Philip Ireland, M.D., an orthopedic surgeon at Indiana University Health, shares his best advice for controlling pain, preparing for joint replacement surgery, and more.
Be wary if your doctor suggests prescription opioids.
There are many reasons why they’re inappropriate for managing arthritis pain. “Opioids aren’t meant for long-term use because it’s very easy for people to get hooked on them,” Dr. Ireland says. “And we don’t want people to take them for a correctable problem like arthritis.” If frontline treatments for arthritis—anti-inflammatories and cortisone injections—aren’t helping your pain, it may be time to consider joint replacement surgery, he says.
In addition, taking opioids can lead to a poorer functional outcome if you do need surgery. “Patients who have baseline tolerance for opioids coming into surgery have to nearly double their dosage during recovery to manage pain,” says Dr. Ireland. “This can make people so sedated and lethargic that it’s harder for them to do the necessary therapy.” He advises patients on opioids to at least cut their dosage in half 6 to 8 weeks prior to surgery to make managing post-operative pain easier.
Don’t get cortisone injections if you’ll need joint replacement surgery soon.
Research presented at last year’s annual meeting of the American Academy of Orthopedic Surgeons revealed that receiving injections in the months prior to knee or hip replacement surgery may increase the risk of infection and other complications. Most contain corticosteroids, which ease pain and inflammation, but may also diminish the body’s immune response. Though the risk of infection is low, the consequences can be severe. “You’re looking at additional surgery to take out the joint and clear the infection, as well as IV antibiotics and a longer recovery time,” says Dr. Ireland. If you’ve been receiving cortisone injections or are considering starting them, know that you’ll need to wait at least three months following an injection to be considered for replacement surgery.
Exercise and weight loss can do more than ease pain.
Increasing your muscle strength—and taking pressure off your joints by slimming down—can postpone your need for replacement surgery, says Dr. Ireland. “These lifestyle changes can also be tremendously helpful if you do need surgery, because recovery will be a lot easier if you have a good baseline of strength already,” he explains. Swimming, biking, and using an elliptical trainer are all good, low-impact options, as is yoga: A study published in the Journal of Rheumatology showed that eight weeks of yoga classes improved pain, energy levels, mood, and physical function in those with knee osteoarthritis and rheumatoid arthritis.
Be skeptical of supplements marketed for “joint health.”
Dr. Ireland says that no particular supplements have been shown to be beneficial for joint pain—not even glucosamine and chondroitin, the two most commonly promoted for joint health. “There are good peer-reviewed studies showing that neither is useful for easing pain,” he says. For this reason, the American College of Rheumatology advises patients to avoid glucosamine and chondroitin in their recommendations on therapies for osteoarthritis of the hip and knee.
-- By Jessica Brown