Pain Relief: Meds & More

Released June 9, 2026 

PODCAST OPEN: Thank you for tuning in to the Live Yes! With Arthritis podcast, produced as a public service by the Arthritis Foundation. You may have arthritis, but arthritis doesn’t have you. Here, you’ll get information, insights and tips you can trust — featuring volunteer hosts and guest experts who live with arthritis every day and have experience with the challenges it can bring. Their unique perspectives may help you — wherever you are in your arthritis journey. The Arthritis Foundation is committed to helping you live your best life through our wide-ranging programs, resources and services. Our podcast is made possible in part by the generous financial contributions of people like you. (MUSIC BRIDGE) This episode of the Live Yes! With Arthritis podcast is brought to you in part by AbbVie. 

Jamie Nicole: Hello, and welcome to the Live Yes! With Arthritis podcast. I'm Jamie Nicole, your host for today's episode. I've been dealing with osteoarthritis for years, including multiple surgeries. My first was in 2019. And a few years later, I was diagnosed with rheumatoid arthritis and needed double shoulder surgery. And now, I am managing advanced osteoarthritis in both knees. Across all of those experiences, one thing has been consistent — and that is pain. But pain doesn't look the same for everyone. It shows up differently, feels different and often requires different approaches to treatment. Today, Dr. Yawar Qadri, a pain specialist with Emory Healthcare in Atlanta, joins us to talk about medical and complementary pain therapies. Dr. Qadri, welcome to the podcast. 

Dr. Yawar Qadri: Thanks so much for having me. 

Jamie Nicole: So, before we dive in, can you tell us a little about yourself and your work in pain management? 

Dr. Yawar Qadri: Yeah. I've been in pain medicine now about 10 years, and my base training was in anesthesiology. A lot of pain doctors focus on spine problems, but some of us also do things focused on joints or peripheral nerves, facial pain, pelvic pain or some of the rarer pain states. Here at Emory, we run the gamut, from medications to complex implants and minor procedures. And so, I'm happy to share all those options with you. 

Jamie Nicole: Can you tell us about how people experience pain differently and what are the main types of arthritis-related pain? 

Dr. Yawar Qadri: Sure. We think of arthritis pain as, "OK, my joint hurts." And the hard part is there's a lot of different things that can make your joints hurt in a similar way. Whether that's the pain of kind of wear and tear from osteoarthritis, or the pain of an autoimmune disease like rheumatoid arthritis causing your body to attack the joint cells, or something like the crystal arthropathies like gout or pseudogout, where you've got these little particles forming inside the joint. Those all present as either hot joints, swollen joints, joints that aren't moving the way they should and pain around the joint, whether it's the shoulder or the knees, or even the little joints along your spine. And that's the challenge for us is: It causes a lot of similar looking but different caused pain patterns. 

And as a physician or a patient, it's hard to say, "Is it this joint? Is it this muscle? Is it this tendon?" As a pain doctor, we're not able to necessarily reach in and fix all of that all the time, so we try to treat all of those things. But the joint, in most cases, is connected with connective tissue and muscle and all of those things around it that also get irritated and inflamed. And so, this is why we lean on many different types of therapies to target it. 

Jamie Nicole: How does arthritis pain overlap with these other chronic pain conditions? 

Dr. Yawar Qadri: There's a lot of different chronic pain conditions, and at the crux of it is: All of this pain comes to your spinal cord, and then it goes from your spinal cord to your brain. And the longer you've been in pain, the harder it is for your spinal cord and your brain not to get changed. That causes your body to start amplifying pain in different places. But in folks with like rheumatoid arthritis or folks with lupus, that inflammatory flare-up also changes the way the spinal cord works; also changes the way your brain works. All those aches and pains that your immune system's activating also activate that arthritis pain; also make your old joint pain worse. 

Even people that have had joint replacements, their shoulders may still hurt, or their knees may still hurt when they get sick. And so again, there's this complex interaction between things like chronic, inflammatory diseases and arthritis, but also chronic mood issues, so people with depression, people with anxiety. And that's because pain isn't just a sensation; it's an experience. And so, if we take those folks and we put them in Disney World, most people's pain feels better, even though they're doing a lot more. And that's not because it's in their head; it's just because they're able to distract, they're able to kind of change the way their brain is thinking; they're focused on other things. 

And conversely, when they're sad, when they're having problems in their personal life, when they lose loved ones or their anniversaries of that, that all can cause pain to flare up. Things like heart failure, asthma, can also cause issues, because those disease states can affect your ability to get oxygen to the tissue or your ability to get rid of fluid, which can cause more swelling in regions and can make movement difficult. None of these things happen in isolation. So, as a pain doctor, we try to help pull all of that together into a simple package for you to work with. 

Jamie Nicole: I want to move on and talk about the different treatment options, starting with medications. If over-the-counter meds like ibuprofen or acetaminophen aren't enough, what are the next steps? 

Dr. Yawar Qadri: There's about 200-some medications that doctors in theory can use that are used broadly to treat pain. There's new ones coming, but normally people start with the over-the-counter things and sometimes they forget that they also should stop for a second and look at bracing or physical therapy and exercise before they get there. But by the time they get to me, they're normally… We're looking at medicines in the prescription/anti-inflammatory setting, like stronger NSAIDs. We're talking about antidepressants, some of which are FDA-approved for the disease of chronic musculoskeletal pain. We're looking at anti-seizure medicines that are helpful for turning down the intensity of the pain for the nerves that are feeling the pain. We're looking at muscle relaxers that help with that tightness and spasm that happens across the muscles that connect to the joint. And then it's just trying to find the right cocktail that works for the individual there. 

Jamie Nicole: Corticosteroids are common. When are they appropriate? And what are the downsides of using them? 

Dr. Yawar Qadri: Steroids are wonderful things for doctors because they work on just about everything. I tell people it's kind of like rocket fuel. You can really get a lot out of it, but it may kind of burn you down in a while. The steroids have an anti-inflammatory effect, but they also have broader effects on your hormones. The easiest things to notice about them are for folks that are diabetic: Their sugars go out of whack. And some people find that the steroids give them a lot of energy. You'll have these little old ladies just kind of cleaning their whole house at night, not being able to sleep because the steroids just cause a little bit of... It's described as steroid psychosis, but it really is just a boatload of energy. 

And again, it's not a bad thing in the short term, but in the long term it can cause problems with bone health, worsening joint issues, weight gain. We talked about the diabetes, and in some circumstances where you've been on steroids for so long, your body has a struggle remembering to make its own steroids, and now you're dependent on those external steroids to keep you from having a crisis. So, I'm happy for people to try them once or twice early on, but unless it helps you for six months, I'm not excited about doing it again and again. Somewhere in that three to six months range is where it gets a little dicey, where the more you're doing it, the more likely you are to see these negative effects. Because oftentimes you're not just getting steroids from one doctor. For folks with other chronic illnesses, I try to minimize them where I can, to save it for when I need it. 

Jamie Nicole: So much to unpack there. I was prescribed steroids after both of my shoulder surgeries and can relate to the impact of them having on other aspects of my health, but they were useful for that particular period of time. But I want to ask about opioids next. They used to be prescribed more often. Are there still situations where they are appropriate? 

Dr. Yawar Qadri: Yeah, opioid medications are very strong pain relievers, but they're very good at doing a lot of other things. The appropriate indications for them are normally thought to be for acute surgical pain, time-limited pain. And the problem with the opioids that doctors worry about, before we get to the weird guidelines and the legal issues and the addiction issues is: The opioid medications aren't really just pain drugs; they're pain and alarm drugs. 

That endogenous opioid system that your body has and my body has — that helps us when we do things like working out that releases endogenous opioids. And that is saying, "I want you to quiet down the pain, quiet down the discomfort from me lifting all those heavy things." But it also rings an alarm bell in your body that says, "Hey, something's wrong here. There's a reason that this is hurting. We should be careful." And that can cause your body to become more sensitive over time. It also causes changes in your immune system, so your immune system may not work as well. The CDC guidelines, when they came out 2015- ish, what they really brought out was that, "Hey, look, when we look at people that are on these medications for long term, they die sooner, not because they're doing something wrong, but because the medications are doing things that we don't quite understand." The more of it you're on, the more likely you are to die sooner, and that's the challenge with them. 

There are maybe safer opioids, there are maybe less addictive opioids, there may be some people that are less likely to have problems with them. But I tell my patients: It's kind of like cigarette smoking. It may do something for you — you may like it — but it's going to be expensive on you, it's going to be expensive on your body, and it may take some time away. But for some patients, it allows them to have some quality of life or some function. So, we have to find some balance with that, but it is a very strong analgesic, where it stops you from feeling the pain. And it's a very good anxiolytic. It helps you not care about the pain. It helps you with some of the stress of life, depending on which opioid it is. But this is why they're controlled, where we recognize that they do have a lot of risk to them. 

Jamie Nicole: That was the point I was going to make: the quality of life versus the life expectancy. That's a decision that a lot of us have to make in the moment, when we're battling these issues, especially if we've tried everything else. 

PROMO: The Arthritis Foundation’s website is packed with helpful information about various types of arthritis and how to manage them. You can find inspiring stories from people living with arthritis every day, as well as opportunities to connect with others through support groups and community events. Get resources on physical activity with arthritis, nutrition tips that support joint health and so much more. Check us out at arthritis.org. 

Jamie Nicole: My next question is about other medications that are used off-label. You mentioned antidepressants or nerve-related drugs. Can you tell us a little bit more about that? 

Dr. Yawar Qadri: Yeah. So, there are on-label antidepressants for the disease of chronic musculoskeletal pain, but antidepressants, anti-seizure medicines, even antipsychotics are all medicines that work on these proteins or chemicals in nerves. Nerves are the wires that are sending and feeling the pain and processing the pain. They're being used to kind of change the way the signal that's coming from your bad knee or your bad hip are being processed by your spinal cord and your brain. 

Something like Cymbalta or Duloxetine is actually FDA-approved for chronic musculoskeletal pain. And for mood and depression, they may go up to 120 milligrams. But at that 20 to 60 milligram range, it may help turn the volume down on the pain. It's not going to take it down as much necessarily as an oxycodone or a hydrocodone. It may not work as fast. It's not like a light-switch medication. Those medications though are changing the way those nerves send the signals or process the signals, and the hope is that in two to four weeks, they'll help rewire it so the microphone is a little less loud in your spinal cord and brain to that pain. 

They can be very effective. And I generally tell people that when I think about their joint pain, I want to figure out what part of their joints just hurt just because they exist and what parts of their joints hurt just when they move them. The pain that you're just existing with, that is probably more related to nerve and nerve processing. And the hope is that type of pain, these antidepressants can maybe turn down a little bit. They will help with some of the pain that happens when you move stuff around, but that type of pain may do better with things that target inflammation, target muscles or target the signals in a way that stops them from happening. I use a lot of different medications that target your body's stress systems to help target the physiologic response, kind of how maybe you get really high blood pressure because of the pain. We can target that. And targeting that seems to also quiet down the way you're thinking about the pain. 

Jamie Nicole: I never thought about that: the pain-brain connection. I actually cried two days straight after my shoulder surgery, and I never would've thought to connect that to the actual pain. I just thought maybe I was in the house by myself and, you know, wanted to be out and couldn't be. But I was in excruciating pain, and I had never had that particular pain before the shoulder surgeries. 

Dr. Yawar Qadri: It's a challenge. Because a lot of the medicines that we often will use will help you with the stress part of the pain. And so, I think someone had asked about benzodiazepines in animals: The benzodiazepines just get the animal drunk. But, you know, a lot of people don't feel the pain, don't feel the stress, when they're drunk, or it helps their stress response, which reduces that amplification. Not really an ideal situation to be reaching for that kind of thing, but sometimes, like in the hospital or right after surgery, it can help you not just spiral out of control. That's why a lot of the other things that we do with, like, cognitive behavioral therapy when you're in a good place to kind of build those tools, and that resilience is really useful, but it's just so hard because it seems like a lot of voodoo sometimes. 

Jamie Nicole: My next question is about topical treatments. What ingredients actually work? And also, for what type of pain? 

Dr. Yawar Qadri: A lot of those topical treatments are not often insurance-covered, similar to the supplements. And so, a lot of my patients just aren't able to get them. But there are non-medicated, supplement-based things, things with capsaicin, menthol, that create heat or ice feeling that work on different receptors. Things like that have some anti-inflammatory aspect to them, things like salicylates or some of the things like Voltaren that's available over the counter. Both have a little bit of an aspirin or NSAID-like activity, and they can definitely help with some of that surface burning, stinging and some of the tightness… can help with distracting feeling around the joint for many people. 

Over the counter nowadays, we also have access to lidocaine-based ointments. The lidocaine ointment's just going to numb up that skin, kind of make it feel less stingy, burning, is what most people would say. And they're all reasonable options. It's just trying to understand whether or not it's reasonable for your wallet, really. Voltaren's an interesting one because that used to be a prescription ointment, and that is, again, diclofenac as a topical lotion, and that's an actual NSAID. So, for folks that can't take non-steroidal, anti-inflammatory drugs, like ibuprofen or naproxen, this just kind of allows you to build it up locally right around the joint. 

And so, I do recommend some patients try them, because they're not going to hurt them. Some patients do really appreciate the feeling of the capsaicin being warm or the menthol being cool or going back and forth. And it does benefit people to rub them on, because it forces them to massage it. It forces them to interact with the joint, and that can be really helpful in their recovery. I like ointments because they seem to soak in better, but the lotions and rubs I like better for the surface. And then I tell people that, you know, if it feels like it's not getting deep enough, then just rub it in and put some heat on it, because it's all diffusion-based, right? That's just the physics of it. It's got to get in deeper, so give it some more energy. And just a heat pack over that can help your body take it up a little bit better. 

Jamie Nicole: Can you tell us more about the supplements, maybe even CBD or medical cannabis, that can also help? And then what does the evidence say about using those? 

Dr. Yawar Qadri: There's a large variety of supplements, and there are clinical studies and papers and patient anecdotes about how this one's amazing, but a lot of this lives in kind of the gray zone that on the farther side are things like the peptides and whatnot that people are injecting. And a lot of this is not very well regulated. The common ones that, at Emory… We often will reach for things like turmeric or omega-3 fatty acids, polyunsaturated fatty acids, things like magnesium and things like vitamin D. These generally have a larger amount of literature saying, "Hey, these are anti-inflammatory." 

Magnesium helps with nerve excitability and muscle tension. And vitamin D seems to really help with bone health and possibly with some pain processing, especially in folks of us that are darker skin or don't get out and see the light, because those folks don't make as much vitamin D from the sunlight. But they're not miracle treatments, and unfortunately, a lot of them are expensive because insurances don't cover supplements in all cases. And because they're not regulated the same way as pills, I can't always tell you what you're getting in the powders or the capsules or things like that. So, it gets to be challenging, but they're generally safe enough to try. And normally, worst case scenario, you just have expensive pee and poop. And, you know, that's not horrible. 

Now, CBD, cannabis, THC products, that gets a little more complicated because of federal legislation and local state legislations. Marijuana as a whole has a lot of things in it, and it's a natural plant, but, you know, there's a lot of natural things that can kill you. The two big parts though in marijuana would be the CBD and the THC. The CBD is probably the safer of the two if you just want to try something. It seems to be what kind of has a little bit of a calming anti-inflammatory effect. The THC is probably more of what people think of when they think of the high or the dissociation. That one has actually been isolated as something like dronabinol or Marinol for people with nausea or appetite issues after chemotherapy. 

Most of the patients that use it don't tell me that the pain goes to zero, but it's less loud to their brain. And again, that can be useful to allow them to function the way they want to function. But you have to recognize that these medications or supplements are not regulated. In states that have been using a lot of the THC products and legalized it, like Colorado early on, we recognize that, hey, there might be some more cardiovascular risk. People might have more heart attacks and strokes on this stuff than on nicotine products even. And so again, it's a challenge of figuring out how useful it is. But for some patients and some types of nerve pain or diffuse pain or suffering, it does seem to help kind of calm things down. 

Jamie Nicole: I want to take a look at what's on the horizon. A newer non-opioid medication called suzetetrigine has been approved. What should people know about that? 

Dr. Yawar Qadri: It's suzetrigine, or I always say Journavx, because it's easier to kind of use the brand name. But it's an interesting medication in that it kind of blocks what are known as sodium channels that are specifically found on the sensory nerves. The easy way to think about it is that it's an oral equivalent of something like a Novocaine or lidocaine, but instead of numbing up the nerves everywhere, it just numbs up one specific channel on just the sensory nerves. Unlike something like gabapentin, which works on a calcium channel on kind of sensory nerves and brain nerves and spinal cord nerves, this just kind of works on the nerves on the outside. It doesn't make you sleepy, it doesn’t make you stupid or stupider; it doesn't cause you to get dizzy or off balance. Right now, it's really approved for acute surgical pain. So, for example, you could have used it for your shoulders. You can use it for about two weeks around the surgery. And it does seem to have some help. 

And for some people, they're finding that they can use it after surgery to not have to use any other narcotic medications. But this is a medication that works differently than the opioids, differently than most of the anti-seizure medicines, differently than the anti-inflammatories. Right now, most doctors have a hard time getting it approved for the disease of chronic pain. Most insurances struggle with that, but much like a lot of our other medicines, I suspect people will start using it for it, and there may be some benefit for some patients. But we're still waiting for more studies, more data, more experience with that one. But the pharmaceutical companies as a whole really like this sodium channel pathway as a family, so we'll probably see more drugs coming out targeting that in the next 5, 10, 15 years. 

Jamie Nicole: Great. So, people will be able to discuss that with their doctors as a possible option in the future. Are there other non-opioid medications or newer approaches people should be aware of? 

Dr. Yawar Qadri: Yeah. So, I always have to ask folks if they're looking more for medications or interventions, because those are different pathways to think about as a physician. Sometimes you want to do both. We have a lot of new immunotherapies that are targeting different parts of the inflammatory pathways, some of which interact with nerve signaling pathways. We have medications that work on bone health, which may be really useful for arthritis pain. All of these things come with risk and often aren't in a pain doctor's bag of medications that they use, and so that may require a rheumatologist or an endocrinologist or sometimes even a neurologist. 

Like I said, I use a lot of medicines that are sympatholytics. I like things like propranolol or clonidine. These are medications that are used for heart rate or blood pressure control that are really just trying to change your fight or flight or freeze response so that the pain doesn't cause you to make worse choices. I use a lot of antidepressants, anti-anxiety medications, and a lot of weird anti-seizure medicines that are on the list but often get overlooked. And then, again, there are maybe safer opioids like buprenorphine, which has a little bit more of a built-in safety and maybe less likely to cause you to fall or less likely to cause you problems with your breathing. Again, it's a process of you finding a doctor that you trust and a doctor that's willing to kind of explore the pharmacopia with you, and that takes time. Each of these medications, you might notice an effect in two, four, six weeks, and we always start low and go slow and want to give your body time to react. It takes a while sometimes to get through that journey to something that's satisfactory. But yeah, we do have a lot of interesting drugs that are in the pipeline. 

PROMO: Arthritis Foundation webinars can help you better understand and manage your condition. Available in real time and on demand, our webinars allow participants to engage with experts and access information at their convenience. Let our webinars empower you to take charge of your arthritis journey. Visit arthritis.org/webinars. 

Jamie Nicole: What about the overall landscape? Is anything changing in how pain is being treated overall? 

Dr. Yawar Qadri: There's a push to kind of have a more holistic approach to pain management. And so, you'll see that your doctors maybe now do a lot more questionnaires with you. We ask a lot of weird questions about your mood. We ask a lot of weird questions about, "Hey, how's the pain interfering with things?" We ask questions about your functionality. The recognition's happening that pain scores are maybe not the most important thing. Maybe patient satisfaction may be not as useful as, "Hey, are they moving better? Are they less depressed? Are they sleeping well? How are their blood sugars doing?" All of these things are kind of going more into the numbers that your pain doctors as a whole are looking at. 

You'll see more complementary therapies, you'll see more discussion of hopefully things like psychotherapy, cognitive behavioral therapy to help you with the way you think about your pain. You'll see hopefully more usage of physical therapy/occupational therapy. You'll probably see more usage of things like braces that kind of help maintain some higher degree of functionality. The other part that we're trying to figure out is better ways to diagnose what's actually happening. Is this really an inflammatory issue? Is this really a bone health issue? Is this really a meniscus tear that looks like an arthritis issue? And that helps your physician make a better decision to say, "Hey, this is what will probably work for you. " But that's the challenge is, again: It takes a little bit more time to kind of dig through that rather than saying, "Oh, it's knee pain, here's an injection, try this brace, do these exercises, see me back in six months, we'll do it again." But that may help us get to less overall suffering, but it may require more work in a single visit. 

Jamie Nicole: As someone who's battling a meniscus tear at this moment, it, it (laughs)… 

Dr. Yawar Qadri: Yeah, that's true. 

Jamie Nicole: It is frustrating. 

Dr. Yawar Qadri: Difficult. 

Jamie Nicole: Yeah, very difficult. Can you tell us anything else that's potentially coming down the pipeline for arthritis pain treatment? 

Dr. Yawar Qadri: Yeah. So, we haven't really talked about the interventional parts. We have the ability now — for say, hips and knees and shoulders — to go in, find the little nerve that goes to the joint and just disconnect the joint from your brain. And we can do a nerve block, and then if the nerve block helps, we talk about things like a thermal ablation or cryoneurolysis, where we go and cook or freeze the nerve so it doesn't bother you as much. There's things that my interventional radiology colleagues can do better for the knees, where they can take a look through a small blood vessel in your arm or your leg or your foot. Find these little vessels that feed the inflammation in your joints, and they can cause them, those vessels, to kind of clot off, so they can choke off the blood supply to the inflammation. 

There's things that we can do where we inject into the bone right underneath the cartilage. That is something known as a subchondroplasty. That's a procedure where you can take somebody's bone marrow and/or something like PRP, inject that right into that area in that bone, and that bone is kind of the soil that feeds the cartilage we recognize. And sometimes that can help with avoiding a knee, joint knee replacement or a hip replacement. And then on the further side of the spectrum, sometimes after you've had those knees or shoulders fixed and you still have that severe pain, because those nerves and things in the area are traumatized, that's when we start talking about using electricity to fight the pain. 

You know, nerves communicate with chemicals. They also communicate with electricity. When they don't want to listen to that language or the side effects are too much of the medications, then we'll just shock them into submission, right? We'll just use electricity to kind of rehabilitate the nerves. And we've gotten better with smaller electronics, of putting wires on the nerves that go to the shoulder or to the knees or to the hips, or just going upstream to the spinal cord, and that's become more and more prevalent. As we progress, people are recognizing that electricity can do a lot. So now, they're using magnetic systems to target the electricity where you don't have to have anything poked into you. 

Now, there's folks that use little vagal nerve stimulators, for example, to help activate the vagus nerve, which acts like the brakes on your body, and that can help with inflammation; that can help with pain; that can help with a lot of different things. And all of these things are coming down the pipeline. But they're just slow. Hopefully in the next five years, there'll be some new injectable things that we can do that can help destroy the nerves that feel the pain, but not anything else in your joints. 

Jamie Nicole: This is such good information. I'm over here taking notes, just because it's something that impacts my life on a daily basis. Is there anything else that we should be looking into? 

Dr. Yawar Qadri: It depends where you are on the spectrum of therapies. Again, what happens for a lot of us as patients or physicians is that we jump in at different parts, right? If you go to an orthopedic physician sometimes and that you show them this MRI that has a meniscus tear, they'll say, "Oh yeah, let me go ahead and fix that for you. I got you." But they may have forgotten that they should have tried bracing with you or forgotten that maybe they should send you to physical therapists or maybe you should do some strengthening first. The easiest things to always keep doing because they aren't going to hurt except your wallet, and maybe your time, is things like the physical therapy/occupational therapy. There's things like massage, acupuncture. Those are very easy and low risk to try if you've tried everything else, but they can be expensive because insurance doesn't always cover all of it. 

I always like to start with physical therapy and a home exercise plan to kind of give you some control, but going to somebody can help you get those things. There's things like biofeedback. Biofeedback's a weird one. It is that true essence of mind over body, where you're trying to retrain your mind to control parts of your body you don't think about like, "Can I make the temperature on my hand get warmer just by thinking about it?" It turns out you can, but you require some special training. And then there's a slew of therapies that are out there: things like red light therapy or green light therapy, things like these peptides or different injectables, things that are in the regenerative pain space. 

And again, there's some possible benefit to this, but it's hard because a lot of this isn't as well studied as a doctor might like. And so, if you have the money and the time, it probably won't hurt you too much, but I can't promise you that it's as magical as I'd like it to be. And so that's where sometimes we go back and say, "Hey, why don't you start over with a fresh pair of eyes, have another doctor that just doesn't know you, just take a look at your history, try to understand things?" And that can be useful to kind of make sure you haven't skipped over things or talking to your local academic pain providers that have the time and bandwidth to kind of sit with you. There's always things to try. But whether or not it makes good sense for you is what we're trying to figure out, because everything gets more and more invasive, more risky, and sometimes just really expensive. A lot of it isn't covered by insurance. 

Jamie Nicole: You've also talked a little bit about nerve-based treatments. So, can you walk us through some of the nerve-based treatments people may have heard about, like TENS, nerve blocks, radiofrequency ablation, cryoneurolysis or spinal cord stimulation? 

Dr. Yawar Qadri: Perfect. OK, so the TENS unit: Surface stimulation gets some energy down into the skin, muscle and things, and that is accessing your peripheral nerves and your spinal cord and your brain through the outside. We can start going closer. We can try to put wires in on the nerves under your skin. We can start putting wires in on the spinal cord. That's that highway that sends, gets signals from your knees to your brain, and we can interfere with signals at that level. Insurance will cover that if you had surgery on your joints or things like that, and they still hurt in some cases. All of these things are trying to interfere with the pain processing and the pain signaling to help with the issue on the outside. They're not fixing the joint. The TENS unit, things like that, can help a little bit with blood flow, so that may be useful for some of that surface and local inflammation in some cases. 

Nerve blocks and nerve ablations, or neurolysis, those are different. Those are disconnecting the joints from your brain. Some of those nerves are easy to find. Some of those nerves are hard to find. And so, those can be a little bit difficult because the blocks will work well, but the joint may not be fully denervated. We may not turn the signal off when we do the neurolysis with heat or with cold. Both of those things are repeatable, though, and so some patients, you have that done every 6, 12, 18 months, depending on how fast their nerves grow back. But that's a way for us sometimes to disconnect the pain source from bothering you without really fixing the joint. 

That could be useful for younger folks that want to avoid having a shoulder replacement. That could be useful for older folks that are too unhealthy for a hip replacement. Same thing with the spinal cord stimulators. Those are generally targeted, and most doctors use them more for pain from surgery to your spine that goes into your hands or legs. But there are doctors that are able to place those for chronic postoperative shoulder, hip or knee pain. 

Jamie Nicole: What kinds of therapies or approaches do pain clinics typically offer? 

Dr. Yawar Qadri: That's a very unique issue for each individual pain clinic. And some pain clinics are happy to take you through the gamut. Some pain clinics are very good with regenerative medicines. Some pain clinics are very good about medication management. Some pain clinics are really focused on interventions. And so ideally, you could find a pain clinic that does the whole spread of things and can walk you through your options. But the majority of them will start talking to you about, "These are your options, these are what we think are the pain generators, and these are the people that you could work with here or in the community to help target this best." But you want to make sure you have a good connection to that provider because, again, it's not just that first visit, it's that second, third and maybe 12th visit that gets you to where you need to be. Because it takes time and trial and error to process through these things of figuring out what's the right option for you as an individual. 

Jamie Nicole: We know daily habits play a role in pain, things like sleep stress and activity. What tends to have the biggest impact? 

Dr. Yawar Qadri: The biggest problems and the folks that seem to struggle the most are the folks that are struggling with sleep in addition to their pain. And so, sleep is a complicated thing, but if you don't have that foundation of a good rest, that will make it harder for you to cope with the stress or activities that life demands of you. Working on sleep hygiene, working on reducing lights, working on reducing stimulants, working on having some kind of bedtime routine. You know, we're all really good about having bedtime routines for our kids, but for ourselves, we just suck at it, and that's something that you have to make a focused effort to do. 

And then, yeah, stress and activity. We can't fix the fact that the world stresses us out, but we need to figure out some way to work in that tiny little space between what the world does to us and how we react to it. And that’s where working on, “How do I cope with my stress? How do I process my stress? Who do I talk to about my stress?” is really useful. And then, yeah, the activity part for my arthritis patients is really hard because I can't move, because it hurts so much. But unfortunately, the more you don't move, the worse it'll get. And so, we try to remind folks that it's OK to feel the pain. We don't want you to run from it. We want you to push at it a little bit, but that motion is lotion for their body, and we want you to keep moving as best as you can. And so, you want to start with just realistic little steps, whether that's walking to the mailbox and back. Even that, for some folks, is a struggle, but every little bit helps, especially if you can stay consistent with it. I'm a big fan of having people make a chart or a table or writing down their goals and just trying to meet them. And these days, with the fitness trackers we all wear, it's easier to kind of keep an eye on yourself. "Did I do too much yesterday? How much did I sleep?" 

PROMO: The Arthritis Foundation’s website offers access to expert resources and strategies for managing arthritis-related pain. Get guidance you can trust and comprehensive information about various pain management techniques and therapies. By using our resources, you’ll expand your understanding of pain relief options and be empowered to improve your quality of life. Visit arthritis.org/pain. 

Jamie Nicole: We asked our community about their experiences, and I'd love to bring their perspective into the conversation. We've asked our community what therapy you've tried, heard about or are curious to explore for managing arthritis pain, and I'd like to read a few of the responses and would love your take. So, from Angela, she asked or states, "CAR T-cell has shown promising results. PRP can help the damage already caused by RA and OA." She also says," I'm sick of these Band-Aid BS treatments that cost $5,000 a month and work meh." Can you expand a little bit about that, what CAR-T therapy is and what PRP is and how they work? 

Dr. Yawar Qadri: Sure. Yeah. CAR-T cell therapy is amazing. It's being used in autoimmune disease and cancer. Basically, we take your cells, and we make them attack specific cells in your body — used to help either kill a cancer or help quiet down immune function or autoimmune disease. It's exciting, it's cool. It's where the science is heading for a lot of the autoimmune disorders, but it's very early. Very powerful, but not quite something that you want to jump into yet. PRP, or platelet-rich plasma, therapies are something that doctors have used for quite some time, but it isn't really fixing arthritis. It may help with regeneration recovery and early-stage stuff. 

This is what a lot of NBA players will pursue or NFL players for their knees or their tendons. And it's not really snake oil, but it's not a miracle. It's reasonable for some people with the right expectations, but it also comes with resting that area, reducing your anti-inflammatory intake, and it's part of a therapy. But again, this is often cash pay, and sometimes it is oversold as something that'll be miraculous. It's expensive, it's incremental and it's not complete. And that's the hard part. We're not able to fix a lot of these chronic issues. We try to manage them, and that's why we try to stack them in ways that are thoughtful. A lot of folks want that one and done solution, and I just don't have that always. 

Jamie Nicole: And I have one more. Naomi says to manage pain, she likes to drive and listen to her favorite music and singing also helps. 

Dr. Yawar Qadri: Yeah. And so, all of those things are useful. The driving, the music, the singing, all of those can be rewarding to certain people. It's not going to fix the joint, but it absolutely will change how your brain and your spinal cord are processing the feelings that you're getting from that joint. And again, it's available on demand, and it's available with your control. That's probably the biggest thing about it. But everyone's different on what helps them, and that's where it's a very individual way of recognizing, "I can't fix this problem, but I can cope with it better, and I can still get some joy out of life." 

Jamie Nicole: We also always like to end the podcast with you providing your top three takeaways from our conversation. So, can you share those with us? 

Dr. Yawar Qadri: The number one thing I'd like to impress is that this is a relationship between the patient, the pain and the provider. All three of those things kind of go into that for pain doctors. I just want to recognize that the pain is different for everybody, and everyone's goals are different. The hardest patients for me are athletes that have a really high level of function that they're trying to relate to. And that, again, is trying to figure out what it is, that everybody needs. And to me, the best care is always kind of layered or stacked. It's got these different parts of movement, lifestyle, medications, procedures and these complementary therapies working together that allows us to synergize. And again, it's slow, it's difficult. But to me, that's the challenge of medicine. That's where we kind of struggle. 

Jamie Nicole: Thank you so much for that. I want to add my three takeaways from this conversation as well. You mentioned having multiple, overlapping conditions and the importance of working with your doctor, so you can make sure that everyone's on the same page. So, really informing each doctor of what's going on with me is going to help me get the optimal care that I need. Also the importance of the mind-body connection when managing these conditions. Making sure also that you're informing your doctor of other things that are happening with your body that may be contributing to the pain as well, not just the physical pain. And then also patience. It's not a one and done, and you really have to be invested in making sure that you take the time and find out what works for you and what does not work for you. 

For more arthritis resources, please visit the Arthritis Foundation's website at arthritis.org. And if you have any suggestions about topics you'd like to see us cover or any other ideas you want to share, email us at [email protected]. Until next time, take care. 

PODCAST CLOSE: Thank you for listening to the Live Yes! With Arthritis podcast, produced as a public service by the Arthritis Foundation. Get show notes and other episode details at arthritis.org/podcast. Review, rate and recommend us wherever you get your podcasts, on Apple, Spotify and other platforms. This podcast and other life-changing Arthritis Foundation programs, resources and services are made possible in part by generous donors like you. Consider making a gift to support our work at arthritis.org/donate. We appreciate you listening. And please join us again!