Pain in the lower back is a pathology caused by various factors, such as excessive stress or poor posture. Less common is the lower back pain caused by more serious problems like herniated discs. The most common cause of lower back pain is because the lumbar spine, the final segment of the spine, has endured excessive weight. The main symptom of this injury is pain that is usually located in the lower back, sometimes reaching the legs. This pathology may cause alterations in the different structures that form the backbone such as ligaments, muscles, spinal discs and vertebrae. In addition, lower back pain can be accompanied by a muscular contraction in the area, limiting mobility in this section of the body.
The elbow is a complex joint formed by bones, cartilage, ligaments and fluids. The muscles and tendons help to move the joint and if any of these parts suffers any damage, the pains and problems appear.
Elbow pain can occur as a result of:
You should see your GP in the first instance, who is likely to refer you to a specialist rheumatologist for pain management, or possibly an orthopaedic surgeon if surgery is required. As part of your diagnosis, imaging tests (such as an X-ray or MRI) may be required.
The relevant specialist will coordinate your care, which may involve:
If no improvement is seen in the patient's elbow pain, then the following treatments may be required:
Fibromyalgia is a chronic disease that causes pain throughout the body and sensitivity in joints, muscles, tendons and other soft tissues.
It is more common in women between the age of 20 and 50.
Fibromyalgia causes fatigue and muscle pain throughout the body, headaches, IBS (irritable bowel syndrome), increased pain sensitivity, problems with memory and concentration, and can affect sleep patterns and overall amount of sleep.
There are different conditions related to fibromyalgia or those which have the same symptoms. Sleep disorder, Lyme disease, chronic fatigue syndrome, and hypothyroidism, among others, may cause similar symptoms. It is important to visit your doctor and if necessary, get specialist referral in order to correctly confirm a diagnosis after assessment.
The origin of fibromyalgia is unknown, but several factors can trigger its appearance, such as a physical or emotional trauma, a bacterial or viral infection or a disease such as rheumatoid arthritis.
There is no known way to prevent fibromyalgia.
The treatment of fibromyalgia is aimed at relieving pain and combatting sleep disorder with drugs and relaxation techniques. Therapy, counselling and support is also beneficial in those with fibromyalgia, as talking about the condition and receiving therapy can help to counter depression, sometimes experienced in those with fibromyalgia.
Exercise has been shown to be beneficial for those with the condition, and it can also help to reduce pain. Speak to your GP or specialist about recommendations for exercise, and referral for therapy if necessary. Many also find it beneficial to speak to a psychologist as part of their ongoing treatment.
Cervical pain (neck pain) occurs in the upper part of the spine, in the cervical area. It is a pain usually caused by trauma, illness, progressive deterioration, bad posture or emotional tension. Specifically, this cervical pain can be caused by any anomaly or tension in this area of the spine, both in the muscles, ligaments, discs or nerves, as well as in the vertebrae and in their joints. The symptoms of cervical pain may be of varying degrees, from mild discomfort to acute, sudden and intense pain. It can also become chronic neck pain when it lasts for more than three months, and it is more common in women than in men. In addition, in patients suffering from persistent cervical pain and headaches, consultation with a physician and physiotherapeutic treatment is recommended.
Osteoarthritis is a degenerative conditions that affects the joints, causing them to become stiff and causing pain. Any of the joints in the body can be affected, but it more commonly affects the hips, knees, and small joints in the hands.
It affects women more commonly than it does men, and is the commonest form of arthritis in the UK.
The most common symptoms of osteoarthritis are joint pain, difficulty in mobility, and stiffness or deformity in the joints.
These symptoms vary depending on the patient and intensify in a progressive manner. Joint pain, the most common symptom, appears first with movement and ceases with rest, but as osteoarthritis progresses, the pain may also be present while resting.
The causes of the onset of osteoarthritis are not currently known but there are a number of risk factors associated with it:
To avoid risk factors and therefore prevent osteoarthritis, it is very important to eat a balanced diet, such as the Mediterranean diet, and perform regular moderate exercise, thus avoiding wear and tear of the joints. Avoiding obesity is important as carrying too much weight can be detrimental.
The objective of the treatment is to avoid or reduce pain and improve mobility. To treat osteoarthritis, the medical specialist will recommend the patient a series of exercises to be performed which are adapted to their situation and abilities, often with the help of a physiotherapist.
Pharmacological treatment: In most cases anti-inflammatories or analgesics are prescribed to reduce swelling and therefore pain. Chondroprotective medications may also be prescribed which may slow the progression of the disease.
Surgical treatment: osteoarthritis in very advanced stages may require prosthetic surgery.
Rheumatoid arthritis is a chronic and degenerative disease that causes joint inflammation. There are certain areas that this type of rheumatic condition affects more often, they include the wrists, fingers, toes, elbows, shoulders, hips, knees, and ankles. Joint inflammation normally causes pain, deformity, and movement issues, as the cartilage wears out and the bones rub against each other.
The cause for this condition remains unknown and there is no known cure. Damage to the bone and cartilage is irreparable, which is why treatment seeks to relieve pain and disability, as well as avoid permanent joint damage.
Rheumatoid arthritis affects joints on both parts of the body equally. Fingers, wrists, knees, feet, elbows, ankles, hips, and shoulders are the areas that tend to be most affected. The condition starts slowly, and the first symptoms tend to be: mild joint pain, stiffness, and fatigue.
Other symptoms include morning stiffness that lasts longer than one hour. The joints may feel hot, weak, or sensitive and rigid when they are not used for a while. Joint pain is often the same on both sides of the body. Joints may become inflamed. Over time, joints may lose their range of movement and become deformed.
Some of the most common symptoms include:
There is no definitive test to diagnose if a patient has rheumatoid arthritis, but some can help in its indication.
Some of the main tests used to indicate rheumatoid arthritis include:
The causes remain unknown. It is an autoimmune disease which involves genetic factors: a family history of the disease increases chance of developing it. Non-genetic factors also play a big role: such as infections, feminine hormones, smoking, stress, being overweight, and the type of diet you follow.
There is no known way of preventing the disease, however, some risk factors have been identified such as smoking and chronic gum infections, which can really aggravate the condition. This is why it is important to not smoke and maintain good oral hygiene. Having a correct and personalised treatment can help prevent joint damage.
In most cases, this condition requires long-term treatment, which may include:
Different types of medication:
Physiotherapy:
Surgery:
Exercise, education, and nutrition also play an integral role in the treatment of rheumatoid arthritis.
The specialists who treat rheumatoid arthritis are rheumatologists.
Dr Dhiya Houssien is an expert consultant rheumatologist, with over 20 years of experience in the treatment of pain. Dr Houssien treats his patients using a combination of both traditional and alternative medicine. He studied medicine at King Abdulaziz University in Jeddah, followed by a Master's degree in rheumatology at Birmingham University and a clinical PhD in rheumatology at King's College.
Dr Houssein's specialist interests include the management of knee, back and shoulder pain, fibromyalgia, osteoarthritis, and rheumatoid arthritis. Dr Houssien has published extensively, with papers in both peer-reviewed journals and over 50 published abstracts, and he regularly presents at conferences on a national and international level. More recently, he has developed a non-drug based treatment of laser acupuncture for the management of back, neck, shoulder, and knee pain, which has been presented at several international conferences.
Arthritis is a disease that causes inflammation of the membrane that covers the joints. There are more than 100 different types of arthritis, but the most common are:
The symptoms of arthritis can be:
This pathology can be a consequence of:
Joint damage can be prevented with timely and adequate diagnosis and treatment. Also, if someone has a family history it is important to talk with the doctor, even if s/he does not have any symptoms. It is also recommended to avoid repetitive and excessive movements to prevent osteoarthritis.
The treatment aims to alleviate the symptoms and prevent the disease from getting worse. The treatment can be covered by several aspects:
Pain in the lower back is a pathology caused by various factors, such as excessive stress or poor posture. Less common is the lower back pain caused by more serious problems like herniated discs. The most common cause of lower back pain is because the lumbar spine, the final segment of the spine, has endured excessive weight. The main symptom of this injury is pain that is usually located in the lower back, sometimes reaching the legs. This pathology may cause alterations in the different structures that form the backbone such as ligaments, muscles, spinal discs and vertebrae. In addition, lower back pain can be accompanied by a muscular contraction in the area, limiting mobility in this section of the body.
Chronic fatigue syndrome (CFS) is a condition which involves long-term disabling tiredness.
It affects about 200,000 people in the UK, and it generally develops between the ages of 20 and 40. It is three times as common in women as in men.
Chronic fatigue syndrome is also known as myalgic encephalomyelitis, or ME.
There is no cure for chronic fatigue syndrome. Symptoms can fluctuate and are different for each person. Some people will completely recover from the condition within a couple of years, whereas others are affected for a longer period of time. Those who are diagnosed with the condition at a young age tend to have a better long-term outlook.
The main symptoms of chronic fatigue syndrome is persistent tiredness – tiredness that doesn’t improve much after rest, and tends to develop a day after activity (known as “post-exertional malaise”.
In addition, it is common to develop other symptoms including:
Symptoms generally get worse after overexertion, and can vary from day to day.
The symptoms can also vary from person to person, leading many doctors to believe that chronic fatigue syndrome could represent a number of different conditions rather than just one.
The cause of chronic fatigue syndrome is not known. Currently the most popular theory is that it is caused by a viral infection. However, it is not known why symptoms of chronic fatigue syndrome persist even after the original infection has cleared up, and there are many people who develop chronic fatigue syndrome without an infection.
Other suspected “triggers” of chronic fatigue syndrome include:
There is no test to diagnose chronic fatigue syndrome. Chronic fatigue syndrome is generally diagnosed when the doctor has made an assessment of your symptoms and can’t find another cause. To rule out other conditions the doctor might ask for blood and urine tests in addition to a clinical examination.
Treatment for chronic fatigue syndrome can include advice and guidance, medication, and therapy.
There a lot of thing you can do to manage chronic fatigue syndrome, and your doctor will likely advise you on:
Although there is no medication to treat chronic fatigue syndrome directly, the doctor might treat pain or sleep problems with antidepressants, or might recommend over-the-counter painkillers.
Graded exercise therapy (GET) is commonly recommended for chronic fatigue syndrome. GET is a structured treatment involving a physiotherapist or occupational therapist that aims to help you gradually increase your ability to physical activity.
Cognitive behavioural therapy (CBT) can help you establish a better sleep routine and manage your energy levels, as well as cope with the psychological impact of your condition. CBT is carried out by a psychotherapist.
The elbow is a complex joint formed by bones, cartilage, ligaments and fluids. The muscles and tendons help to move the joint and if any of these parts suffers any damage, the pains and problems appear.
Elbow pain can occur as a result of:
You should see your GP in the first instance, who is likely to refer you to a specialist rheumatologist for pain management, or possibly an orthopaedic surgeon if surgery is required. As part of your diagnosis, imaging tests (such as an X-ray or MRI) may be required.
The relevant specialist will coordinate your care, which may involve:
If no improvement is seen in the patient's elbow pain, then the following treatments may be required:
Fibromyalgia is a chronic disease that causes pain throughout the body and sensitivity in joints, muscles, tendons and other soft tissues.
It is more common in women between the age of 20 and 50.
Fibromyalgia causes fatigue and muscle pain throughout the body, headaches, IBS (irritable bowel syndrome), increased pain sensitivity, problems with memory and concentration, and can affect sleep patterns and overall amount of sleep.
There are different conditions related to fibromyalgia or those which have the same symptoms. Sleep disorder, Lyme disease, chronic fatigue syndrome, and hypothyroidism, among others, may cause similar symptoms. It is important to visit your doctor and if necessary, get specialist referral in order to correctly confirm a diagnosis after assessment.
The origin of fibromyalgia is unknown, but several factors can trigger its appearance, such as a physical or emotional trauma, a bacterial or viral infection or a disease such as rheumatoid arthritis.
There is no known way to prevent fibromyalgia.
The treatment of fibromyalgia is aimed at relieving pain and combatting sleep disorder with drugs and relaxation techniques. Therapy, counselling and support is also beneficial in those with fibromyalgia, as talking about the condition and receiving therapy can help to counter depression, sometimes experienced in those with fibromyalgia.
Exercise has been shown to be beneficial for those with the condition, and it can also help to reduce pain. Speak to your GP or specialist about recommendations for exercise, and referral for therapy if necessary. Many also find it beneficial to speak to a psychologist as part of their ongoing treatment.
Gout is a type of arthritis that appears when there is a build-up of uric acid in the blood which causes joint swelling. If urate serum levels exceeds the physiological zone of saturation (around 7.6 mg/dl), monosodium urate crystals form and are stored in the cartilage and periarticular tissues of the peripheral joints. From a clinical perspective, the continued deposit is silent and almost 10% of patients have hyperuricemia, which will more than likely lead to clinical gout. Acute gout is a very painful condition that affects just one joint. Chronic gout involves multiple attacks and quite often more than one joint is affected.
If the disease is diagnosed at the onset of symptoms then the affected person can lead a normal life if they follow the prescribed treatment correctly. For older people affected by gout, reducing uric acid levels in the blood could help the tophi disappear and improve joint movement. Broadly speaking gout has more complications when symptoms develop before the age of 30. Metabolic syndrome and heart disease contribute to early death in people with gout. Some treatments are less effective for patients, sometimes the reason is due to lack of monitoring the treatment, low doses of medications, or alcoholism.
Acute gout symptoms include:
There are several medical tests to diagnose gout, including:
A level of uric acid higher than 7ml/dl in the blood is deemed high. However, not everyone with high levels of uric acid has gout.
Gout is caused by higher than normal levels of uric acid. This happened when the body produces too much uric acid or when the body is unable to get rid of the uric acid. When there is too much uric acid in the fluid around the joints, that’s when uric acid crystals form. These cause joint swelling and pain as well as an increase in temperature in the surrounding area. The cause of gout remains unknown. The disease is thought to be hereditary and men, postmenopausal women, and alcoholics are more susceptible to it. As a person ages, their chances of developing gout increases.
People with the following diseases have a higher chance of developing gout:
Gout may also develop after taking medications that prevent the elimination of uric acid. People who take medications such as hydrochlorothiazide and other diuretics are more likely to have higher levels of uric acid in the blood.
It is thought that gout can’t be prevented, however there are certain risk factors that can make symptoms appear. Taking medications to reduce levels of uric acid can prevent gout from progressing.
It is recommended that the patient see a specialist and start taking the medication for gout as soon as possible to lessen symptoms if having an attack. Anti-inflammatory medications such as ibuprofen and indometacin are also recommended. If symptoms worsen, the dose should be increased.
The patient will need different types of medication if they have:
Another effective treatment is to make diet and lifestyle changes to avoid gout attacks:
Drinking coffee and taking vitamin supplements can help some people.
The specialist who treats gout is a rheumatologist. They are often also the specialist responsible for correctly diagnosing the patient and starting them on a treatment which could reduce uric acid levels in the blood so that the urate crystals dissolve. Rheumatologists believe that gout can be cured, and to achieve this the levels of uric acid in your blood should be enough to dissolve the crystals. The symptoms should disappear and there shouldn’t be any long term damage to joints.
Osteoarthritis of the knee is a disease which mainly consists of a tearing of the articular cartilage, and it can be progressive.
The disease is not exclusive to old age, however, the frequency of affliction increases with age. It is also more common in women than in men, and in people who are genetically predisposed to it. Although many of these factors are not preventable, it is possible to slow down its progression or to reduce the chances of it developing.
There are two types of knee osteoarthritis: primary knee osteoarthritis, which is related to age, and secondary knee osteoarthritis, which occurs after a previous injury, such as a fracture and affects people with high levels of strenuous physical activity or those who are obese.
Although osteoarthritis is generally not a serious disease, it can gradually undermine the quality of life of those affected. Prognosis of the disease depends greatly on the pathology and its evolution. Early diagnosis and joint protection measures are key in helping to slow the progression and development of the disease. Pain and a lack of mobility are the main factors that have an impact on the person’s quality of life, causing it to decrease.
The disease mainly affects people over the age of 50. It can make them more sedentary, which can result in obesity and the appearance of risk factors for conditions such as cholesterol, hypertension and diabetes, among others.
The symptoms and manifestations of osteoarthritis are diverse, progressive and appear gradually over time. The most common symptom is joint pain with limited joint movement, accompanied by cracking sounds and sometimes knee joint effusion (also known as ‘water on the knee’). Some people may experience stiffness or joint deformity. The worst symptom is pain. In the early stage of the disease, pain occurs when you move or try to force the affected joint, and it subsides when you rest. As the disease progresses, pain can occur not only when you move the joint but also when it is being rested. However, joint pain is not constant, so you can go for long periods of time without any pain, although the disease continues to progress.
Osteoarthritis can be difficult to diagnose. Firstly, it should be noted that it cannot be diagnosed by X-ray, so a thorough medical history must be taken and a physical examination performed. If there is swelling in the knee, the specialist may decide to remove fluid from the joint to test it and to confirm the diagnosis. In addition to X-rays, a CT or MRI scan may also be used to diagnose knee osteoarthritis.
The cause of osteoarthritis is still unknown. However, there are a number of risk factors associated with its occurrence:
The main measures for preventing the onset of osteoarthritis are simple: eat a healthy, balanced diet and take regular, moderate physical exercise according to your age and physical condition. You should limit strenuous physical exertion, such as lifting or carrying heavy objects. Contact sports such as football and rugby are not recommended for people with osteoarthritis, as they can exacerbate the disease. Footballers are one of the groups most affected by this disease due to frequent meniscus injuries.
The main objective of treatment for osteoarthritis is to improve pain and functional disability. The first step is awareness, as avoiding risk factors is essential for preventing or minimising the disabling effects of the disease.
You will also have a personalised and adapted exercise regimen which you need to follow with the physiotherapist to help improve your condition.
There are several specialists that can treat knee osteoarthritis, including orthopaedic surgeons, rheumatologists and physiotherapists.
Cervical pain (neck pain) occurs in the upper part of the spine, in the cervical area. It is a pain usually caused by trauma, illness, progressive deterioration, bad posture or emotional tension. Specifically, this cervical pain can be caused by any anomaly or tension in this area of the spine, both in the muscles, ligaments, discs or nerves, as well as in the vertebrae and in their joints. The symptoms of cervical pain may be of varying degrees, from mild discomfort to acute, sudden and intense pain. It can also become chronic neck pain when it lasts for more than three months, and it is more common in women than in men. In addition, in patients suffering from persistent cervical pain and headaches, consultation with a physician and physiotherapeutic treatment is recommended.
Osteoarthritis is a degenerative conditions that affects the joints, causing them to become stiff and causing pain. Any of the joints in the body can be affected, but it more commonly affects the hips, knees, and small joints in the hands.
It affects women more commonly than it does men, and is the commonest form of arthritis in the UK.
The most common symptoms of osteoarthritis are joint pain, difficulty in mobility, and stiffness or deformity in the joints.
These symptoms vary depending on the patient and intensify in a progressive manner. Joint pain, the most common symptom, appears first with movement and ceases with rest, but as osteoarthritis progresses, the pain may also be present while resting.
The causes of the onset of osteoarthritis are not currently known but there are a number of risk factors associated with it:
To avoid risk factors and therefore prevent osteoarthritis, it is very important to eat a balanced diet, such as the Mediterranean diet, and perform regular moderate exercise, thus avoiding wear and tear of the joints. Avoiding obesity is important as carrying too much weight can be detrimental.
The objective of the treatment is to avoid or reduce pain and improve mobility. To treat osteoarthritis, the medical specialist will recommend the patient a series of exercises to be performed which are adapted to their situation and abilities, often with the help of a physiotherapist.
Pharmacological treatment: In most cases anti-inflammatories or analgesics are prescribed to reduce swelling and therefore pain. Chondroprotective medications may also be prescribed which may slow the progression of the disease.
Surgical treatment: osteoarthritis in very advanced stages may require prosthetic surgery.
Hip osteoarthritis is a degenerative disease of the cartilage that covers the joint of the pelvic and femoral bones. This tissue facilitates movement between the bones and prevents them from rubbing against each other directly. When the cartilage decreases in thickness and texture, or is lost completely, the mechanism between the femur and the pelvis no longer functions correctly, resulting in hip osteoarthritis. Hip osteoarthritis can vary in severity, from mild to severe.
Hip osteoarthritis is a chronic disease and usually progresses slowly over many years. It is one of the most common types of osteoarthritis.
The main indicator of this condition is pain, which is primarily located in the groin area. Symptoms such as stiffness and impaired functionality (mobility) may also be present. The pain may sometimes radiate down the front of the thigh and also affect the knees, which might lead you to think that the problem is with the knee.
In order to diagnose hip osteoarthritis, the specialist will:
The causes of hip osteoarthritis are numerous and results from a combination of genetic and environmental factors.
Some of the secondary factors that cause hip osteoarthritis, either combined or in isolation, are:
One of the causes for the onset of hip osteoarthritis is ageing, making it impossible to avoid the disease. However, onset of the disease can be significantly delayed.
The main actions you can take to try to prevent hip osteoarthritis are to:
There is currently no treatment that can cure osteoarthritis, but it can relieve symptoms, slow the progression of the disease and improve quality of life. There are several alternatives available:
Physical measures and medication can be considered conservative treatments, the aim of which is to minimise pain and immobilisation and to slow down the progression of the disease as much as possible.
Rheumatologists and orthopaedic surgeons would diagnose and treat hip osteoarthritis.
Spinal osteoarthritis is a degenerative disease that affects the spine, causing the cartilage between the vertebrae to wear out. This can in turn cause significant pain in your back.
Spinal osteoarthritis is a common condition in the UK and low back pain is the most frequent cause of work sick days.
In many cases, spinal osteoarthritis is present without symptoms, which is why it is often diagnosed incidentally by radiographs that are performed for other reasons. When symptoms do occur they can include:
Spinal osteoarthritis becomes more common with age, with the majority of people affected over the age of 50. You are more likely to experience the condition if:
· you have a genetic problem that causes your cartilage to degenerate
Over the age of 50, men are more likely to experience spinal osteoarthritis than women.
Although you cannot prevent osteoarthritis, you can reduce your chances of developing the condition by:
· making sure any heavy lifting is carried out properly and with good form
If you visit the GP with pain in your lower back they are likely to refer you for a scan such as an X-ray or MRI. This will allow a radiologist to see the bones and joints in your lower back clearly and examine any potential damage to the cartilage. You may also undergo blood tests to rule out other causes of your symptoms.
The first line of treatment is investigating what you can do yourself to improve the condition.
If you are overweight or do not do any exercise, then making lifestyle changes to achieve a healthy weight and become physically active can make significant difference to the symptoms you experience. Strength-building exercises, for example, can strengthen your muscles, which are in turn better able to support your joints.
Beyond this, treatment can involve:
In severe cases, especially in cases of sciatica, a form of spinal surgery known as spinal decompression may be considered. This aims to increase the space in the spinal canal so that the nerves inside are no longer compressed, and no longer cause symptoms of sciatica.
Osteoporosis, meaning “porous bone”, is a disease in which the bones become weak and brittle due to the body either losing too much bone or making too little. On a microscopic level, the structure of healthy bone resembles a honeycomb, with hollows and spaces. In bones affected by osteoporosis, these hollows and spaces are much wider, meaning the bones are less dense, and therefore weaker than they should be. This makes them susceptible to breaks and fractures.
Most of the time, a person will not realise they have osteoporosis until they break or fracture a bone. The hip and wrist are the most common places that fractures occur, while spinal fractures are also relatively common.
Stooped posture (in older people) and particularly significant loss of height (>2 inches) should always prompt investigation for osteoporosis.
The DEXA or DXA scan is a reliable method to measure bone mineral density using a low-intensity X-ray. It is painless, straight-forward, and involves minimal radiation – in fact, the operator sits in the same room as the patient. After the scan is done, the results are compared to that of a young, healthy individual, and based on accepted criteria a diagnosis of osteoporosis may be made.
Losing bone is a natural part of getting older, but some people will lose bone density faster than others. In general, women have a higher risk of getting osteoporosis than men, especially in the years following the onset of the menopause, when bone density is lost more rapidly.
Things that can increase the risk of osteoporosis include:
While it is impossible to prevent a condition like osteoporosis with 100% certainty, you can lower the risk of getting the disease by taking steps in your lifestyle to keep your bones healthy:
Treating osteoporosis revolves around treating fractures caused by the condition and trying to improve bone strength, which may involve medication. Your doctor will advise you on treatment depending on the results of your DXA scan and the cause of your osteoporosis.
Most of the therapies available slow down the rate of bone loss and decrease fracture risk except for parathyroid hormone analogues which effectively stimulate bone formation.
Possible treatments include:
Endocrinologists and rheumatologists treat osteoporosis.
Pain management is an interdisciplinary branch of medicine, which aims to improve quality of life for patients with chronic pain by reducing their suffering. It aims to relieve long-term pain, and may be administered by a single doctor, or a pain management team, consisting of different specialists. It can involve pharmacological or psychological treatments, or a combination of both.
While many branches of medicine focus on diagnosing and treating injuries and pathologies and treating the symptoms and pain during the healing process, pain management is needed when the pain persists after the injury or disease has healed. If the cause of the pain is not clear, relieving it becomes the objective. Patients with chronic (long-term) pain are the usual recipients. Types of pain that often require management include chronic back pain and headaches.
There are many types of treatments to manage pain, which can be roughly divided into three categories: physical, psychological, and medicinal.
Physical treatments include physiotherapy, therapeutic physical exercise, the application of heat and/or ice, acupuncture, electrotherapy, and various interventional procedures, such as facet joint injections and spinal cord stimulation. Different sufferers may find different things help relieve their pain, such as massage therapy. Some treatments may have a psychological element, including the placebo effect.
Psychological treatments, such as cognitive behavioural therapy (CBT) and hypnosis have been used to treat pain, with varying reports on the efficacy. Studies have shown a small improvement in mood after CBT, but there is insufficient evidence to definitively say that it relieves pain. Similarly, studies on the effects of hypnosis have been limited, but shows signs of improvement. Some believe it the effectiveness of psychological treatments may be based on the placebo effect.
Medicinal treatments involves different kinds of drugs – mainly painkillers and anti-inflammatories. The type of drug depends on the location, severity, and probable cause of the pain. For example, mild pain can be managed with over-the-counter painkillers, while severe pain (after injury or surgery, for example) may be treated with opioids. Nonsteroidal anti-inflammatory drugs (NSAIDs) are widely used, and for conditions like fibromyalgia, antidepressants may be prescribed.
Due to the multi-disciplinary nature of the specialty, a pain management team can consist of medical practitioners, nurse practitioners, physiotherapists, psychologists, and other mental health therapists.
Rheumatoid arthritis is a chronic and degenerative disease that causes joint inflammation. There are certain areas that this type of rheumatic condition affects more often, they include the wrists, fingers, toes, elbows, shoulders, hips, knees, and ankles. Joint inflammation normally causes pain, deformity, and movement issues, as the cartilage wears out and the bones rub against each other.
The cause for this condition remains unknown and there is no known cure. Damage to the bone and cartilage is irreparable, which is why treatment seeks to relieve pain and disability, as well as avoid permanent joint damage.
Rheumatoid arthritis affects joints on both parts of the body equally. Fingers, wrists, knees, feet, elbows, ankles, hips, and shoulders are the areas that tend to be most affected. The condition starts slowly, and the first symptoms tend to be: mild joint pain, stiffness, and fatigue.
Other symptoms include morning stiffness that lasts longer than one hour. The joints may feel hot, weak, or sensitive and rigid when they are not used for a while. Joint pain is often the same on both sides of the body. Joints may become inflamed. Over time, joints may lose their range of movement and become deformed.
Some of the most common symptoms include:
There is no definitive test to diagnose if a patient has rheumatoid arthritis, but some can help in its indication.
Some of the main tests used to indicate rheumatoid arthritis include:
The causes remain unknown. It is an autoimmune disease which involves genetic factors: a family history of the disease increases chance of developing it. Non-genetic factors also play a big role: such as infections, feminine hormones, smoking, stress, being overweight, and the type of diet you follow.
There is no known way of preventing the disease, however, some risk factors have been identified such as smoking and chronic gum infections, which can really aggravate the condition. This is why it is important to not smoke and maintain good oral hygiene. Having a correct and personalised treatment can help prevent joint damage.
In most cases, this condition requires long-term treatment, which may include:
Different types of medication:
Physiotherapy:
Surgery:
Exercise, education, and nutrition also play an integral role in the treatment of rheumatoid arthritis.
The specialists who treat rheumatoid arthritis are rheumatologists.
e-Consultation is a private messaging and video conference service that allows contact with leading specialists at the time you choose, from any place.
For those who live with the chronic condition fibromyalgia, it can be debilitating. Leading rheumatologist Dr Dhiya Houssien explains where the eight tender points are on the body and how to deal with a flare-up.
Read more
It seems to be a growing trend in the UK - seeing an osteopath or acupuncture specialist to treat chronic pain. So why are people turning to complementary therapy? And can it live up to the promises it makes?
Read more
Musculoskeletal conditions are common in the UK, affecting millions of us across the country. Dr Dhiya Houssien, international rheumatologist and expert in rheumatic diseases, explains the causes of rheumatism and his innovative approach to the management of pain.
Read more
