Arthritis pain can be divided into two categories, non-inflammatory such as osteoarthritis and an inflammatory such as rheumatoid arthritis, gout, psoriatic arthritis, and arthritis from lupus and other connective tissue disease. Osteoarthritis typically results from wear and tear in the joint involving the large and small joints such as the ankle, the knee, and/or the hand joints. We approach arthritis pain conservatively with NSAIDs such as Celebrex, ibuprofen, naproxen, meloxicam, or diclofenac. We also add a diclofenac cream or liquid (Pennsaid and Voltaren gel) or a compounding cream that includes an NSAID, that also can provide some relief to the patient. If the patient continues to experience pain despite this treatment then we move to the tramadol, which has been shown to be effective in treating arthritic pain. Lastly we move to opioids. If the osteoarthritis involves major joints such as the knee, we can proceed with interventional procedures such as steroid injections and/or Supartz or Synvisc.
Inflammatory arthritis are more difficult to treat and there are two components to treating them. One component is the treatment of the disease itself and that is usually handled by a rheumatologist with infusions and the pain management which handled by pain management. Again, approach treating this pain same as outlined above with osteoarthritis.