Alternative Pain Management: Treating Rheumatoid Arthritis

Over the course of a lifetime most people will develop some kind of arthritis. Instead of depending on a course of harsh pharmaceuticals there are other options for managing the pain caused from arthritis. The following article discusses some different options: 

"A woman with rheumatoid arthritis (RA), whom we’ll call Linda, recently consulted us. She had received her diagnosis three years ago, and her symptoms had grown worse and become disabling. Since her diagnosis, Linda had tried many treatments for her RA, including nonsteroidal anti-inflammatory drugs (NSAIDs) to relieve her pain; methotrexate (brand name Rheumatrex), hydroxychloroquine (Plaquenil), sulfasalazine (Azulfidine), and the biologic drug etanercept (Enbrel) to address the underlying inflammatory process of RA and control symptoms; and physical and occupational therapy to keep her joints functioning. She’d had to stop taking NSAIDs because of unacceptable stomach distress, despite also taking medicines to protect her stomach. Methotrexate had been reasonably effective for Linda’s symptoms, but then she had developed scarring of the lungs (a condition called fibrosis), so that drug was also stopped. She couldn’t stay on hydroxychloroquine because it was causing vision problems. And then she became allergic to sulfasalazine. To make matters worse, Linda had lost her health coverage because she’d become unable to work. Although we waived our fees, the costs of all other aspects of Linda’s care — therapy, medicines, and laboratory and imaging studies — were a problem for her. Fortunately, we were able to obtain etanercept for Linda at no cost through the manufacturer’s patient assistance program. Most of her symptoms were adequately controlled after she restarted etanercept. However, Linda was disappointed with her experiences with conventional medicine and still concerned about the cost of care. She wanted to know which complementary or alternative therapies she could use that would be safe, effective, and inexpensive. This article explores the available alternative treatments for rheumatoid arthritis.

People with RA want to know — and need to know — about so-called complementary and alternative medicine (CAM). After you received your diagnosis of RA, you probably asked how your condition would be treated. Upon learning that there is no cure for RA, you may have set a goal of achieving remission, or at least a satisfactory quality of life without new problems arising from your therapy. Perhaps you’ve wondered about or tried CAM treatments, although you may not have brought them up with your physician.

There are several reasons that people with arthritis find CAM appealing. Some people fear conventional medicines. Others haven’t fared well on conventional treatments; like Linda, they’ve experienced problematic side effects or found the costs daunting. Some people prefer so-called natural or holistic therapies. For others, CAM seems more appropriate for their lifestyle. Studies have shown that people with emotional or psychological distress tend to favor CAM. Some people believe that CAM treatments will offer them more control over their condition. And others think of CAM as a simpler, safer, cheaper approach to managing their arthritis — although this isn’t necessarily the case.

Alternative treatments for rheumatoid arthritis: What is CAM?

CAM therapies are those that are not part of conventional medical practice. Although they are often lumped together, complementary treatments are those used alongside conventional treatment, and alternative treatments are those used in place of conventional medicine. We don’t particularly like the terms “complementary” or “alternative” because we think they make these treatments sound more promising than they may be. We prefer nonmainstream to describe CAM therapies and mainstream to describe conventional ones.

A major difference between mainstream and nonmainstream therapies is that while mainstream therapies have been studied rigorously, most nonmainstream therapies have not. By and large, mainstream therapies have proven benefits, and they have been shown to be safe for the population they’re intended for. Some nonmainstream treatments are supported by evidence of safety and effectiveness, but most are not. Bearing this difference in mind, many doctors practice integrative medicine, which seeks to incorporate into mainstream treatment those nonmainstream therapies that have credible scientific evidence supporting their use. In integrative medicine, it doesn’t really matter whether a therapy has its origin in mainstream or nonmainstream medicine, as long as well-conducted studies have shown that it is safe and effective.

Considering the scientific evidence, we don’t think that any truly important treatments for RA have emerged from nonmainstream medicine. That said, some popular nonmainstream treatments may be of some help when integrated into mainstream care for RA. Others are not useful at all. Below, we discuss the evidence for some of the nonmainstream treatments you may have heard about.

Controlling rheumatoid arthritis through diet: Can it be done?

Trying to control arthritis through dietary changes has long been the most appealing nonmainstream approach for people with RA. The notion that today’s symptoms reflect what one ate yesterday — and that symptoms are therefore simple to control by eating certain foods and not others — is very seductive. Unfortunately, RA is not so simple. There is no good, consistent evidence that either foods (or food products) or special diets affect the symptoms of most people with RA.

One factor related to diet that can affect your well-being, however, is being overweight, which can put extra stress on painful weight-bearing joints such as the hips and knees. To reach and maintain a healthy weight, and for good overall health, we recommend a healthful, balanced diet for people with RA. A balanced diet is one that emphasizes a variety of vegetables and fruits, whole grains, lean meats, and low-fat dairy products eaten in moderate portions.

OTC Supplements for rheumatoid arthritis

Many over-the-counter dietary supplement products are advertised to help with joint symptoms, including fish and plant oils, vitamins, and herbs.

Fish and plant oils

Fish oil supplements contain the omega-3 fatty acids docosahexaenoic acid (DHA) and eicosapentaenoic acid (EPA), and plant oils contain omega-3 and omega-6 fatty acids such as alpha-linolenic acid (ALA) and gamma-linolenic acid (GLA). These fatty acids may have modest anti-inflammatory properties, similar to those of nonsteroidal anti-inflammatory drugs (NSAIDs). They may be useful for people who can’t or won’t take NSAIDs because of preference, allergies, sensitivity, toxicity, pregnancy, lactation, gastrointestinal problems, bleeding issues, or cardiovascular disease. Some health-care professionals think fish and plant oils are underused in treating arthritis.

Glucosamine and chondroitin

These substances are naturally found in cartilage, the spongy material that cushions the ends of the bones in joints. Glucosamine and chondroitin supplements were briefly a part of mainstream treatment for osteoarthritis (OA), whose underlying problem is breakdown of cartilage, because some studies suggested they could relieve joint pain. Subsequent studies were more disappointing. Glucosamine and chondroitin have not been well-studied for RA, and we would not expect them to have any benefit.

Vitamins

We know of no proven role for vitamin supplements in relieving the symptoms of RA. RA has been linked to deficiencies of certain vitamins, but studies have not shown that taking these vitamins helps to treat RA. Vitamin D plays an important role in bone health, and people who take corticosteroids, which can cause thinning of the bones, may take calcium and vitamin D supplements to help keep their bones strong. Doctors sometimes prescribe one type of B vitamin, called folic acid, to people who take methotrexate because it can help to reduce methotrexate side effects.

Herbs

If a truly useful treatment one day emerges from nonmainstream medicine, we suspect it’s most likely to come from herbal therapies. Many important medicines were originally derived from plants, including digoxin (Lanoxin), which is used to treat heart failure and abnormal heart rhythm; colchicine (Colcrys), which is used to treat gout; and the NSAID aspirin (Bayer and others).

Many herbal preparations have been, and continue to be, studied to see if they can benefit arthritis or other musculoskeletal conditions. A good example is the root extract of a plant called Tripterygium wilfordii Hook F, or thunder god vine, a Chinese herbal remedy that can be applied to the skin or taken orally. This herb has been scientifically studied for RA, with results presented in the scientific literature. It works reasonably well at improving RA symptoms, but it can cause a number of troublesome side effects, including nausea, infertility in men, menstrual problems in women, and an elevated risk of infection. Purchasing thunder god vine is risky because high-quality thunder god vine products are not made in the United States, and improperly prepared products (for example, those extracted from the leaves and flowers of the plant, rather than the root) can be poisonous.

Other herbs and supplements that have been studied in people with arthritis include the following:

  • Articulin F (a proprietary combination of Boswellia serrata, turmeric, winter cherry [Withania somnifera], and zinc)
  • Black currant (Ribes nigrum)
  • Cat’s claw (Uncaria tomentosa)
  • Devil’s claw (Harpagophytum procumbens)
  • Eazmov (a mixture of different herbs used in Ayurveda, a traditional Indian form of medicine)
  • Evening primrose (Oenothera biennis or Oenothera lamarckiana)
  • Extract of avocado and soybean unsaponifiables (ASU)
  • Feverfew (Tanacetum parthenium)
  • Garlic
  • Ginger extract
  • Gitadyl (an herbal preparation containing feverfew, American aspen, and milfoil)
  • Green-lipped mussel extract
  • Indian frankincense (Boswellia serrata)
  • Phytodolor (a combination of aspen bark, ash bark, and goldenrod)
  • Pine bark
  • Reumalex (a combination of black cohosh, guaiacum resin, poplar bark, sarsaparilla, and white willow bark)
  • Rose hip
  • Selenium
  • Stinging nettle
  • Turmeric
  • White willow bark

The evidence in support of these supplements is limited, however, and for most of these products, standardized preparations are not available. We are not aware of any proven, consistent role for these preparations for people with RA.

Mind-body techniques to ease pain

Mind-body techniques are based on the idea that thoughts, emotions, and behaviors affect the body and one’s overall state of health. These techniques are designed to focus the mind, relax the body, and relieve stress. Helpful techniques for people with arthritis include the following:

Biofeedback

In this technique, you wear sensors attached to a machine that shows you your heart rate, level of muscle tension, or other measurements as a biofeedback practitioner guides you through relaxation techniques. The instant feedback from the machine allows you to learn how to get your body to a more relaxed state.

Guided imagery

With the guidance of a practitioner or an audio recording, you visualize a pleasant scene, calming your body and mind in the process.

Hypnosis

In this technique, a hypnotherapist guides you into a trancelike state of relaxation.

Meditation

The goal of meditation is to focus the attention and quiet the mind. There are many different types of meditation, but the practice typically involves sitting or lying down and focusing on your breath or on a word or phrase. Prayer can be a form of meditation.

Tai chi

A traditional Chinese practice, tai chi is a form of meditative exercise that involves slowly and gracefully moving through a series of postures. In addition to relaxation, tai chi’s potential benefits include improved balance, flexibility, and strength.

Yoga

This practice, which originated in India, involves moving into different postures while focusing on breathing and alignment. Like tai chi, yoga fosters relaxation and can improve flexibility and strength. Not all forms of yoga are gentle enough for people with arthritis, however. If you’re new to yoga, start with a yoga class (not a video) and find an instructor who has experience working with people with arthritis. Your local YMCA, senior center, or chapter of the Arthritis Foundation may offer an appropriate class.

The above techniques are sensible and rational, and there is scientific evidence of their effectiveness. Mind-body techniques can help people with RA control anxiety and pain, especially when used in conjunction with mainstream treatments.

Homeopathy

Homeopathy is a therapy based on a theory that “like cures like” — in other words, that a condition can be treated with very small doses of a substance that causes similar symptoms. Homeopathic remedies contain small amounts of highly diluted substances. Most mainstream scientists have been skeptical that anything so diluted could have value. We are not aware of research supporting the usefulness of homeopathy for RA or any other rheumatic condition, and we do not recommend it.

Exercise

We include exercise in this list because it wasn’t always a mainstream treatment for RA. It used to be thought that exercise wasn’t safe for people with RA, but research has shown that it is both safe and beneficial. Nowadays, exercise is part of a conventional rheumatoid arthritis treatment plan. It can help to increase strength and endurance, maintain joint flexibility, and control pain. Exercise is also important for cardiovascular health. In addition to its physical benefits, participating in an exercise program also has psychological and social benefits. We strongly encourage exercise, but you must seek advice from your doctor or a physical therapist to be sure the activities you undertake are safe and appropriate.

Additions, not alternatives to rheumatoid arthritis treatment

We have discussed a number of nonmainstream therapies that are popular among people with RA. There are many other treatments touted for arthritis that we did not discuss, including acupuncture, Ayurvedic medicine, electromagnetic fields, lasers, leeches, magnets, marijuana, the supplements methylsulfonylmethane (MSM) and cetyl myristoleate (CMO), venoms, and many others. We are not aware of any proven benefit for people with RA from any of these treatments.

It is important to understand that just because something is called “complementary,” “alternative,” or “natural” does not mean it is safe. Some nonmainstream therapies are dangerous. If you are curious about or thinking of trying a particular nonmainstream therapy, you should first discuss it with your physician. And you certainly shouldn’t neglect your regular treatments in favor of nonmainstream ones. When nonmainstream therapies are useful, they work as additions to standard therapy, not replacements for it."

Excerpted from: https://www.painfreelivinglife.com/tools-chronic-pain/alternative-therapies/complementary-and-alternative-medicine-for-ra/