What Are Nondrug Treatments For Osteoarthritis-Related Pain?

Pain can be the predominant symptom in OA, and it is a major cause of the disability associated with this type of arthritis. Your doctor should assess the level of pain that you have at each meeting and determine how much this pain is affecting your ability to function. This assessment provides a rational basis for a pain treatment program. Your doctor should teach you about pain, pain management options, and self-management programs as part of any OA treatment plan.

OA pain is traditionally treated with nonsteroidal anti-inflammatory drugs (e.g., ibuprofen, naproxen) if it is of moderate intensity, or with medications from the opiate family (e.g., demerol, morphine, hydrocodone) if it is severe. But what if these medications are not controlling the pain and surgery is not an option? What other options are available?

Experts in pain management recognize that pain is not simply the result of a physical problem, but has psychological and social dimensions, too. Addressing all of these areas is important when treating pain.

A group of therapies, collectively known as cognitive-behavioral therapy (CBT), addresses the physiologic, psychological, and social dimensions of pain. In fact, current research supports the use of CBT as an effective means to reduce pain and improve function in OA. CBT is based on the idea that thought and behavior patterns can worsen the perception of pain and contribute to feelings of helplessness and fatigue. These feelings can be significant obstacles to recovery. The goal of CBT, then, is to alter the way you think and behave when you feel pain. CBT is not a single treatment, but rather a group of treatments, each of which employs a different modality to reduce pain—for example, stress management, relaxation techniques, and cognitive restructuring.

Both anxiety and stress have negative effects on patients with OA. Pain and its accompanying disability can increase a person's stress level. Conversely, stresses from work, family, or the environment can increase a person's perception of pain. Stress management is used to break this cycle of stress and pain and minimize a patient's response to stress. First, you learn to recognize those situations or occurrences that trigger stress. Once identified, you can learn to avoid these stressful conditions. When avoidance isn't possible, relaxation training may provide relief. Relaxation training can take the form of biofeedback, progressive relaxation exercises, or guided imagery. All of these techniques can reduce muscle tension, which can in turn aggravate pain, and allow you a chance to shift your attention away from your pain, which reduces your perception of pain.

Cognitive-behavioral therapy is an important and effective therapy that can reduce pain and psychological disability and enhance a person's self-efficacy and pain coping skills. It should be integrated with other treatments in a multidisciplinary approach to the treatment of osteoarthritis.

Negative thoughts that are associated with pain are often erroneous and distorted, but can nevertheless worsen your pain and increase your emotional distress. Cognitive restructuring is a technique that attempts to deal with this problem. Patients are taught to identify the negative thoughts that enter the mind when they experience pain. For example, you might think, “This pain is the worst I've ever felt. I'll never get better. Maybe there's something else the matter with me, like cancer.” A therapist can help you first challenge the validity of these thoughts and then modify them. For example, you might tell yourself, “I've had this kind of pain before and got better in a few hours” or “This pain is bad, but I haven't had a flare in a month since starting my exercise program. I'm really getting better.”

CBT is an important and effective therapy that can reduce pain and psychological disability and enhance a person's self-efficacy and pain coping skills. This does not imply that you should replace all of the more common pain treatments with CBT, but rather that this technique should be integrated with other treatments in a multidisciplinary approach to the treatment of OA.