What Is Joint Pain?

Joints are the spaces between bones. They are the part of the musculoskeletal system that supports the body and helps it move. Joint pain is an extremely common ailment, and is known as arthralgia by medical professionals. A survey by the U.S. Centers for Disease Control and Prevention estimates that approximately 33% of adults have complained of this symptom in the preceding 30 days.

Joint pain can vary from person to person. It can affect any joint in the body, but the most common areas affected include the knee, shoulder, and hip. Symptoms can be acute or chronic. There can be associated swelling and stiffness of the joint. It can adversely affect some people mildly and others severely. Lastly, the pain can be intermittent.

Causes Of Joint Pain

Joint pain has many different etiologies. Some of the more common causes are:

  • Osteoarthritis: This is caused by inflammation in the bones and joints. It is the most common of the forms of arthritis. It can result from years of hard wear on joints or specific injuries, such as fractures. The condition is usually progressive and culminates in the deterioration of cartilage, which cushions and protects joints. End-stage of this disease results in bone rubbing upon bone, which is extremely painful and can result in consideration for joint replacement.Anatomy of male joint pain in blue
  • Rheumatoid arthritis: A chronic autoimmune disease that causes joint pain due to the immune system attacking a person’s own joints. It typically affects the small joints of the hands and feet, which can result in painful swelling, bony erosions, and joint deformities. This disease affects women more commonly than men.
  • Bursitis: This is inflammation of a bursa, but it can also cause joint pain. A bursa is a small fluid-filled sac near a joint. The most commonly affected joints include the elbow, shoulder, and hip. The disease is a result of joint overuse or injury.
  • Gout: A form of arthritis that can also be an origin of joint pain. It is one of the oldest diseases known to man. The disease results from blood becoming supersaturated with uric acid. Uric acid then precipitates and forms crystals that settle into joints. The uric acid crystals irritate joints leading to inflammation and joint pain. The disease can occur in any large joint, but most commonly occurs in the joints of the big toe.
  • Tendinitis: This is inflammation of a tendon and another cause of joint pain. Tendons connect muscle to bone. Common sites for this disease include the shoulder, elbow, knee, lower leg, and Achilles tendon.
  • Certain infections such as osteomyelitis, hepatitis B virus, parvovirus B-19, and Lyme disease can manifest as joint pain.
  • Trauma such as sprains, strains, and fractures can also be causes of joint pain.

Treatments For Joint Pain

The goals for joint pain management include relief of pain, restoration and maintenance of joint function, and prevention of further joint damage.

Shoulder Joint Anatomy Pain concept with Circulatory SystemThe following modalities can be used to treat moderate joint pain:

  • Acetaminophen (Tylenol) can be helpful for benign joint pain with little or no swelling
  • Topical agents such as capsaicin and methyl salicylate (BenGay) can also be helpful for joint pain
  • Non-steroidal anti-inflammatory drugs (NSAIDs) can be helpful for moderate to severe joint pain

Examples of NSAIDs include aspirin, ibuprofen (Advil, Motrin), and naproxen sodium (Aleve). The aforementioned medications are all available over-the-counter. Some prescription NSAIDs used to treat joint pain include colchicine (Indocin), meloxicam (Mobic), and celecoxib (Celebrex). Care should be taken when using NSAIDs as they can have side effects such as liver and kidney damage, inflammation of the stomach, bleeding, and stomach ulcers. Special care should be taken with celecoxib (Celebrex) as it has been shown to increase the risk of heart attacks and strokes.

Oral steroids and opioids also have a place in the treatment of joint pain. They should be considered in cases of joint pain that are non-responsive to NSAIDs and topical agents. Oral steroids such as prednisone are powerful inhibitors of inflammation, while opioids such as hydrocodone and oxycodone specifically target pain. Oral steroids and opioids have no place in the long-term treatment of joint pain due to their toxicities and risk of addiction, however.

Those with joint pain may be helped by joint injections. Steroid joint injections reduce inflammation, and as a result reduce pain. Hyaluronan (Synvisc) injections can be particularly helpful in those with severe osteoarthritis of the knee. Hyaluronan is a synthetic form of the body’s natural synovial fluid that bathes joints. As a general rule, joint injections should not be given more than three times a year.

3d rendered illustration - pain neck

Supplements of chondroitin and glucosamine have been helpful for those experiencing joint pain. The two compounds are found in native cartilage. They exist in tablet, capsule, powder, and liquid forms. They are available over-the-counter and have no significant side effects.

Non-pharmacological modalities to treat joint pain include physical therapy and weight loss. Physical therapy can stabilize, strengthen, and improve range of motion in joints. Weight loss can be accomplished through low-impact aerobic exercise, such as swimming and bicycling. Weight loss will also reduce stress on joints.

Finally, those with chronic joint pain related to osteoarthritis can be treated with joint replacement. The most commonly replaced joints are the knee and hip.

Conclusion

Joint pain is an extremely common condition and can ultimately affect quality of life. There are a multitude of causes for joint pain, which can be acute or chronic.

Treatments for joint pain include pharmacological, non-pharmacological, and surgical methods. Treatment methods for joint pain can also range from conservative to aggressive. Any program for the diagnosis and treatment of joint pain should be sought in consultation with a qualified medical professional.

References

  1. Arend WP, Lawry GV. Approach to the patient with rheumatic disease. In: Goldman L, Schafer AI, eds. Cecil Medicine. 24th Philadelphia, PA: Saunders Elsevier; 2011:chap 264.
  2. Ayral X. Injections in the treatment of osteoarthritis. Best Pract Res Clin Rheumatol. 2001;15(4):609-26.
  3. QuickStats: Percentage of adults reporting joint pain or stiffness. National Health Interview Survey. 2006: United States.
  4. Martin TJ, Eisenach JC. Pharmacology of opioid and non-opioid analgesics in chronic pain states. J Pharmacol Exp Ther. 2001;299(3):811-7.
  5. Schaible HG, Eberseberger A, Von Banchet GS. Mechanisms of pain in arthritis. Ann NY Acad Sci. 2002;966:343-54.
  6. Sluka KA. Pain mechanisms involved in musculoskeletal disorders. J Orthop Sports Phys Ther. 1996;24(4):240-54.