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Complementary Therapy:
Eicosopentaneoic acid (EPA) and gammalinolenic acid (GLA) have been shown experimentally to be anti-inflammatory
and to blunt immune responses.
Fish oils,including cod liver oil,contains EPA.
Plant oils specifically oils from evening primrose and borage,contain GLA.
Theoritically,blackcurrent seed oil is even better,because it contains both GLA and a chemical which
is converted to EPA
Studies with these oils have shown that they definetly reduce the "tenderness and pain" index in rheumatoid arthritis,and
may affect the extent of the swelling as well.
But studies have only looked at high doses. It remains to be seen whether lower doses, (safety-factor),which
would be much safer and easier to take,will be as good.
Seaton is an extract of the New Zealand green-lipped mussel. It appears to have some anti-inflammatory effect
in the lab and rats,but well designed studies haven;t turned up any evidence of effectiveness in rheumatoid arthritis or osteoarthritis.
It is expensive.
In the last few years,three dietary supplements-glucosamine (with or without chondroitin), SAM-e and MSM-have
been popular. Glucosamine- it seems to help patients with osteoarthritis pain,but has never been shown to be effective in
inflammatory arthritis like RA.
SAM-e ("sammy" or S-adenosylmethionine) is an antidepressant and early studies support its claim as a pain reliever.
It has also been recommended as an anti-arthritis-but without proof,at least so far. At $1.00 (Canadian) per 100 mg caplet
(recommended dosage 4 to 16 a day),it is expensive
MSM,which is a breakdown product of dimethylsulfoxide (DMSO),is being promoted by a great deal of advertising
and word-of-mouth enthusiasm as a arthritis cure. There is no convincing studies,but I have seen some written by pharmicist-their
advice stay away from it .
A couple years ago there was a write up about a Chinese herb called thunder god vine,in a prestigious medical
journal and it listed warning signs about the herb. I forgot the contents about the article,but noted that I would stay away
from it. Probably the side effects of the herb was valid. Recent studies have been done.
Triptolide-its active ingredient have been isolated. It has now ben tested in the lab and shown to keep immune
cells from turning on the inflammation chain reaction. It is also believed have anti-cancer actions. The trip from lab to
pharmacy has been a troubled and long journey.
Zinc,selenium,copper and vitamin B and C have been investigated Addition of these does not affect arthritis.
A small study was done on a diet that eliminated red meat,dairy products,alcohol,preservatives,fruits and spices. A slightly
different study showed that 17 patients put on a long-term vegetarian diet improved and were able to maintain their improvement
fo at least a year.
Nutritionists examining this study have criticized it for two reasons: the numbers were too small,and the diet itself
had nutritional deficiencies that could lead to difficulty over the long run.
There is no blanke prescription. A small nunber of individuals-probably a few- have food allergies that cause symptoms.
In other instances,a vegetarian-type diet may modestly improve the signs and symptoms of inflammation. But for moderate-severe
RA ? We haven't heard the last word on dietary manipulation.
There have ben clear-cut instances where arthritis sysmptoms in patients diagnosed as having rheumatoid arthritis have
come and gone in response to the addition and addition of specific foods give in a "double-blind: fashion. the foods varied
by patient,and included corn,wheat,nitrate shrimp,and milk.
Most of the patients appeared to be rheumatoid fator (RF) negative. but estimates of the number of RA patients whose
symptoms are affected by food are well under 5 %. The scientists argue that there is no scientific evidence to support diet
or food have on effect on rheumatoid arthritis,as of today.
The National Institue of Health found that acupuncture may be a reasonable plan option for Osteoarthritis. More recently,the
American College of Rheumatology reported that acupuncture works no better than a placebo.
Acupuncture may be worth a try,particularly if you're attempting to deal with longstanding,diabling,non inflammatory
pain. But don't give up on conventional medicine. It seems to work best when it's co-ordinated with a variety of other approaches-physiotherapy,fitness
and muscle strengthening,behavioral modification. There are various schools of acupuncture.
We need larger studies to find out what types of arthritis benifit from the procedure .Acupuncture needle stimulation
in experimental animals causes release of natural painkillers (endorphins).
According to folk wisdom,when you wear copper bracelets small amounts of copper pass through your skin and neutralize
free radical,which are toxic molecules that damage cells. Wearing copper jewelry is probably harmless,but most doctors find
no scientific basis on which to recommend them.
Guided imagery and hypnosis can help you relax by creating a vivid and plesant mental picture. In you're mind's eye,e.g.,
You might see yourself lying on an ocean beach on a summer day listening to slow,gentle waves lapping against the shore.
Hypnosis is another controversial subject. Some experts see no value,while others claim it does
A related option may be biofeedback. During a biofeedback session,various machines monitor you and give feedback on certain
body functions--heart rate,breathing patterns,body temperature and more. When you enter a relaxed state,some of these functions
change. By monitoring such changes,you might learn how to produce them voluntarily and better cope with pain.
Meditation help you enter a deep,restful state that reduces your body's stress response. Meditating regularly can relax
your breathing,slow your brain waves,and heart rate. Medical professionals acknowledge that therupeutic massage (when
done properly) can help some patients and promote relaxation.
More study is needed to determine whether plant oils derived from plant extracts and resin can help various illness
when massaged into your skin or inhaled (generally).
Joint manipulation is practised by chiropractors and osteopaths. They claim that the treatment can relax the tissue surrounding
the joints,improve circulation and make joints more mobile. However, it's unclear whether joint manipulation or realignment
of the spine helps relieve joint pain caused by OA
If you have RA avoid neck manipulations. The chiropractors association endorses neck manipulations as safe,but some patients
have been crippled. There are some outstanding law-suits pending,with regard to this procedure. In Canada one chiropractor
settled a $1,000,000 law-suit out of court despite association backing.
Researchers are starting to look at magnets as a possible therapy for pain associated with arthritis. Some studies show
benefits. Some researchers believe in appropiate use of magnet therapy. Actually,it could lead to health problems. You should
not bring a magnet within 6 inches of a pacemaker.
According to some alternative practisioners,bee venom has enzymes that relieve the symptoms of RA. Others think that
bee venom stimulates your body to produce more steriods,which may help symptoms. 10 to 15 % of the population has mild to
fatal allergic reactions to insect venom,so this treatment is risky to some individuals.
Snake venom is toxic to some people,so arthritis experts warn against this treatment until more research has been
done. The FDA has not approved any arthritis medication derived from snake venom.
Unfortunately,there have been few scientific experiments with fish oils in patients with RA that have shown favourable
results,and consequently a practical,and safe dose are still unknown in this dietary therapy.
In most of the studies using fish oils,benefits are not usually observed until at least 12 weeks of continuous
use and appear to increase with extended treatment time.
Tests which favour fish oil indicate the inflammation improvement is moderate,
equal to what NSAIDs give.
It is important to note that fish oil supplement may interfere with blood clotting and increase the risk for stroke especilly
when consumed in conjunction with aspirin or other NSAIDs. Taking fish oils has also been linked to change in bowel habits
such as diarrhea and may cause upset stomach.
Until more is known about safe doseage for omega-3 fatty acids, supplemen -tation in the form of gelatin capsules
is not advised by some medical professionals. Rather increased consumption of fish rich in omega 3 fatty acids such as salmon,herring
and mackerel may be safer.
Whether omega-3 fatty acids should be included as standard therapy for RA remains controversial.--( Baron/John
Hopkins/) .
A consumer testing laboratory did some testing on supplementary tablets of fish oils containing omega-3 fatty acids by
different manufacturers and they concluded that the quantity actually advertised,and what was actually found differed
by different producers. Other researchers said the high dose needed ( supplement-capsules) for efficacy is of concern.
Professor Bruce Caterson,Cardiff,Wales U.K. reported what thousands of people with arthritis have said for years,and
some scientists said was "old-wives-tales"--that cod liver oil,really is effective in controlling joint pain in osteoarthritis.
According to Caterson,the omega-3 fatty acids in cod liver oil work by switching off the aggrecan and collagan--degrading
enzymes that breakdown the cartilage.
"A case of old-wives-tales and science coincide",says Caterson. He hopes to publish his findings in Arthritis and Rheumatism
publication. Caterson's intension is for those patients that can not take NSAIDs due to the side effects. (News release did
not mention dose).
Some research studies suggest that vitamin C may help people with OA. Other studies suggest worsening of OA.
According to some investigators osteoarthritis of the knee may be partially associated with low levels
of Vitamin D in the diet.
Taking too much Vitamin A may worsen osteoarthritis as reported by some other studies.
Elimination diets require you to stop eating certain foods. One such diet forbids night-shades vegetables,such as potatoes,eggplants,bell
peppers and tomatoes--you can go to far. According to the Arthritis Foundation,food sensitivities may play a role in arthritis.
However,scientist disagree on how common the problem is and what food,if any,to avoid Before you alter diet ask a dietician.
You can always eliminate one food product at a time and see whether symptoms can be helped.
Does homeopathy work ? Again we come to controlled studies,and again the data just isn't there. There has been only one
small acceptable study in RA. In contrast to a number of other reports that showed no benifit,it demonstrated a reduction
in pain in patients recieving homeopathic treatment
This study has ben criticized on the grounds that patients weren't assigned in a random fashion to one group or the other,and
so it does not meet strict study criteria.
In most Western countries,including Canada and the U.S.,herbal remedies are classified as foods and don't have to pass
the more strigent regulations applied to drugs. Quality control appears to be a big problem.
Analysis has shown some preparations to be adulterated with other drugs,and with heavy metals. This is particularly true
of products for which there's a huge market-and many unscrupulous individuals wishing to share it.
SOME GUIDELINES FOR USING HERBAL MEDICINES.
1. Approach any herbal medicine as you would a prescription drug or over-the-counter (OTC) drug. Herbals can have adverse
effects, drug interactions, contraindications (conditions when they should not be used), and all the other problems that go
along with the kinds of medications you are used to. Some are widely recognized to be dangerous, but are still allowed to
remain on the market.
In fact, you should even be more cautious when using an herbal than a prescription or over-the-counter (OTC) drug for many
reasons.
Herbals are virtually unregulated. You are not protected by the same government controls exercised over prescription
and OTC drugs. This means there is no assurance that what it says on the label is in the bottle. Also, because of lack of
regulatory controls, herbals are marketed in a way that may make them look like what they aren't and they are held out with
claims they can't fulfill. Their labels may not disclose their adverse effects and everything else you would expect on drug
labels.
Lack of knowledge about herbals. Only now are medical, pharmacy and other professional schools gearing up to give their
students the kind of intense instructions they should have on the subject.
Some herbal medicines are unsafe, ineffective, and potential killers.
When initiating a course of herbal medicine treatment, start with one herb only so you can clearly identify its adverse
effects and benefits. Otherwise, if you start with a bunch at one time, it may not be clear which one is causing problems
or which one is working. The same process makes sense in initiating drug therapy.
2. People with special conditions should proceed with special caution, and get the advice of a doctor, pharmacist or
other qualified professional before taking an herbal medicine.
People with special conditions include but are not limited to
Pregnant and nursing mothers
Anyone with impaired immune system
Anyone with impaired liver or kidney function
Anyone with chronic disease such as diabetes or heart disease,
Young children (especially infants)
Senior citizens
Anyone taking prescription medicines
The Mayo Clinic Family Health Book (2nd edition) says flat-out, "Don't give herbal supplements to children."
If in doubt, anyone, in perfect health or not, should get the advice of their doctor.
In some cases, it may be more convenient to ask your pharmacist, who may be able to advise you on the herbal medicine and
whether you should consult your doctor before taking it. You should use your pharmacist as an automatic check on what your
doctor recommends in terms of drugs, herbal medicines, food supplements and the like.
3. When getting advice from your doctor, pharmacist or other qualified professional on herbal medicines or on other
matters, you should tell them about all the herbal medicines you're taking, along with other nutritional supplements, vitamins,
minerals, prescription and over-the-counter drugs. In other words, what herbal medicines you're taking should be part
of your medical history. A competent doctor should ask you about all of the drugs, nutritional supplements, herbal medicines
and anything else you're taking as a part of your medical history and before prescribing any treatment.
When seeking advice from a pharmacist or any other professional, you should also be sure your medical history is fully
communicated.
4. When getting advice from your doctor, pharmacist, or other health care professional, make an allowance for the fact
that the major focus on herbal medicines is so new, your advisor may simply not be informed on the subject. Recently,
the American Pharmaceutical Association found only one-third of pharmacists felt comfortable in advising patients about herbal
medicines. The percentage of doctors, in my view, is likely to be just as low or probably lower. Dr. Dan Hussar, a leading
authority on pharmacy practice, says that pharmacists are in a unique position to assume a major role in counseling on herbal
medicines and will become the authorities on the subject. Other professional groups can also be expected to develop expertise
in this area.
5. Check it out yourself by going to the growing number of useful books and web sites on the subject. There are
now many sources available for checking out herbal medicines on your own. We've already mentioned The PDR for Herbal Medicines.
Other good sources are the Review of Natural Products (formerly called The Lawrence Review of Natural Products),
published by the same company that puts out the widely used and highly regarded Facts and Comparisons on drugs; Dr.
Varro Tyler's books including The Honest Herbal, available in paperback and hardback, and Herbs of Choice: The Therapeutic
Use of Phytomedicinals; The Professional's Handbook of Complementary and Alternative Medicines published by the
Springhouse Corporation; The American Pharmaceutical Association Practical Guide to Natural Medicines; Dr. James A.
Duke's The Green Pharmacy; and Jean Carper's books, including Miracle Cures and Food Your Miracle Medicine.
There is also a web site maintained by the National Institutes of Health that includes a data base of studies on herbal
medicines at http://odp.od.nih.gov/ods/. Other valuable sites, among
many others, are those of the American Botanical Council, www.herbalgram.org., and the site of the American Herbal Products
Association, www.ahpa.org. A good continuing source of information on herbal medicines is Consumer Reports on Health, the
newsletter published by Consumer Reports.
6. Don't fall for the idea that herbal medicines are perfectly safe because they are natural. There are huge catalogs
of natural substances that can be deadly ranging from arsenic and hemlock to opium (from the poppy). And what could be more
natural than the rays of the sun, which can cause melanoma and other skin cancers? Of course, as the PDR for Herbal Medicines
notes, "Some -- such as ginkgo, valerian, and saw palmetto -- seem genuinely useful, while others -- such as ephedra,
tansy, and nightshade -- can actually be dangerous." The Mayo Clinic Family Health Book (2nd edition) reports that
Ma huang may cause a dangerous increase in blood pressure, and germanium's long-term use may cause kidney damage and death.
Yohimbe may cause tremors, anxiety, high blood pressure and rapid heart beat; and chaparral may cause liver disease. Mayo
also notes that toxic chemicals in comfrey, borage and coltsfoot may cause liver disease.
7. Avoid the widespread fallacy that if some is good, more is better. This is dangerous. Whenever you start taking
extraordinarily large doses of an herbal you increase the chances of adverse effects and other problem. The same is true for
medicines, vitamins, minerals and all other dietary supplements.
8. If you do decide to use a herbal medicine, ask your doctor and pharmacist for recommendations on the brand to buy,
and check out the brand and source. Many suggest that you increase your chances of getting a standard and reliable product
if you buy an herbal from one of the major drug companies that are now moving into the market. Other suggestions of quality
include products that carry the seal of the National Formulary (NF), which indicates the product meets the specified guidelines
of the U.S. Pharmacopoeia (USP), a respected standard-setting organization. Such products whose manufacturer asserts they
meet NF standards will be coming onto the market by the end of 1999. However, the USP is still in the process of setting standards
for herbals and is many years from completing the job.
Still another indication of quality is the fact that the product is also sold in Germany, where higher regulatory standards
are set for herbs. In Germany, an agency of the government — called the Commission E — regulates herbals in a
fashion similar to the FDA's regulation of drugs in the U.S. Commission E has published 300 monographs on herbal medicines
and has allowed about 700 herbals on the market. Some 80 percent of German doctors use herbals. Dr. Ara DerMarderosian, a
nationally known expert on herbals, says if you want more information, you can write or call manufacturers and they should
provide details about their product and the testing and quality control standards. Many manufacturers have toll-free 800 numbers
making it easy to contact them. In the case of bulk herbs, one expert, June E. Riedlinger, offers this advice: "If the patient
is buying bulk herbs, it is important to select a product that is labeled with the identity of the plant and that still has
its color, is free of evidence of bacteria or fungus, and carries data indicating when the plant was collected."
9. Buy any herbal from a reliable store so you increase your chances of getting a fresh product and a quality product.
Check any expiration dates or other freshness information on the label. Varro E. Tyler says, "The labeling of herbal products
should show the scientific name of the botanical, the name and address of the actual manufacturer, a batch or lot number,
the date of manufacture, and the expiration date." You should also check for dosage information (it may indicate dosage information
under a section entitled "recommendation" or "suggested use"). Also check for storage information (which may say store in
a cool, dry and dark place which is inaccessible to children; some containers say store in a dry place at controlled room
temperature. Avoid heat above 80 degrees Fahrenheit). Some containers come with child resistant caps and safety seals.
10. While using an herbal medicine be alert for any possible adverse effects and report them to your doctor immediately.
You should be aware that any new symptoms may relate to the herbal medicine. Some recommend you keep a journal and record
each day the effect you experience in using the product. Dr. Varro E. Tyler has advised pharmacists to "advise patients to
cease taking a natural product (herbal medicine) immediately if adverse effects (e.g., allergy, stomach upset, skin rash,
headache) occur."
11. You should also report your experience with adverse effects to the Food and Drug Administration at 800-332-1088
(more easily remembered as 800-FDA-1088) or the U.S. Pharmacopeia at 800-4USP-PRN (the PRN stands for Practice Reporting Network).
That number is more easily dialed at 800-487-7776. Those two organizations share information.
12. Don't put off needed medical treatment with the hope that some self-prescribed herbal medicine will solve your problem.
You can endanger your health and life by delaying treatment of many conditions that may progress to become much more dangerous
or even fatal if not promptly treated. Don't try to use herbal medicines in place of needed medical advice.
13. Approach any recommended herbal medicine or any other medical recommendation for that matter, with a skeptical and
inquiring mind. Ask questions. Get answers. Check out recommendations. And needless to say, don't rely on medical advice
from a clerk or owner of a health food store. Remember that herbals are neither panaceas nor therapeutic pariahs. They range
from dangerous to valuable, and some are used by the most highly qualified physicians. As in much of life, two key Latin words,
which make sense in all languages and in all contexts, are worth observing — caveat emptor. Buyer and user beware.
The theory behind "free radicals" : The unstable oxygen compounds called "free radicals" are essential to life and to
normal immune response,but they play a destructive role in chronic rheumatical inflammation.
In what has become a vicious cycle,free radicals stimulate production of inflammatory mediators which tend to stimulate
production of more free radicals,and so on.
Even after immune system cells release anti-inflammatory mediators,free oxygen radicals can keep the flame burning for
a time. In RA patients,whose blood levels of antioxidant enzymes (glutathione, superoxide, dismutase, catalase) are
abnormally low,free radicals are left relatively unchecked to do damage.
The theory belief is that carefully selected herbs may supplement conventional medicine and are helpful precisely,because
they possess the antioxidant power to neutralize free oxygen radicals.
New research suggest that antioxidant compounds that act on cytokines-cutting off the inflammatory command at the source-may
be even more important than the antitoxidants that act to scavenge the free radicals that local immune cells release at the
behest of cytokine messengers.
These include carotenoids,essential fatty acids,soy isoflavones,vitamin E, branched-chain amino acids.curxumin,lipoic
acid,and phenolic flavones from such foods as green tea,rosemary,and grape seed extract (OPC)
Which makes sense as long as conventional therapy is followed and complementary therapy introduced,intelligently,or to
those patients unable to follow conventional,time-tested and clinically-tested therapies.
In other words,use complementary therapy to supplement conventional therapy without ,total replacement of conventional
therapy.
Curcumin is the main active constituent in turmeric,an Indian herb with an ancient history of medicinal use against inflammation.
Known to India's Ayurvedic physicians as rajani,turmeric is most familiar to Westerners as the bright yellow element in curry
powder. This spice is a close cousin to ginger. Curcumin is a name for the antioxidant pigment in turmeric,called curcuminoids
(natural NSAIDs). Whole turmic contains only about 5 % curcumin. making its anti-inflammatory action rather weak. You can
now purchase standardized dietary supplements of turmeric that contains 95 % or more curcumin.
There is a family of antioxidant plant compounds called oligomeric proanthocyanidins (OPCs) or pycnogenols. Supplemental
OPCs have been used in Europe since 1950 to treat weak blood capillaries,postsurgical edema (swelling),cirrhosis,varicose
veins,and diabetic retinopathy. The early research into OPCs as a treatment for capillary fragility hinted at their potential
value in connective tissue disorders,but this limited focus understates their therapeutic promise and until recently,has distracted
scientists from looking into broader uses for OPCs
Some researchers call OPCs "vitamin C2",because they restore tha antitoxidant function of vitamin C molecules worn out
by free radicals scavenging activities. Vitamin C is critical to immune functions and the health of connective tissues,making
it and OPC valuable to people suffering from arthritis,cardiovascular disease,and other conditions involving degradation of
connective tissue (e.g.,joints,artery walls) As yet,there are no clinical trials to support the theory,but work done in the
laboratory,looks very promising.--Grape skin extract,pine bark extract,pycnogenol -anti-inflammatory-antioxidant-collagen
protective). We should hear more about this in the future.
An approach similar to biofeedbck was developed by Dr. Wells in the wake of the gate-control theory,called transcutaneous
electrical nerve stimulation,or Tens, (minor pain). Electrodes taped to the skin near a painful area are wired to a electrical
stimulator,which produces a series of electrical pulse that "closes the gate" on the nerve cells that transmit pain signals
to the brain. You adjust the strength of the pulses until you feel a slight tingling.
Massage is widely used for pain relief,not least because anyone can perform it on himself or others,but it's results
are open to question. At best,massage (professional massage) may relieve muscle ache or tension,and it's results are relatively
short-lived. There is no question that a soothing stroking action ,on a painful area,done by yourself has a soothing effect
and it's cheap unlike the former.
Heat is another common treatment method (though it shouldn't be used on already inflamed joints}. From hot springs and
spas to Finnish saunas,relief is most likely due to general relaxation a sense of well-being . Exercising in a heated pool
will enable patients to do exercise that may not be done on dry land.. Heating pads is dry heat-what a muscle in spasm really
needs is moist heat,as in a water bottle.
Cold,not heaat is the recommended treatment for inflamed joints Ice packs,even a bag of frozen objects wrapped in a towel
can provide temporary relief,but then again some people can not stand cold packs.
Diathermy uses small paddles taped to the skin to direct electromagnetic radiation (as against the pressure waves of
ultrasound-another method) to heat a part of the body or limb from the middle outward.
If you have inflammatory arthritis,splints and other custom orthotics protect fragile joints from injury and keep them
properlu aligned,thus reducing pain.
Counterirritants,which include liniments,vaocoolant spray and poultices,work by pitting one pain against another,inducing
the body to lower it's sensitivity . Applied to a painful joint,they produce a trmporary local reaction that may cause skin
irritation,mild swelling,or a temperchange change and lessening of pain. Most countrtirritants "distract" the brain
from recognizing the signal from the pain source,a gate-theory effect.
A more effective compound would interrupt the flow of the neurons sending the signals in the first place. That's what
a substance P "antagonist" like capsaicin does Prescription salves are available in such brand names as Zostrix,Capzasin-P
and Capsin etc. Be careful not to get it into your eyes,via through your hands,while rubbing it in.
Capsaican,the hot chemical in chilies,is a slow-acting but effective topical (external) treatment for pain. For unknown
reasons,it appears that capsaicin has more effect on the pain of osteoarthritis than on rheumatoid arthritis pain.
Instead of hypnosis psychotheraphy may be more appropriate in providing people with "assistance in plannining their lives
and thinking differently about things". Where hypnosis does show encouraging results is when it's combined with other treatments.
Hypnosis,aid, in RA remains questionable.
Try to avoid thinking about pain,if you can,although it is hard,not to.
Improvise! Just because you have arthritis doesn't mean that every piece of equiptment is going to work for
you. No one's joint function is exactly the same as anyone else's,an a tool or device designed for someone with mild OA may
not be ideal for someone with severe RA-for that matter,it may not be equally suitable for two people with mild OA. Make sure
the device you're thinking of buying works for you before you put down any money. Otherwise you're liable to end up with a
closetful of doorstops and paperweights.
By all means,consult the professionals-from the supplier of aids and devices to the members of your health
care team. Many of the best solutions to disability impediments are engineered by patients.
How ? Learn to be flexible. Discover ways to alter your lifestyle to meet the demands of the disease,and
exercise as much ingenuity as you can muster to deal with the minutes of life. From the time you wake in the morning ("How
do I lift my stiff,aching body out of bed ?" to the time you go to bed at night ("I can't reach my toes-how am I going to
get my shoes and socks off ?"),you may need a whole new bag og tricks to ease your burden-and your mind.
There are lots of ways to adapt your environment. Start by making your activity centres,be it kitchen or
workplace,as convenient as possible. Organize materials so you can reach them with a minimum of twisting and stretching,preferably
from a seated position.
Beyond the lightweight and ergonomically designed housewares available-knives,scissors and clamps,touch-activated
lamps,oversize button on the phone,and grab bars and non-slip mats for the bathroom-are all sorts of economical tricks. You
don't have to buy expensive cutlery-build up the handle of your paring knife with friction tape, replace round doorknobs and
taps with lever-type handles,or build them up with rubber grips or elastic.
Clothing is infinetely adaptable. Try Velco fasteners in place of buttons, and equipt zippers with pull rings
for easier use. Loose clothing is easier to get in and out of. Slip-on shoes are preferable to shoes with laces,and shoehorns
are available with extra-long handles,so you don't have to bend over. In winter,a long coat offers more protection for sensitive
joints from the frigid air,and ir it has large pockets,you may be able to dispense with a hand bag or shoulder bag-back-pack
is even better,but some may not prefer the looks. For women,front-closing bras and wrap-around skirts are much easier to put
on. Clthing in easy-to-care fabrics need little or no ironing or hand washing.
Even your car can be adapted for ease of use: You can have a swivel seat installed,which makes getting in
and out a snap,there are special "one-handed " seatbelts available,and you can avoid some twisting and turning by mounting
a multipart rearview mirror. For stiffened hands and fingers,get a built-up handle for your ignition key and a padded cover
for the steering wheel.
Arthritis imposes a lot of barriers on everyday life,but don't let it stop you. Staying active as you can-mentally
and physically-is the way to approach the disease.
Transcutaneous electrical nerve stimulation (TENS) is a drug-free method of pain relief that has been used to treat a
wide variety of muscle and joint problems, as well as many other painful conditions. TENS uses electrical impulses to stimulate
the nerve endings at or near the site of pain, diminishing the pain and replacing it with a tingling or massagelike sensation.
TENS can be used in a health-care setting, but most often the patient uses it at home. Researchers still are not certain
exactly how TENS works. The two explanations suggested most often are that electrical stimulation of the nerves blocks the
pain sensation and that TENS triggers the release of the body's natural painkillers, called endorphins.
A TENS device consists of an adjustable power unit and electrodes that attach to the power unit via wires.
- The typical power unit is small — about the size of a beeper or a cell phone. Controls allow the patient to adjust
the intensity of the stimulation. Some units also adjust for either high-frequency or low-frequency stimulation. Frequency
is a measure of the number of electromagnetic waves in a given time period.
- Electrodes come in a variety of shapes. They usually are self-adhesive and made of cloth or foam. A gel is applied under
the electrode to improve the flow of current.
Before beginning treatment, the patient must put the electrodes in place — usually on top of or next to the painful
area. Patients can experiment with different locations for the electrodes to see what provides the best pain relief. In some
cases, it may be more effective to position the electrodes on top of a related nerve or a site that is considered to be a
trigger point or acupuncture point for the painful area.
Electrical stimulation can be used in the following ways:
- Conventional TENS — This is the most typical type of treatment. It uses a high stimulation frequency, but
the intensity of the electrical stimulus is low. Patients usually leave the electrodes on for long periods of time, turning
them on and off at intervals. A typical treatment might last 30 minutes, but the length can vary depending on patient needs.
Pain often is relieved only while the treatment is under way, but the relief may last longer.
- Acupuncturelike TENS — In this case, the stimulation frequency is low, but the electrical impulse is quite
intense. Some patients find this more effective or longer lasting than conventional TENS. Other patients find acupuncturelike
TENS too uncomfortable.
- Percutaneous electrical nerve stimulation — PENS, as it is known, is a combination of acupuncture and electrical
stimulation. Instead of electrodes, PENS uses needles to penetrate the skin and deliver the electrical stimulatio
TENS has been used in patients with muscular pain, osteoarthritis, rheumatoid arthritis, sciatica, pain after surgery
and other conditions.
Studies have shown varying results as to how well TENS works, what types of pain it can best relieve and how long the
relief lasts. Many people have found TENS helpful, however, and many doctors recommend it as part of an overall pain-management
progr
- Advantages
- TENS does not involve the use of drugs. For patients who find it helpful, TENS can reduce drug use for pain relief and
thus reduce the side effects of drugs.
- Some patients also like TENS because they are in control and can adjust the length and intensity of treatment.
- Disadvantages
- TENS can cause skin irritation. This often can be avoided by changing the type of gel or electrode used.
- TENS is not always effective.
- Electrical stimulation should not be used on the front of the neck. This can be dangerous.
- People who wear pacemakers should ask their doctors about whether TENS is safe for them. TENS can interfere with the operation
of some types of pacemakers.
- It is not clear whether TENS is safe for pregnant women.
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