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Because of limited clinical research, the causes of myofascial pain syndrome (MPS) are not thoroughly understood. However, physicians have identified several factors that can lead to the development of one or more trigger points (TrPs) resulting in chronic musculoskeletal pain. These include:

* Trauma to the musculoskeletal tissues (e.g., muscles, ligaments, tendons, bursae)
* Repetitive motion injuries, such as bursitis or tennis elbow
* Poor posture and ergonomics
* Skeletal asymmetry (e.g., gait disturbances such as leg-length discrepancies, short upper arms)
* Sedentary lifestyle
* Nervous tension or stress
* Clenching or grinding the teeth (bruxism)
* Sleep deprivation
* Nutritional deficiencies (e.g., low levels of calcium, potassium, iron and vitamins C, B1, B6 and B12)
* Hormonal changes, such as occurs during menstruation and menopause
* Chilling areas of the body (e.g., sitting under an air conditioning vent for long periods of time)
* Alcohol
* Smoking cigarettes
* Overexertion

Additionally, many chronic illnesses may activate TrPs, such as:

* Viral or bacterial infections
* Inflammatory diseases including:

- Rheumatoid arthritis. Inflammation of the joints that can lead to damage, pain and reduced movement.
- Fibromyalgia. A rheumatic condition characterized by widespread pain in the joints, muscles, tendons and other soft tissues, among other symptoms. MPS can also co-exist with fibromyalgia.
- Appendicitis, gallbladder or stomach inflammation.
- Lupus. An autoimmune disorder that can affect many systems, including the skin, joints and internal organs.

* Other conditions, such as abnormal levels of blood sugar (e.g., diabetes, hypoglycemia), heart attack, hyperuricemia (buildup of uric acid in the blood, associated with gout and kidney stones), and hypothyroidism (underactive thyroid gland).

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Most patients suffer with fibromyalgia for years before it is diagnosed. There are no diagnostic laboratory or imaging tests available for this disorder, and many physicians are not adequately informed or educated about it. Because there is no lasting tissue damage, fibromyalgia cannot be evaluated by the classical medical model, which uses degree of tissue damage for evaluation. Diagnosis and treatment are usually frustrating for the physician and the patient.

Medical history and physical examination are the keys for making the diagnosis. The American College of Rheumatology (ACR) has established criteria for fibromyalgia diagnosis in adults:

* Widespread pain in all four body quadrants. Pain must exist on the left and the right sides, and above and below the waist, and must persist for at least three months.

* Manual tender point survey (at least 11 of the 18 specified trigger points). A site is considered a tender point only if the individual feels pain upon the application of 4 kilograms (about 9 pounds) of pressure. Physicians may be trained to recognize “the feel” of this amount of force when applying pressure by finger.

There are different criteria for diagnosing fibromyalgia in children:

* Widespread pain in three sites without any other underlying cause lasting at least three months.

* Presence of five to 11 trigger points, which may be identified at less than 4 kilograms of pressure. Some researchers have suggested a standard of 3 kilograms (about 7 pounds) of pressure for children.

* Between three to 10 other major criteria. These criteria include:
- Chronic anxiety or tension
- Fatigue
- Poor sleep
- Chronic headaches
- Irritable bowel syndrome
- Soft-tissue swelling
- Numbness
- Pain varies with physical activity (more than with adult fibromyalgia)
- Pain varies with weather conditions (less than with adult fibromyalgia)
- Pain varies with anxiety and stress (less than with adult fibromyalgia)

These criteria do not have to be noted all in one examination but can be recorded over time.

In addition to the ACR criteria mentioned above, doctors rely upon thorough patient medical histories, patient-reported symptoms, clinical or physical examination, pain assessment forms and routine tests to help exclude certain other conditions with similar symptoms. Many conditions that mimic the symptoms of fibromyalgia must be ruled out. However, the presence of other diseases does not eliminate the possibility of a diagnosis of fibromyalgia. Conditions that may be tested for include:

* Polymyalgia rheumatica. An episodic, chronic, inflammatory condition primarily affecting individuals over the age of 50. It is characterized by muscle stiffness and pain within the shoulders, hips, or other regions and is frequently associated with inflammation of certain large arteries. Fibromyalgia does not involve inflammation. A blood test may be used to verify the presence or absence of polymyalgia rheumatica.

* Osteoarthritis. A generally noninflammatory degenerative joint disease common in older individuals. It is marked by stiffness, tenderness, pain and potential deformity of affected joints. Fibromyalgia does not involve deformity but may coexist with osteoarthritis. Imaging tests may be used to diagnose osteoarthritis.

* Ankylosing spondylitis. A chronic, progressive, inflammatory disease primarily involving joints of the spine and leading to stiffness, pain and potential loss of spinal mobility. Fibromyalgia does not involve inflammation or loss of spinal mobility. A diagnosis of ankylosing spondylitis may involve imaging tests.

* Rheumatoid arthritis. A chronic disease primarily characterized by persistent inflammation of joints, resulting in discomfort, pain, swelling and potential deformity of the affected joints. Fibromyalgia does not involve inflammation or deformity but may exist with rheumatoid arthritis. A diagnosis of rheumatoid arthritis may involve blood and imaging tests.

* Systemic lupus erythematosus (SLE). A chronic, inflammatory disorder that can involve many parts of the body, including joints, skin and kidneys. Fibromyalgia is not inflammatory but may exist with SLE. Blood and imaging tests may be used in the diagnosis of SLE.

Although there are no specific tests for fibromyalgia, certain abnormalities may be detected through blood tests, spinal tap or imaging tests. Levels of substance P (responsible for initiating pain signals) are high in the brain and spinal fluids, whereas levels of serotonin (responsible for reducing pain intensity) and growth hormone (responsible for building muscle) are low. These tests are not sensitive and specific for the disease and not commonly performed. Blood flow to the thalamus region of the brain is also low. Brain wave levels are high at night and low during the day. Normal findings in the levels of many blood chemicals may be used to eliminate other possible conditions.

Once fibromyalgia is diagnosed, physicians may require formal or informal assessments to detect potential mood disturbances such as depression and anxiety, and a sleep history including investigation into possible disturbances such as restless leg syndrome or sleep apnea.

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Certain conditions are commonly associated with fibromyalgia, though their exact links to the condition are not well understood.

The following conditions often appear along with fibromyalgia:

* Irritable bowel syndrome (IBS). Characterized by frequent abdominal pain, bloating and episodes of alternating constipation and diarrhea. More than half of all fibromyalgia patients suffer from this condition.

* Migraines. Many people with fibromyalgia also suffer migraines and other headaches. Researchers have found that a common link may be problems with a brain chemical called serotonin and adrenal hormones such as cortisol or adrenergic nerve fibers.

* Restless legs syndrome and periodic limb movement disorder. Characterized by uncontrollable contractions of the calf muscles and leg muscles that twitch, ache or feel like pins and needles. Many fibromyalgia patients experience this source of leg pain.

* Raynaud syndrome. Characterized by episodes of whitish and bluish discoloration of the fingers and toes, associated with tingling sensations, numbness or pain and the subsequent redness of the affected areas. It is usually triggered by cold temperatures and strong emotions. Researchers have reported that nearly half of all fibromyalgia patients suffer from this disorder.

* Urethral syndrome. Characterized by the often severe urge to urinate without an identifiable cause, such as infection. Often associated with urinary frequency and pelvic pain.

* TMJ disorder. Commonly associated with fibromyalgia. It is characterized by:

- Jaw and facial pain or tenderness
- Limited jaw movement
- Clicking, snapping, or popping sounds while opening and closing the mouth
- Pain within the facial or jaw muscles, as well as in or around the ear
- Headaches

* Rheumatoid arthritis. A chronic disease primarily characterized by persistent inflammation of the joints, resulting in discomfort, pain, swelling and potential deformity of the affected joints. Fibromyalgia does not involve inflammation or deformity but may exist with rheumatoid arthritis. In fact, rheumatoid arthritis patients are more likely to develop fibromyalgia.

* Immune dysfunction. Fibromyalgia may cause a dysfunction with the immune system, making patients more susceptible to infections.

A great deal of controversy remains as to the relationship between fibromyalgia and certain similar disorders. Two disorders seem particularly linked to fibromyalgia, although physicians and researchers disagree on whether these links are substantiated:

* Chronic fatigue syndrome (CFS). A condition characterized by excessive fatigue that seriously impairs the patient’s ability to function. Many physicians believe that fibromyalgia and CFS may be different manifestations of the same underlying disorder. Both conditions share a large number of symptoms (e.g., headache, fatigue, pain) and similar physical abnormalities (e.g., reduced blood flow to key areas of the brain). Also, brain scans of fibromyalgia and CFS patients display very little difference. The most prominent difference lies in whether pain or fatigue is the most dominant symptom. Although fibromyalgia is the more common of the two, more than half of those diagnosed with fibromyalgia also fulfill the criteria for CFS.

* Myofascial pain syndrome (MPS). A chronic disorder characterized by pain and tenderness confined to a specific body region, such as the neck and shoulders. Many researchers have suggested that this may be a localized or regional form of fibromyalgia.

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* Nutrients
Cayenne pepper is an excellent source of vitamin A. It’s a good source of vitamin C and dietary fiber.

* Weight Loss
Epidemiological data (data hatgered from population studies) indicates the consumption of capsaicin rich foods such as cayenne and other peppers is associated with a lower prevalence of obesity.

In a human study conducted at the Division of Kinesiology, in Québec, Canada, the addition of red pepper to meals significantly increased diet-induced thermogenesis (heat production) and lipid oxidation (the burning of fat for energy). In a second study, results show that the intake of red pepper decreases appetite.

In recent research there is evidence that capsaicin from cayenne and other chili peppers may inhibit the growth of fat cells by activating AMP-activated protein kinase (AMPK), which is found in muscle and other human tissue. AMPK has been found to regulate eating behavior and energy expenditure, and AMPK activation also stimulates hepatic and skeletal muscle fatty acid oxidation.

* Arthritis
In a 4-week double blind study of 70 patients with osteoarthritis, and 31 with rheumatoid arthritis, it was concluded that capsaicin cream is a safe and effective treatment for arthritis. Another double blind study suggest that capsaicin is a safe and potentially useful treatment for painful osteoarthritis of the hands.

* Digestive Health
Cayenne has been, and is still used for digestive problems in traditional Chinese, Japanese, Korean and Ayurvedic medicines. Studies have shown cayenne, or the ingredient capsaicin, to be effective in relieving the symptoms of dyspepsia. It also offers protection against peptic ulcers, and against injury to the stomach lining caused by aspirin.

* Pain Relief
Capsaicin from cayenne peppers is used effectively in many areas of pain relief.

It has been shown to be effective in acute pain relief following surgical procedures such as inguinal hernia repair, mastectomy and other cancer surgery.

There have been several preliminary studies, and a large double blind study supporting evidence of the effectiveness of capsaicin for pain relief in individuals with post-herpetic neuralgia, the pain following an outbreak of herpes zoster, or shingles.

Results of studies also suggest that topical capsaicin cream is a safe and effective treatment for diabetic neuropathy, the pain that is thought to result from injury to the micro blood vessels supplying nerves. In one study topically applied capsaicin was equally effective as amitriptyline (antidepressant drug with side effects sometimes prescribed for pain relief) for relief of the pain of diabetic neuropathy.

A preliminary study has suggested that topically applied capsaicin cream may decrease neck pain, but a double blind, placebo controlled trial is needed to substantiate this result.

* Cardiovascular Health
Cayenne pepper reduces atherosclerosis by inhibiting platelet aggregation (blood clots), and increasing fibrinolytic activity, which is the ability to prevent blood clots that can be the cause of heart attack, pulmonary embolism and stroke.

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Are the Newer Arthritis Drugs Always the Better Choice?

Arthritis drugs have long been considered the “traditional” treatment option. Since individual response to drugs can vary and because potential side effects and adverse reactions are also a factor, finding the most effective combination of arthritis drugs can be a more difficult process than one would expect. Patients should become knowledgeable about the various arthritis drugs so they can make decisions with their doctor.

NSAIDs / COX-2 Inhibitors

NSAIDs (nonsteroidal anti-inflammatory drugs) are among the most commonly prescribed and widely used arthritis drugs. There are three types of NSAIDs: salicylates (both acetylated, such as aspirin, and nonacetylated such as (Disalcid) salsalate, (Trilisate) choline magnesium trisalicylate and (Doan’s Pills, Novasal) magnesium salicylate), the traditional NSAIDs, and COX-2 selective inhibitors. NSAIDs work by blocking the activity of the enzyme, cyclooxygenase, also known as COX. Research has revealed that there are two forms, known as COX-1 and COX-2. NSAIDs affect both forms. COX-1 is involved in maintaining healthy tissue, while COX-2 is involved in the inflammation pathway. COX-2 selective inhibitors became a new subset of NSAIDs born of this research.

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Arthritis is one of the most common chronic diseases in the world. According to Ayurveda arthritis is primarily a vata (air) disease which is due to accumulation of toxins in the joints and is known as amavata.This can be caused by poor digestion and a weakened colon, resulting in the accumulation of undigested food and the buildup of waste matter. Poor digestion allows toxins to accumulate in the body, and problems with the colon allow the toxins to reach the joints.

Symptoms:

* Fever
* Immense pain & stiffness in affected muscles in case of chronic muscular rheumatism.
* Pain or tenderness in a joint which is aggravated by any movement or activity, such as walking, getting up from a chair, writing, typing, holding an object, throwing a ball, turning a key.
* Excruciating pain and stiffness in the joints in case of chronic articular rheumatism.

Home Remedies

The following are a few simple cures that might just help relieve you from the pain of arthritis. Try any of them to see what works for you.

* Two teaspoons of lemon juice and a teaspoon of honey mixed in a cup of warm water taken twice a day is good for curing arthritis.
* Two teaspoons of juice from fresh leaves of bathua, drink every day on an empty stomach for 2-3 months.
* Half a teaspoon of turmeric powder with warm water helps cure arthritis.
* Taking alfalfa tea twice a day makes a good cure.
* Two teaspoons of apple cider vinegar and 2 teaspoons of honey dissolved in a small glass of warm water taken once or twice a day brings relief.
* Rub the aching joints with hot vinegar to get some relief from pain.
* Two parts pure olive oil and one part kerosene makes a wonderful liniment to bathe afflicted joints.
* Add one tablespoon cod liver oil to the juice of one orange, whip and drink before sleeping.
* One raw clove of garlic every day is very beneficial. This clove can be fried in ghee (clarified butter) or castor oil. Take for 2 months.
* Guggulu is very helpful in curing arthritis. Eat half a teaspoon twice a day after meals with warm water.
* Exercise the afflicted joints in a tub full of hot water.
* Drink carrot juice, cucumber juice, eat cooked vegetables and/or vegetable soups, and drink coconut water for a healthy body & massage your joints daily to cure arthritis.
* On an empty stomach eat 2-3 walnuts or some coconut.
* Avoid mental tensions that lead to stress.
* Lose weight, if necessary, to get close to your ideal weight. If you weigh less, there is less weight on your joints and less pain.

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Arthcare Oil is the best natural solution for your problem, manufactured under the guidance of renowned MD Ayurveda Specialist doctor. Arthcare is an anti-arthritic herbal oil which not only gives a sure relief in rheumatic arthritis but also strengthens the bone tissues, the skeletal and the neuromuscular systems, giving a comfortable movements of joints and muscles. It is a powerful antioxidant and increases the energy level. Arthcare penetrates the body tissue faster than any other ointment because of its strong anti-inflammatory action. It removes stiffness and improves mobility of limbs. It brings relief from backaches, muscular strains, rheumatic pains, joint pains etc. Body massage with Arthcare oil, relaxes an asthmatic person. Arthcare is scientifically proven Ayurvedic formulation containing the herbal combination of well known traditional herbs described above. Within few minutes of application you will feel relaxed from pain. For Best Results Take 2 Arthcare Capsules twice a day and massage the affected area with Arthcare Oil 2-3 times a day.

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Your back is an intricate structure composed of bones, muscles, ligaments, tendons and disks — the cartilage-like pads that act as cushions between the segments of your spine. Back pain can arise from problems with any of these component parts. In some people, no specific cause for their back pain can be found.

Back Pain Strains

Back pain most often occurs from strained muscles and ligaments, from improper or heavy lifting, or after a sudden awkward movement. Sometimes a muscle spasm can cause back pain.

Back Pain Structural problems

In some cases, back pain may be caused by structural problems, such as:

* Bulging or ruptured disks. Disks act as cushions between the vertebrae in your spine. Sometimes, the soft material inside a disk may bulge out of place or rupture and press on a nerve. But many people who have bulging or herniated disks experience no pain from the condition.
* Sciatica. If a bulging or herniated disk presses on the main nerve that travels down your leg, it can cause sciatica — sharp, shooting pain through the buttock and back of the leg.
* Arthritis. The joints most commonly affected by osteoarthritis are the hips, hands, knees and lower back. In some cases arthritis in the spine can lead to a narrowing of the space around the spinal cord, a condition called spinal stenosis.
* Skeletal irregularities. Back pain can occur if your spine curves in an abnormal way. If the natural curves in your spine become exaggerated, your upper back may look abnormally rounded or your lower back may arch excessively. Scoliosis, a condition in which your spine curves to the side, also may lead to back pain.
* Osteoporosis. Compression fractures of your spine’s vertebrae can occur if your bones become porous and brittle.

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What Is Rheumatoid Arthritis?

Rheumatoid arthritis, or RA, is a systemic inflammatory disease that causes pain, stiffness, swelling and loss of motion in the joints. It is an autoimmune disease – one of many in which, for unknown reasons, a person’s immune system attacks his or her own body tissues. In RA, the immune system attacks the synovium, which is the tissue that lines the joints, causing inflammation in and overgrowth of this tissue.

How Do I Know If I Have RA?

The symptoms of RA vary from person to person and can mimic those of other inflammatory joint conditions, sometimes making the diagnosis difficult. Common RA symptoms include:

* Tender, warm, swollen and stiff joints, often first noticed in the hands and feet and usually symmetrical, e.g., both wrists are affected at the same time.
* Stiffness and pain that are usually worse after waking in the morning and last at least an hour before improving, which occurs with use and motion.
* Symptoms like tiredness, low-grade fever, weight loss and a general feeling of malaise that may develop even before the onset of joint symptoms.
* Systemic effects on other parts of the body such as the tear and salivary glands, lungs, heart and blood vessels.
* Soft lumps called rheumatoid nodules that range in size from a pea to a walnut, which occur in 20 to 30 percent of people with RA.

How Is RA Treated?

RA patients use a combination of treatments to relieve pain, improve mobility and slow down or perhaps even stop damage to the joints. A treatment plan may include:

* Lifestyle modifications: exercise, stress reduction, healthful eating
* Medications including non-steroidal anti-inflammatory drugs (NSAIDs), steroids, disease-modifying anti-rheumatic drugs (DMARDs), and biologic therapies
* Physical therapy
* Surgery to repair damaged joints
* Alternative and complementary therapies such as acupuncture, massage or biofeedback for pain control

Sports-related activities as well as falls and other trauma can injure the cartilage within a joint and, if it is not provided sufficient time to heal, chronic pain and persistent disability can follow. These activities and incidents may increase the risk of osteoarthritis, especially if there’s impact involved or there’s the risk of injury to ligaments. Additionally, damage to the bone surface can start a biological process that results in joint degeneration. This in turn, often leads to rheumatoid arthritis or osteoarthritis.

Arthritis is often a chronic disease meaning it can affect the person afflicted over a long period of time. It cannot be cured, but it can be treated through a variety of methods and products. Learning how to manage your joint pain over the long term is an important factor in controlling the disease and maintaining a good quality of life. This is a brief overview of some of the methods that arthritis sufferers can use to alleviate many of the symptoms associated with arthritis, especially joint pain. Products, both prescription and over-the-counter, for relieving arthritic joint pain are described in Joint Pain Products.

Heat and cold

Heat and/or cold therapy is not recommended to alleviate symptoms associated with all types of arthritis and as such, the decision whether to use it or not should be discussed with your doctor or physical therapist. If your care provider determines that the use of heat and/or cold is appropriate for use on your arthritis pain, it must be determined which kind of temperature treatment should be used. Moist heat, such as a warm bath or shower, or dry heat, such as a heating pad, placed on affected joint for about 15 minutes may relieve the pain. An ice pack or bag of frozen vegetables wrapped in a towel and placed on the sore area for about 15 minutes may help to reduce swelling and stop the pain. If you have poor circulation, do not use cold packs.

Joint protection

In order to relieve the stress of everyday activity on an afflicted joint, which can exacerbate the condition and may lead to additional injury, a splint or brace can be used to allow joints to rest and keep them from being used. As with many other treatments, a medical care provider such as a physician or physical therapist can make recommendations and possibly provide you with the brace.

Massage

Massage is associated with temporarily relieving joint pain, one of the major symptoms associated with arthritis, rather than treating the underlying cause of a loss of cartilage. A massage therapist will typically lightly stroke and/or knead the muscles around the joint, which increases blood flow to the stressed area. It is important to realize that arthritic joints are very sensitive, so the massage therapist must be familiar with the disease and problems associated with the affected joints.

Exercise

Low-impact exercises such as stretching exercises, swimming, walking, low-impact aerobics, and range-of-motion exercises may reduce joint pain and stiffness while increasing joint mobility. A physical therapist or gym trainer can help plan an exercise program that will give you the most benefit with the least stress on the arthritis-stressed joints.

Weight Reduction

In addition to alleviating some symptoms, the weight loss associated with an exercise program is beneficial in relieving the extra stress that extra pounds put on weight-bearing joints such as the hips and knees. Studies have shown that overweight women who lost approximately 10 pounds substantially reduced the development of osteoarthritis in their knees. In addition, these studies suggested that if osteoarthritis has already affected one joint such as the knee or hip, weight reduction would reduce the chance of it occurring in the other knee or hip. A physical therapist or gym trainer can help plan an exercise program that will give you the most benefit with the least stress on the arthritis-stressed joints.

Transcutaneous electrical nerve stimulation (TENS)

Transcutaneous electrical nerve stimulation uses a small devi ce that is placed near the joint afflicted with arthritis and directs mild electric pulses to nerve endings in and around the arthritic joint. It is theorized that TENS blocks the pain messages sent to the brain from the nerves and modifies the body’s perception of pain. Although TENS relieves some joint pain associated with arthritis, it doesn’t offset the joint inflammation that is associated with arthritis.

Surgery

In some extreme cases of persons with arthritis, surgery may be necessary. The surgeon may perform an operation to remove the synovium, realign the joint, or in extreme cases, replace the damaged joint with an artificial one. Total joint replacement provides not only dramatic pain relief but also significant improvement in joint motion and mobility for many people with arthritis.

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Reasons why we have neck pain and how to find relief of this excruciating pain.

What is neck pain and how does one find relief after experiencing this type of pain? Neck pain is usually a result of a strain or spasm in the muscles of the neck, which also includes pain in the shoulder area. The pain can also be caused by inflammation in the joints of the neck, arthritis, or damaged disks.

Muscle strain occurs when one sleeps on a pillow that doesn’t support the neck properly, such as, sleeping with a twisted neck (happens when sleeping on stomach), lying down reading or watching TV with the neck in an awkward position, improper positioning of the computer monitor, working too long in front of the computer without a break, sitting hunchback while working at one’s desk, stress, and injuries to the neck.

Knowing this, how can one prevent neck pains in the future?

· Using good posture while walking, sitting, and sleeping.
· Avoid slouching.
· Avoid keeping your head bent forward for long periods of time.
· Exercise the neck muscles by using stretching exercises geared towards the neck.
· Avoid sitting for long periods of time without getting up or changing positions.
· Adjust the computer monitor so that the top of the computer screen is at eye level.
· Use a document holder that attaches to the side of the computer screen, instead of looking down at the paper, which increases neck strain.
· Learning to type without having to look at the keyboard will also decrease neck strains.
· Getting a headpiece, or a speakerphone, will also decrease neck pain for those who spend more than a half hour at time on the phone.
· When driving in one’s car, consider sitting the seat straight up and down.
· Purchase a hard mattress instead of a one with a lot of cushions.
· Purchase a neck support.
· If stress is the cause for the pain, consider relaxation exercises.

Home remedies that may help ease some of the pains associated with neck pain are:

· Place an ice pack, such as a bag of frozen peas, on the neck for fifteen minutes.
· Never use heat to sooth neck pain.
· Sitting in a lukewarm tub of water, or a Jacuzzi, with jet streams hitting the soar muscles will also help to decrease the swelling of the neck muscles.

Neck pain should never be masked with pain relief medications, such as aspirin, ibuprofen or acetaminophen. If your neck pain is severe and constant, seek the help of your doctor or chiropractor.

When home remedies do not seem to relieve the neck pains, chiropractic care may be needed. Sometimes, the nerves in one’s neck may become pinched, causing inflammation in the muscles. To relieve the pain, one has to un-pinch the pinched nerves.

Caution: Meningitis can cause neck pain. If you experience neck pain along with headaches, fever, sleepiness, vomiting, and/or loss of consciousness, get to your doctor right away. While viral meningitis is not usually life threatening, bacterial meningitis can be life threatening if left untreated.

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Are The Newer Arthritis Drugs Always The Better Choice?

Arthritis drugs have long been considered the “traditional” treatment option. Since individual response to drugs can vary and because potential side effects and adverse reactions are also a factor, finding the most effective combination of arthritis drugs can be a more difficult process than one would expect. Patients should become knowledgeable about the various arthritis drugs so they can make decisions with their doctor.

NSAIDs / COX-2 Inhibitors

NSAIDs (nonsteroidal anti-inflammatory drugs) are among the most commonly prescribed and widely used arthritis drugs. There are three types of NSAIDs: salicylates (both acetylated, such as aspirin, and nonacetylated such as (Disalcid) salsalate, (Trilisate) choline magnesium trisalicylate and (Doan’s Pills, Novasal) magnesium salicylate), the traditional NSAIDs, and COX-2 selective inhibitors.

NSAIDs work by blocking the activity of the enzyme, cyclooxygenase, also known as COX. Research has revealed that there are two forms, known as COX-1 and COX-2. NSAIDs affect both forms. COX-1 is involved in maintaining healthy tissue, while COX-2 is involved in the inflammation pathway. COX-2 selective inhibitors became a new subset of NSAIDs born of this research.

Traditional NSAIDs Include:

* Ansaid (Flurbiprofen)
* Arthrotec (Diclofenac/Misoprostol)
* Cataflam (Diclofenac potassium)
* Clinoril (Sulindac)
* Daypro (Oxaprozin)
* Dolobid (Diflunisal)
* Feldene (Piroxicam)
* Ibuprofen (Motrin, Advil)
* Indocin (Indomethacin)
* Ketoprofen (Orudis, Oruvail)
* Lodine (Etodolac)
* Meclomen (Meclofenamate)
* Mobic (Meloxicam)
* Nalfon (Fenoprofen)
* Naproxen (Naprosyn, Aleve)
* Ponstel (Mefanamic Acid)
* Relafen (Nabumetone)
* Tolectin (Tolmetin)
* Voltaren (Dicolfenac Sodium)

COX-2 Inhibitors include:

* Celebrex (Celecoxib)
* Vioxx (Rofecoxib)(no longer on market)
* Bextra (Valdecoxib)(no longer on market)

DMARDs

DMARDs (Disease-Modifying Anti-Rheumatic Drugs) have also been labeled “slow-acting anti-rheumatic drugs” (because they take weeks or months to work) and “second-line agents”. However, research has shown the effectiveness of DMARDs in the treatment of rheumatoid arthritis, psoriatic arthritis, and ankylosing spondylitis and the importance of early, aggressive treatment with these drugs. For some, these drugs can stop disease progression and halt joint damage.

DMARDs Include:

* Arava (Leflunomide)
* Auranofin (Ridaura, Oral Gold)
* Azulfidine (Sulfasalazine)
* Mycophenolate (CellCept)
* Myochrysine (Injectable Gold)
* Cyclosporine (Neoral,Sandimmune)
* Cytoxan (Cyclophosphamide)
* Imuran (Azathioprine)
* Leukeran (Chlorambucil)
* Methotrexate (Rheumatrex, Trexall)
* Minocin (Minocycline)
* Penicillamine (Cuprimine, Depen)
* Plaquenil (Hydroxychloroquine)

Corticosteroids (Steroids)

Corticosteroids or glucocorticoids, often called “steroids”, are potent drugs which can reduce swelling and inflammation quickly. These drugs are closely related to cortisol, a hormone produced on the cortex of the adrenal glands. They are prescribed in widely varying doses depending on the condition and goal of treatment. Used to control inflammation of the joints and organs in diseases such as rheumatoid arthritis, lupus, polymyalgia rheumatica, vasculitis, it has been determined that the potential for serious side effects increases at high doses or with longterm use. Doctors can prescribe short-term, high-dose intravenous steroids in some situations, or give shots or injections with drugs such as Triamcinolone (Kenalog) locally into a specific joint for relief.

Corticosteroids Include:

* Betamethasone (Celestone)
* Cortisone (Cortone)
* Dexamethasone (Decadron)
* Hydrocortisone (Cortef)
* Methylprednisolone (Medrol)
* Prednisolone (Prelone)
* Prednisone (Deltasone)

Analgesics (Pain Killers)

Analgesics are pain relieving drugs. Controlling pain is a vital part of treating arthritis. However, unlike NSAIDs, analgesics do not relieve inflammation. Acetaminophen (Tylenol) is the most commonly used analgesic. Narcotic analgesic drugs can also be prescribed for more severe pain.

Narcotics Include:

* Codeine (Tylenol#3)
* Darvocet (Propoxyphene/Acetaminophen)
* Darvon (Propoxyphene)
* Duragesic (Fentanyl Skin Patch)
* Hydromorphone (Palladone)
* (no longer on market) Morphine Sulphate (MS Contin)
* Oxycodone (OxyContin)
* Percocet (Oxycodone/Acetaminophen)
* Percodan ( Oxycodone/ Aspirin)
* Talwin NX (Pentazocine/Naloxone)
* Ultracet (Tramadol/Acetaminophen)
* Ultram (Tramadol)
* Vicodin (Hydrocodone/Acetaminophen)

Biologic Response Modifiers (Biologics)

Biologic Response Modifiers (BRMs) stimulate or restore the ability of the immune system to fight disease or infection. BRMs are drugs derived from living sources as opposed to being synthesized chemicals.
Enbrel (etanercept), Remicade (infliximab), and Humira (adalimumab), target TNF-alpha, one of the most important cytokines involved in rheumatoid arthritis. BRMs which bind to TNF-alpha, render it inactive, interfering with inflammatory activity and ultimately decreasing joint damage.

Kineret (anakinra), also a BRM, is considered an IL-1 antagonist. Kineret is the first selective blocker of interleukin-1 (IL-1), a protein which is found in excess in rheumatoid arthritis patients.

By blocking IL-1, Kineret inhibits inflammation and pain associated with rheumatoid arthritis. Kineret can be used alone, or in combination with DMARDs other than anti-TNF drugs.

Orencia (abatacept) is the first T-cell co-stimulation modulator approved for the treatment of rheumatoid arthritis.

Rituxan, the world’s best-selling cancer drug, was FDA approved 3/1/2006 to be used in combination with methotrexate to treat rheumatoid arthritis by reducing the signs and symptoms in adult patients who have moderately-to-severely active rheumatoid arthritis and have failed one or more anti-TNF drugs. Rituxan is the first treatment for rheumatoid arthritis which selectively targets the CD20-positive B-cells.

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