Joint Pain Management

Clarification:

Depends on the underlying diagnosis. However it should include :

- Nature of the problem
- Magnitude of the problem in Therommunty
- Prognosis

Reassurances :

Benign diagnosis:
reassurance about the nature

Serious diagnosis:
reassure the patient that he will be given appropriate care
A- Non-pharmacological therapy:
RICE:
most of the common injuries are treated with the RICE. recommendations

Rest
Rest the joint, avoiding any activities that can aggravate the pain.

Ice
Applying Ice the joint for about 15 minutes, several times each day can relieve the pain and
inflammation.

Compression
Compress the joint by using an elastic wrap.

Elevation
Elevate the joint above the level of your heart.
Protection: Splinting
Protect the joint with a brace or wrap.

Physical therapy:
Usually useful regardless of the diagnosis
by using techniques such as ultrasound, heat or cold therapy, electrical nerve stimulation, and
manipulation.
Splinting
Heat/Cold Therapy
 Ultrasound

Electrical Stimulation
Manipulation
B- Pharmacological therapy :
Topical Agents :

1/ Capsaicin
Capsaicin may relieve joint pain from arthritis and other conditions.
*Side effects of capsaicin cream include burning or stinging in the area where it
is applied.

2/ Methyl salicylate topical

methyl salicylate topical is used for temporary relief is used for temporary relief
of minor joint pain .
Medications :

According to severity:

1/ Acetaminophen
For mild pain without any swelling, acetaminophen can be effective.

2/ Nonsteroidal anti-inflammatory drug (NSAID)

For moderate-to-severe joint pain with swelling Nonsteroidal anti-inflammatory drug such
as aspirin, celecoxib, ibuprofen, or naproxen can provide relief.
*NSAIDs can have side effects, potentially increasing risk for gastrointestinal bleeding.
3/ Opioid medication
If pain is so severe that NSAIDs aren't effective

4/ Other drugs that may help relieve pain include:

-Muscle relaxants to treat muscle spasms (may be used together with NSAIDs to increase the
effect)
-Some antidepressants and antiepileptic drugs (which both interfere with pain signals)
Injections :

1/Steroids.

Most common, may be combined with a local anesthetic - every 3 to 4 months.

Steroid injections are most commonly used in patients with arthritis or tendinitis.
the effect may be temporary.

2/Platelet-rich plasma therapy.

3/Prolotherapy:

It involves a series of injections of an irritant (often a sugar solution) into joints,

ligaments, and tendons. the injections stimulate local healing of injured tissues. A
treatment program may involve 15-20 shots given monthly for 3-4 months.

4/Other injection options include:

-Aspiration of fluid from the joint (and is often done in connection with a steroid
injection)
According to the disease:

-Septic arthritis:
Antibiotics

-Osteoarthritis:
Paracetamol (1" choice)

-Rheumatoid arthritis:
Non-steroidal anti inflammatory drugs (NSAIDS) ,Disease modifying drugs:

Methotrexate, Sulfasalazine, Hydroxychloroquine

Penicillamine, Azathioprine, Corticosteroids
-SLE:

NSAIDs
Corticosteroids
Antimalarials
Azathioprine

-Gout:

NSAIDs
Cholchicine
Allopurinol
Probencid
 Referral:

Rheumatologist: if patient needs disease modifying drug.

Orthopedic: If there is a need for joint drainage.

Ophthalmofogist: basic fundus examination and follow up check for any

complications. eg. retinopathy in patient on hydroxychloroquine.

Nephrologist: e.g protinuria and glomerular toxicity in patient on gold therapy

Thank you