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Suffering From Osteoarthritis In Hands. Not Cured By Surgery. How To Get Cured?

Posted on Wed, 25 Jul 2012

Question: Greetings. I am concerned about the psychological dimensions of pain. My 53 year old wife suffers from some osteoarthritis in her hands (probably inherited from her late mother). We were contemplating surgery on the basal thumb joint but the physicians prefer working with NSAID medications such as Naproxen. For some strange reason my wife claims she does not feel any improvement in pain reduction from the NSAIDS, and physicians (including at least one here on Healthcare Magic) have suggested this is very unusual for the NSAID not to work.
If this is true, what could possibly be the psychological dimension in relation to pain (and perhaps related things such as anger, loneliness, anxiety)?? I have never heard of this before but am very concerned. Thank you for your insights.

Answered by Dr. Ashish Mittal (5 hours later)

Hello,
Thanks for your query.

I appreciate your efforts for medical consultation in so much distress.

As she is already having diagnosis of osteoarthritis, then it is the most probable cause of her pain. Search for psychological causes of pain needed when there is no apparent physical cause of pain or severity of pain is more than pathology.

NSAID act by reducing inflammation which lead to pain relief. If inflammation is much, in that case it used to become ineffective like in most of the cases of osteoarthritis. So, unresponsiveness to NSAID do not prove psychological origin of pain.

If pain is severe and unresponsive to medicines then surgery is treatment of choice for osteoarthritis.

I hope this information has been both informative and helpful for you. In case of any doubt, I will be available for follow ups.

Wish you good health.
Regards,

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar

Follow up: Dr. Ashish Mittal (5 minutes later)

Thank you for your reply, Dr. Mittal. She has started to taken 500 mg of Naproxen x 2 a day. Is it likely that this amount or using diclofenac would not suffice to affect the pain that she is experiencing? I do not understand the physiology of pain, but we do not want her to have to take Tramadol or other potentially addictive medications. Would a higher dosage of Naproxen be safe (of course with her physician's approval) in general?

Answered by Dr. Ashish Mittal (28 minutes later)

Hello again,

Thanks for follow up,

Yes, tramodol (opioid compound) is better pain reliever but highly addictive and XXXXXXX for chronic use. It is good she is not using this.

Naproxen 500mg 2 times a day is appropriate dose. No need to increase it. You can also try some other NSAID like Diclofenace sodium upto 100-200 mg per day under supervision.

NSAID frequently cause acidity. So it is better to take pantoprazole 40mg per day with its chronic use.

Wishing her good health.
Regards,

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar

Follow up: Dr. Ashish Mittal (3 minutes later)

I am sorry to admit that I was suspecting my wife was imagining the ongoing pain n her thumb area although she was taking the Naproxen. I could not conceive the possibility that this amount 2xday would not take away the pain.

Answered by Dr. Ashish Mittal (10 minutes later)

Hello again,

If she has osteoarthritis then it is very much possible.

Is she having some of the following symptoms?
Anxiety, low mood, nervousness, restlessness, mild irritability, excessive worry regarding own health, tremor, muscle spasm, heaviness in body, easy fatigability, headache, sleep disturbance, palpitation and dry mouth.

Although I know only she can only answer them better.

Wishing her good health.
Regards,

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar

Follow up: Dr. Ashish Mittal (7 minutes later)

No, she does not exhibit most of those symptoms except for nervousness/anxiety and some erupting anger which I am told is typical of women beginning menopause. She is somewhat of an impulsive person. She can complain about the extent of her symptoms and then the next go out with a friend or shopping. But mainly she complains the pain awakens her in the middle of the night which is why she tends to take Ambien. Perhaps the Ambien doesn't work sufficiently. She is in general rather emotional and tends to be rather sensitive when she feels slighted by people and dislikes it when acquaintances, friends or relatives appear to be selfish or insufficiently compassionate or truthful.

Answered by Dr. Ashish Mittal (8 hours later)

Hello again,

Her pain mostly non psychological due to:
-She does not have most of the symptoms asked by me, apart from some impulsive nature.
-Typical presence of pain in midnight which awakens her. It is rarely seen psychological pain.

Apart from that cheerfulness decrease every kind of pain symptoms, like in her case during: going out with a friend or shopping

Regards,

Note: For further guidance on mental health, Click here.

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar