How to beat joint pain: medication exercises supplements food and gadgets

This is part 1 and part 2 of this excellent article written by Cameron Henderson for the Mail+

These have been blended for for reference

How to beat joint pain: Which medication and supplements really CAN help – and what are the best foods to eat? In the first part of a comprehensive joint pain guide, we ask leading experts for their verdict on popular treatments...

CAMERON HENDERSON Mail+ feature writer FEBRUARY 17, 2022

From an achy back to throbbing wrists, joint pain may feel like an inevitable part of getting older.

Indeed, nearly nine million Britons suffer from osteoarthritis – the most common type of arthritis, associated with the wearing down of joints and the body’s attempts to repair them – with most people who get it developing it in their mid-40s or older. However, musculoskeletal conditions are more widespread than you might think. These are problems to do with your joints, bones, muscles and spine and affect over 20 million people in the UK – including young people – according to the charity Versus Arthritis. Yet many of these people are currently not receiving the care they need. The latest NHS statistics report that six million people in the UK are waiting to start routine hospital treatment, including surgery such as a hip or knee replacements. And Dr Benjamin Ellis, consultant rheumatologist at Imperial College Healthcare, says, ‘many people with osteoarthritis who are in agony, struggling to move and unable to function are having to wait months for operations.’ But what to do about it? If your knees are clicking more than a 70s backing dancer – or if you’re concerned about that one day being the case – there may be steps you can take to soothe your aching joints.

First things first, not all joint pain is the same, and some conditions need urgent medical attention. So, if you don’t know why your joints hurt – especially if they’re stiff in the morning or swollen – Dr Ellis says you should see a health professional first to get checked out.

But for arthritis that doesn’t need urgent treatment, we spoke to leading medical experts for their top tips on what works and what doesn’t when it comes to tackling the joint pain they can cause.

Today: Supplements, diet and medication Tomorrow: The best exercises to ease joint pain – and the gadgets that can help. Click here to read this other piece

SUPPLEMENTS If you’re suffering from constant joint pain that won’t subside no matter what you do, it can be very tempting to turn to the internet for solutions. However, seeking out health advice online can be a minefield of misinformation. From turmeric to omega-3 capsules, there are hundreds of supplements out there that promise an easy fix. But according to Ian Clark, professor of musculoskeletal biology at the University of East Anglia and spokesman for Versus Arthritis, ‘the evidence for supplements having any effect on joint pain or osteoarthritis is generally of very poor quality.’ Glucosamine and chondroitin Of all the supplements that claim to soothe sore joints, two that are supported by research are glucosamine and chondroitin. These compounds are available in various forms and are both components of the cartilage in your joints. But even then, Professor Clark says, ‘the evidence for them being effective is very minimal.’ Indeed, chondroitin products are not recommended for treating osteoarthritis by the health watchdog NICE. Having said that, he says they are safe to try out and that you might even get some pain relief from a placebo effect. If you do choose to take one, he recommends opting for a chondroitin sulphate supplement. But before taking any new supplement, he says to make sure to check with your GP first, particularly if you have high blood pressure or diabetes as these supplements can affect your blood sugar levels.

Turmeric Turmeric has long been used in traditional eastern medicine to cure all manner of afflictions. Meanwhile, in the western world, its usage has skyrocketed in recent years with wellness influencers touting its health-giving properties. The active ingredient in turmeric powder is curcumin, which can be taken in supplement form. And, Professor Clark says, ‘there are some short-term trials of less than three months that show an effect of curcumin reducing pain in patients with osteoarthritis.’ However, he says that we lack long-term evidence. Another problem he mentions with taking curcumin is that ‘it’s not very well absorbed by the body’. ‘If you take a curcumin supplement, the chances of you getting much in your bloodstream would be quite small.’ If you are interested in trying out a turmeric supplement, he recommends finding one that says it is easily absorbed or bioavailable as there are a lot of supplements out there that are not very well validated. As for adding extra turmeric to food for its supposed pain-relieving properties, Professor Clark says, ‘I don’t think you get enough curcumin from increasing the amount of turmeric in your curry.’

Fish oil Fish oil is sometimes viewed as a panacea for all sorts of ailments, from staving off heart disease to delaying the onset of dementia. And some claim that it can be used to relieve joint pain too. However, Professor Clark says, ‘the link between dietary fats and osteoarthritis or joint pain is controversial.’ There’s a small amount of evidence to suggest that omega-3 fatty acids – the active component in fish oil – might help certain joint conditions. For instance, in an analysis of 68 studies, researchers at Surrey University found that taking one and a half capsules of fish oil supplement a day could reduce pain in patients with osteoarthritis. Moreover, Dr Ellis adds that oily fish has also been shown to improve symptoms of rheumatoid arthritis. Indeed, a study of 176 people with rheumatoid arthritis by Arthritis Care and Research found that those who ate more than two servings a week had the best control of their arthritis pain. Rheumatoid arthritis is an inflammatory auto-immune disease, which means that your body attacks itself. There are about 430,000 people who have it in the UK and, unlike osteoarthritis, it can strike at any age. However, Professor Clark says that for osteoarthritis, the research is ‘not at the stage where you’d say it’s definitely the thing to take’.

Rosehip Picked from beneath the petals of a rose, these berry-like growths are actually the seedpods of the plant and have long been used as a herbal remedy for all sort of medical problems. They can also be bought in supplement form with some studies suggesting the pills may help people suffering with certain types of joint pain. Indeed, a study of 89 participants by researchers at Charité University in Berlin found that rosehip powder may be beneficial for people with rheumatoid arthritis. But once again, Professor Clark says, ‘I don’t think the quality of evidence is high enough to categorically say that it has an effect.’ He adds that boswellia serrata, known as Indian frankincense, and French maritime pine bark – which comes as a supplement called Pycnogenol – also both have a small amount of evidence for relieving joint pain. Across the board, his advice is simple. ‘For my money, rather than take supplements, I would say to lose weight, if you’re overweight, and eat a diet that’s rich in fruit, vegetables and whole grains.’

DIET Be a healthy weight While most of us know what foods to avoid as part of a healthy diet, you might be surprised to hear that eating well can have a big impact on your joint health. Indeed, Professor Clark says that by far the most important risk factor for joint pain is obesity. ‘If you’re overweight and you have osteoarthritis, or if you want to stop yourself from getting osteoarthritis, then losing weight is probably the best thing you can do,’ he says. And pressure on your knees and hips isn’t the only cause for concern. He says that being obese can also increase your risk of developing osteoarthritis in non-weightbearing joints such as your fingers and wrists. This is because fat cells produce inflammatory molecules called adipokines which can aggravate your joints. To help shift some excess weight – and thereby either relieve osteoarthritis pain or slash your chances of developing it in the first place – Professor Clark recommends cutting out processed, high-calorie foods as well as animal proteins. Instead, he advises eating a varied diet that’s rich in fruits, vegetables and whole grains. In fact, in a study of nearly 6,000 people, researchers from Tufts University, Boston, and Manchester University found that eating a high-fibre diet – which you get from eating plenty of fruit, veg and grains – reduced participants’ risk of developing osteoarthritis by up to 61 per cent. One vegetable that Professor Clark is particularly interested in is broccoli as it contains a compound called sulforaphane which has been shown to be good for cartilage. In fact, he and a team of researchers are currently running a trial looking at the effects of a high-broccoli diet on pain and physical function in osteoarthritis patients. Although broccoli may not turn out to be the magic cure for joint pain, whether you’re a broccoholic or not, Professor Clark says that as long you are not taking a blood-thinning medication, you can safely eat more broccoli and it may have some benefit. Healthy gut, healthy joints? Demand for gut health products has boomed in recent years with evidence showing that eating plenty of probiotic foods not only aids your digestive system but can also boost your memory and help regulate your mood. These foods include live yoghurt, kimchi and sauerkraut, and can also be consumed as supplements. For more information on the foods that fuels your gut bugs, read this article But can having a healthy gut actually stave off joint pain? ‘There appears to be a link,’ says Professor Clark. However, as far as osteoarthritis is concerned, ‘there isn’t the evidence to say that it helps in practice.’ On the other hand, there is evidence for the benefits of probiotic food for helping with rheumatoid arthritis by supporting the immune system, he says. Although the benefits of probiotics for joint pain are not clear cut, Professor Clark says you can experiment with these foods as you are unlikely to do yourself any harm. MEDICATION Popping a pill or getting occasional injections for your joint pain might seem like an easy fix. However, Professor Philip Conaghan, consultant rheumatologist at Leeds Teaching Hospitals NHS Trust, says there is a limit to how effective these treatments are and encourages people to err on the side of caution, especially when it comes to more experimental drugs. ‘We’ve got so few effective therapies but there’s such a desperate need for pain relief,’ he says. This can leave people vulnerable to spending money on expensive treatments or supplements without any guarantee that they are effective. But which medications work, and which do not? Diclofenac and ibuprofen creams These topical anti-inflammatory creams are safe to use and can easily be bought over the counter at most pharmacies or supermarket chemists. What’s more, Professor Conaghan says, they do work for arthritis. The only downside is they may require multiple daily applications which can be a bit of a hassle. Capsaicin cream Known for giving chillies their spicy flavour, ‘capsaicin has been shown to have benefits for osteoarthritis,’ says Professor Conaghan. But, he adds, ‘we still need more trials until they are proven to work.’ That said, capsaicin creams, which you can buy at most pharmacies, are safe to use and supported by NICE guidelines. They work by numbing the pain receptors in your joints if you apply the cream repeatedly over a couple of weeks – just like how spicy food can numb your tongue. However, he warns that some people may find the burning sensation slightly off-putting. FOR MORE INFORMATION ON PAINKILLING GELS, CLICK HERE . Oral non-steroidal anti-inflammatory drugs (NSAIDs) These are the most commonly used drugs to combat osteoarthritis pain and they include ibuprofen, naproxen and diclofenac. But be warned: roughly two thirds of people can’t tolerate long-term use of NSAIDs and experience side-effects of burning sensations, indigestion and bloating. And even if you don’t experience any unpleasant symptoms, they can still be very damaging to the gut if taken for prolonged periods, so be very mindful of how many you swallow. Professor Conaghan adds they can also aggravate blood pressure, put you at greater risk of heart disease if you are already prone and make kidney problems worse if you have abnormalities. Weak opioids These include codeine and co-codamol – a mixture of codeine and paracetamol – and ‘may have a small effect on reducing pain’, says Professor Conaghan. However, he adds, ‘these become less effective over time as our bodies become used to the medication and they don’t seem to get more effective by increasing the dose.’ You should also be wary of common side-effects such as constipation and occasional drowsiness. And while it is unlikely, there is a small risk of addiction. Steroid injections ‘There is a role for steroid injections in some people,’ says Dr Ellis, explaining that he’ll sometimes offer them to people as a back-up after trying simpler methods such as topical creams. Meanwhile, Professor Conaghan says steroid injections are effective at relieving joint pain but they only work for three to six weeks. This means they are useful at providing you with a chance to do your exercises and get stronger but they are not a long-term solution. He adds, ‘there are many other injections that claim to work but we are lacking rigorous trial data.’ These include hyaluronic acid, platelet rich plasma, stem cells and botox. For more information and support about living with arthritis or joint pain, visit www.versusarthritis.org and check out its decision support tools or call the charity’s free helpline on 0800 5200 520.

Battling joint pain? In part 2 of our brilliant guide, experts reveal the best gadgets and simple exercises you can do at home

Written by CAMERON HENDERSON Mail+ feature writer FEBRUARY 18, 2022

Yesterday, in the first part of our comprehensive guide on beating joint pain, we asked leading experts about the medication, supplements and diets that really can help. Today, we’re going to cover the simple exercises you can do at home that’ll make a real difference – and the gadgets the experts say could be worth trying...

Why building muscle is better at relieving pain than any drug

While building muscle might sound like the preserve of bodybuilders and fitness fanatics, Professor Philip Conaghan, chair of musculoskeletal medicine at Leeds University, says: ‘For the majority of people, the thing that most helps joint pain is building strong muscles.

‘Muscles stabilise joints by reducing strain through the tendons and ligaments around the joint.’ When you have weak muscles, your tendons, which connect your muscles to your bones, are less supported and start to pull more on your bones, causing inflammation known as tendonitis, he explains. He says this ‘is probably what a lot of people’s joint pain is related to’. He adds the benefits of building strength for reducing joint pain are ‘far more noticeable’ than anything you can get from a drug, adding, ‘for people with knee osteoarthritis, you may not need a joint replacement if you can get strong enough’. Plus, you don’t even need to go to the gym to get started! Why you shouldn’t fear exercise And while many people with joint pain fear exercise for a variety of reasons, Dr Benjamin Ellis, consultant rheumatologist at Imperial College Healthcare, says moving more is a safe and effective way for you to manage your arthritis symptoms. In effect, using your joints can actually make them stronger and reduce painful inflammation. ‘Inflammation is the normal process the body uses to start to heal any injury,’ explains Dr Ellis. ‘When we’re young, we use our joints every day and the body repairs the small amounts of damage we do.’ However, as we get older, the cartilage covering the ends of our bones can become damaged or thinned, causing osteoarthritis. Over time, this means the bones start to rub against each other. While most of us will get osteoarthritis in some of our joints as we age, it doesn’t always cause pain. But sometimes, our body’s repair cycle doesn’t work so well, meaning the changes in our joints can lead to pain, stiffness and swelling. How it helps Exercise may reduce joint pain for a number of reasons. Firstly, it stimulates our cartilage to properly regulate its normal repair and rebuilding mechanisms. There is some evidence that it also reduces inflammation in the fluid surrounding the joint – and less inflammation may mean less pain. He adds: ‘Increased blood flow to the joint lining during exercise may improve the delivery of oxygen and nutrients and support the removal of waste products from the joint’. Meanwhile, by increasing the strength of the muscles, ligaments and tendons around a joint, ‘exercise also stabilises the joint, helping to ensure that everyday loads are spread evenly across the joint, which may help with pain too’. However, he adds, if you experience significant joint pain that has come on rapidly, have swollen joints or feel very stiff in your joints or spine for more than half an hour when you wake up, then you should see a doctor. This is because it may be caused by an inflammatory condition such as rheumatoid arthritis or ankylosing spondylitis which affect between one and two per cent of Britons and require urgent specialist treatment. Exercises for achy hands, wrists or elbows If you get stiffness in your hands, wrists or elbows for up to half an hour in the morning, Professor Conaghan recommends doing a sustained squeeze of a sock or soft ball for half an hour with your forearm resting on a cushion – best done in front of the TV to relieve boredom! As well as helping to relieve pain, this can help to strengthen your forearm muscles, which will make it easier to perform everyday tasks such as opening a jar. Exercises for achy knees or hips Meanwhile, if you struggle to get out of a chair, Professor Conaghan recommends strengthening your thigh muscles, aka your quadriceps. To do so, he suggests lying flat on your bed or sofa and placing a rolled up towel under one of your knees. Lock the knee by lifting your heel off the bed and hold for ten seconds before lowering the heel slowly and relaxing for three seconds. Repeat this hold ten times or until your thigh is tired before swapping to do the same thing on the other leg. As you get stronger, he recommends ramping up the difficulty by locking your leg for longer or increasing the number of repetitions. But however you choose to progress, he says the most important thing is that you make strengthening your achy joints part of your daily routine, performing these exercises twice a day. Besides leg raises, walking in a swimming pool is fabulous for improving your strength and he recommends walking either widths of a swimming pool or laps of a spa pool until you feel tired. If you’re new to exercising, Dr Ellis suggests trying to build an exercise routine into your day. He suggests the Let’s Move with Leon programme by Versus Arthritis as a good place to start as it’s designed to help people with arthritis and related conditions improve their strength, flexibility and cardiovascular fitness. It’s also completely free and doesn’t require any extra equipment. GADGETS THAT MAY HELP JOINT PAIN On top of going to see a physio for treatment to help soothe your achy joints, there are numerous gadgets available that may give you some additional relief and help with everyday living. Here are the ones our experts recommend: Using hot and cold treatment If you do suffer from joint pain, periods of inflammation can be unbearable, making basic day to day tasks feel near impossible. That’s why, as an easy household solution, London-based chartered physiotherapist Sammy Margo recommends using cold treatment to relieve swelling for up to three days if you have a flare up or sustain a new injury and using heat from then on to treat ongoing low-grade pain. She advises buying both heat and ice treatments in the form of roll-on balms as they’re easy to apply, localised and can be used in tandem with other medications. Many options can be found in pharmacies. ‘Cold causes vasoconstriction, where your blood vessels narrow, which reduces circulation to the joint. This is what you want in the early stages of a flare up because it limits swelling,’ she explains. ‘Heat causes vasodilation which is what you want later on as it increases the circulation to the joint. This brings more oxygen and nutrients to the area and takes away waste products, promoting healing.’ She adds that heat also relaxes any muscles that might be in spasm around the area which can cause pain. And if the roll-on balms don’t last long enough for you, Dr Ellis says buying a hot water bottle and an ice pack might offer a more affordable and sustainable solution. Therapearl compress TheraPearl Compress Multiple-Areas, £12.94, amazon.co.uk This reusable gel bead pack can be kept in a fridge or warmed in a microwave to provide hot or cold compression. It’s kept in place with a thick, adjustable strap. ‘It’s an easy-to-use and affordable device with three effective therapies: compression, heat and cold,’ says Miss Margo. ‘The ice may help to reduce inflammation at the acute stage of a new sports injury by vasoconstriction [narrowing of blood vessels], slowing the circulation. ‘Applied at a later stage, the heat may boost healing by improving blood flow and compression will minimise swelling.’ Dr Rod Hughes, a consultant rheumatologist at St Peter’s Hospital, Chertsey, Surrey, adds: ‘It’s more convenient than a bag of frozen peas or a hot water bottle.’ Heated grain wrap WheatyBags neck and shoulder pain heat pack, £11.01, wheatybags.co.uk This U-shaped fabric bag filled with wheat grains slips around your neck. Heat it in the microwave for about two-and-a-half minutes and this warmth ‘provides relief from pain or even chronic injury’, says the maker. ‘These bags would possibly help those living with arthritis of the shoulders — when the cartilage in the joint is damaged, leading to inflammation and stiffness,’ says Gary Jones, a physiotherapist at Physio 206 in Bromsgrove, Worcestershire. ‘They may also help people with tension in the muscles, including the levator scapulae at the back of the neck,’ he adds. ‘The heat would increase the blood flow by widening blood vessels, which can help with pain, but this would offer only temporary relief for arthritis. A hot water bottle would do the same job, but these look easier to keep in place across the shoulders.’ Chilled ‘cuff’ Aircast Shoulder Cryo Cuff and Cooler, £129.98, physioroom.com This uses both cold treatment and compression to reduce swelling and shoulder pain. The support cuff fits tightly around the shoulder, and ice-cold water from a connected cooler canister circulates through it. The cuff is worn over one shoulder with the injured arm in a sling-like position. It is said to help with shoulder problems, including arthritis, sprains and recovery from surgery. ‘This is excellent for reducing pain, as ice therapy reduces blood flow, which dampens down inflammation and in turn helps lessen pain, leading to improved mobility,’ says Tim Allardyce, a physiotherapist at Surrey Physio clinic. ‘Shoulders are notorious for being affected by inflammation, which is often due to repetitive overuse strains. ‘Although you could use a bag of frozen peas over the affected area for the cooling effect, this product also provides compression, which helps with recovery too. However, it is not a cheap option.’ Compression gear Compression gear, such as Skins leggings or tubular bandages, can be used to reduce inflammation by causing vasoconstriction, says Miss Margo. This limits blood flow to your joints which prevents them from becoming swollen. ‘For patients with sore wrists, we often suggest they buy compression gloves because they also help keep your wrists nice and warm.’ Although a 2021 study from the National Institute for Health Research found that special arthritis gloves are no better at reducing pain and stiffness than looser-fitting gloves, Miss Margo says that, from a psychological perspective, it can feel relieving to have pressure on the area as it feels like your joints are being supported. Compression gear can also help to encourage people to do their dedicated joint exercises, which Miss Margo says is the most important thing. Knee brace Active650 knee support brace, £29.99, active650.co.uk This high-tech fabric brace fits over the knee to support the joint – the manufacturer says it allows movement but won’t slip. Available in different sizes, it’s said to be suitable for osteoarthritis, ligament injuries and cartilage tears, as well as bursitis (inflammation of the fluid-filled sacs which help the joint glide). ‘This support will help anyone feel more confident that their knee isn’t going to give way, enabling them to exercise,’ says Dr Hughes. Miss Margo adds: ‘This helps you stay active, but if you have an injury you should also have physiotherapy to strengthen the knee from the inside out.’ A good pillow Sports medica knee pillow, £12.95, amazon.co.uk While getting yourself a whole new bed might be a bit of a stretch, a suitable pillow can help to take the weight off your joints as you sleep, without breaking the bank. Although there are all sorts of pillows out there to choose from, depending on the joint you are hoping to support, Miss Margo recommends knee pillows for supporting your knees, hips and lower back. ‘These go between your knees and are contoured to shape your requirements so that your body can remain in a well-supported position while sleeping,’ she says. This orthopaedic knee pillow, which the company says has been designed by doctors, physiotherapists and athletes, is a memory foam pillow with a groove in it to fit between the knees and is said to prevent pelvic rotation and realign your spine. ‘Great for side sleepers,’ says Miss Margo. ‘It aligns you correctly so you don’t put pressure on your knees in your sleep and it helps to stack up your lower back, hips and knees so they are not subjected to a twisting/torsional strain.’ Arthr , a company specialising in products for people with arthritis, also has a range of products to help you sleep comfortably including pillows for the neck, shoulders, knees and hips. All its products are tested by experts and people with arthritis. Shoulder rope pulley MoVeS Shoulder Rope Pulley, £6.05, physiotherapyequipment.co.uk This consists of an adjustable rope, secured between a door and its frame with an ‘anchor’ attachment. The idea is that you use it to increase the shoulder’s range of movement, with the device apparently suitable for ‘prevention and rehabilitation of shoulder injuries’. ‘This would be helpful for anyone with a stiff shoulder, which is often the result of arthritis, or a frozen shoulder, when the tissue around the joint becomes inflamed, tighter and painful,’ says Gary Jones. ‘Pulleys don’t strengthen the shoulder, but they do encourage you to use a good range of motion.’ He therefore says this ‘would be particularly useful for an older patient who wants to maintain their range of motion or someone recovering from shoulder surgery’. ‘Use it five times a week for 15 minutes, with a day or two of rest in between. This is a useful and cheap bit of kit. I have recommended it to patients with a frozen shoulder.’ For more information and support about living with arthritis or joint pain, visit www.versusarthritis.org or call the charity’s free helpline on 0800 5200 520.