varies greatly from person to person, for
reasons that doctors do not yet understand completely. Factors that
contribute to the pain include swelling within the joint, the
amount of heat or redness present, or damage that has occurred
within the joint. In addition, activities affect pain differently
so that some patients note pain in their joints after first getting
out of bed in the morning whereas others develop pain after
prolonged use of the joint. Each individual has a different
threshold and tolerance for pain, often affected by both physical
and emotional factors. These can include depression, anxiety, and
even hypersensitivity at the affected sites due to inflammation and
tissue injury. This increased sensitivity appears to affect the
amount of pain perceived by the individual.
Pain is a private, unique experience that cannot be seen. The
most common way to measure pain is for the doctor to ask you, the
patient, about your problems. For example, the doctor may ask you
to describe the level of pain you feel on a scale of 1 to 10. You
may use words like aching, burning, stinging, or throbbing. These
words will give the doctor a clearer picture of the pain you are
Since doctors rely on your description of pain to help guide
treatment, you may want to keep a pain diary to record your pain
sensations. On a daily basis, you can describe the situations that
cause or alter the intensity of your pain, the sensations and
severity of your pain, and your reactions to the pain. For example:
"On Monday night, sharp pains in my knees produced by housework
interfered with my sleep; on Tuesday morning, because of the pain,
I had a hard time getting out bed. However, I coped with the pain
by taking my medication and applying ice to my knees." The diary
will give the doctor some insight into your pain and may play a
critical role in the management of your disease.
The doctor will usually do the following:
- Take your medical history and ask questions such as: How long
have you had this problem? How intense is the pain? How often does
it occur? What causes it to get worse? What causes it to get
- Review the medications you are using
- Conduct a physical examination
- Take blood and/or urine samples and request necessary
- Ask you to get x-rays taken or undergo other imaging procedures
such as a CAT scan (computerized axial tomography) or MRI (magnetic
Once the doctor has done these things and reviewed the results
of any tests or procedures, he or she will discuss the findings
with you and design a comprehensive management approach for the
pain caused by your osteoarthritis or rheumatoid arthritis.
A number of different specialists may be involved in the care of
an arthritis patient-often a team approach is used. The team may
include doctors who treat people with arthritis (rheumatologists),
surgeons (orthopaedists), and physical and occupational therapists.
Their goal is to treat all aspects of arthritis pain and help you
learn to manage your pain. The physician, other health care
professionals, and you, the patient, all play an active role in the
management of arthritis pain.
There is no single treatment that applies to all people with
arthritis, but rather the doctor will develop a management plan
designed to minimize your specific pain and improve the function of
your joints. A number of treatments can provide short-term pain
-Because people with osteoarthritis have very
little inflammation, pain relievers such as acetaminophen (Tylenol)
may be effective. Patients with rheumatoid arthritis generally have
pain caused by inflammation and often benefit from aspirin or other
nonsteroidal anti- inflammatory drugs (NSAIDs)such as ibuprofen
(Motrin or Advil).
- Heat and cold
-The decision to use either heat or cold
for arthritis pain depends on the type of arthritis and should be
discussed with your doctor or physical therapist. Moist heat, such
as a warm bath or shower, or dry heat, such as a heating pad,
placed on the painful area of the joint for about 15 minutes may
relieve the pain. An ice pack (or a bag of frozen vegetables)
wrapped in a towel and placed on the sore area for about 15 minutes
may help to reduce swelling and stop the pain. If you have poor
circulation, do not use cold packs.
- Joint Protection
-Using a splint or a brace to allow
joints to rest and protect them from injury can be helpful. Your
physician or physical therapist can make recommendations.
- Transcutaneous electrical nerve stimulation (TENS)
small TENS device that directs mild electric pulses to nerve
endings that lie beneath the skin in the painful area may relieve
some arthritis pain. TENS seems to work by blocking pain messages
to the brain and by modifying pain perception.
-In this pain-relief approach, a massage therapist
will lightly stroke and/or knead the painful muscle. This may
increase blood flow and bring warmth to a stressed area. However,
arthritis-stressed joints are very sensitive so the therapist must
be very familiar with the problems of the disease.
-This procedure should only be done by a
licensed acupuncture therapist. In acupuncture, thin needles are
inserted at specific points in the body. Scientists think that this
stimulates the release of natural, pain-relieving chemicals
produced by the brain or the nervous system.
Osteoarthritis and rheumatoid arthritis are chronic diseases
that may last a lifetime. Learning how to manage your pain over the
long term is an important factor in controlling the disease and
maintaining a good quality of life. Following are some sources of
long-term pain relief.
- Nonsteroidal anti-inflammatory drugs (NSAIDs)
-These are a
class of drugs including aspirin and ibuprofen that are used to
reduce pain and inflammation and may be used for both short-term
and long-term relief in people with osteoarthritis and rheumatoid
- Disease-modifying anti-rheumatic drugs (DMARDS)
drugs used to treat people with rheumatoid arthritis who have not
responded to NSAIDs. Some of these include methotrexate,
hydroxychloroquine, penicillamine, and gold injections. These drugs
are thought to influence and correct abnormalities of the immune
system responsible for a disease like rheumatoid arthritis.
Treatment with these medications requires careful monitoring by the
physician to avoid side effects.
-These are hormones that are very
effective in treating arthritis. Corticosteroids can be taken by
mouth or given by injection. Prednisone is the corticosteroid most
often given by mouth to reduce the inflammation of rheumatoid
arthritis. In both rheumatoid arthritis and osteoarthritis, the
doctor also may inject a corticosteroid into the affected joint to
stop pain. Because frequent injections may cause damage to the
cartilage, they should only be done once or twice a year.
- Weight reduction
-Excess pounds put extra stress on
weight-bearing joints such as the knees or hips. Studies have shown
that overweight women who lost an average of 11 pounds
substantially reduced the development of osteoarthritis in their
knees. In addition, if osteoarthritis has already affected one
knee, weight reduction will reduce the chance of it occurring in
the other knee.
-Swimming, walking, low-impact aerobic exercise,
and range-of-motion exercises may reduce joint pain and stiffness.
In addition, stretching exercises are helpful. A physical therapist
can help plan an exercise program that will give you the most
-In select patients with arthritis, surgery may
be necessary. The surgeon may perform an operation to remove the
synovium (synovectomy), realign the joint (osteotomy), or in
advanced cases replace the damaged joint with an artificial one.
Total joint replacement has provided not only dramatic relief from
pain but also improvement in motion for many people with
Many people seek other ways of treating their disease, such as
special diets or supplements. Although these methods may not be
harmful in and of themselves, no research to date shows that they
help. Nonetheless, some alternative or complementary approaches may help you to
cope or reduce some of the stress of living with a chronic illness.
If the doctor feels the approach has value and will not harm you,
it can be incorporated into your treatment plan. However, it is
important not to neglect your regular health care or treatment of
The long-term goal of pain management is to help you cope with a
chronic, often disabling disease. You may be caught in a cycle of
pain, depression, and stress. To break out of this cycle, you need
to be an active participant with the doctor and other health care
professionals in managing your pain. This may include physical
therapy, cognitive-behavioral therapy, occupational therapy,
biofeedback, relaxation techniques (for example, deep breathing
meditation), and family counseling therapy.
Another technique is to substitute distraction for pain. Focus
your attention on things that you enjoy. Imagine a peaceful setting
and wonderful physical sensations. Thinking about something that is
enjoyable can help you relax and become less stressed. Find
something that will
make you laugh—a cartoon, a funny movie, or even a new joke.
Try to put some joy back into your life. Even a small change in
your mental image may break the pain cycle and provide relief.
The Multipurpose Arthritis and Musculoskeletal Diseases Center
at Stanford University, supported by the National Institute of
Arthritis and Musculoskeletal and Skin Diseases (NIAMS), has
developed an Arthritis Self-Help Course that teaches people with
arthritis how to take a more active part in their arthritis care.
The Arthritis Self-Help Course is taught by the Arthritis
Foundation and consists of a 12- to 15-hour program that includes
lectures on osteoarthritis and rheumatoid arthritis, exercise, pain
management, nutrition, medication, doctor-patient relationships,
and nontraditional treatment.
You may want to contact some of the organizations listed at the
end of this fact sheet for additional information on the Arthritis
Self-Help Course and on coping with pain, as well as for
information on support groups in your area.