Slow Medicine for Arthritis

closeup on business woman with wrist pain Arthritis is a common condition whose symptoms are well known: inflammation, limited mobility and painful joints. The pain can be debilitating, preventing a range of physical activities and making daily living challenging. As a result, those with arthritis often experience isolation, sadness, resentment, loneliness and depression, in addition to nagging chronic pain.

What’s going on in the body?
Arthritis most often affects joints that bear weight (hips, knees, spine) and joints that are frequently used throughout the day (fingers, arms, feet). Joints are the space between bones, which are held together by muscles, ligaments and tendons. To keep them gliding easily over each other they are covered by cartilage — a smooth substance that protects the bone from grinding down. For people with osteoarthritis, the cartilage grows damaged.

Researchers have found this continuing damage may be due to an imbalance between the healing and destroying tools the cartilage usually uses to repair itself. Normally, cells in the cartilage produce a number of proteins that help with the building and destroying of cartilage to keep that layer well-maintained. But when the layer is damaged, it seems as though the balance of these creative and destructive forces shifts in favor of destruction, leading to loss of cartilage and the start of osteoarthritis.

Inflammation may also play a role in osteoarthritis. As noted in a study in Rheumatology, OA is commonly described as a non-inflammatory disease in order to distinguish it from ‘inflammatory arthritis,’ such as rheumatoid arthritis (RA) or the seronegative spondyloarthropathies. Despite this, inflammation is increasingly recognized as contributing to the symptoms and progression of OA.”

Inflammation is a two-step process: First, extra blood flows to the site of injury and provides a cushioning layer of fluid, to prevent further exacerbation of that injury. Second, a particular set of molecules circulate around the site of injury, cleaning up the damaged tissue and replacing it with new tissue. If you think about watching a cut on your arm or leg during the healing process, you may recall seeing it get red and swollen initially, then begin to cover itself over with smooth new skin. That’s the inflammation process in action.

While a normal inflammatory response to occasional injury in the body is useful, a chronic inflammation in response to chronic injury — in this case, in the joints — is harmful. Over time, the destructive aspect of the inflammation process only adds to the degeneration caused by the wear-and-tear — ultimately, destroying the cartilage altogether and causing bones to press on each other directly. Considering that each bone has many nerves on its surface, bone-on-bone friction then can lead to excruciating levels of pain.

What’s the conventional medical response to arthritis?
Conventional medicine responds to arthritis once pain already has manifested, and it responds in gradations – beginning with over-the-counter analgesics and anti-inflammatories, such as aspirin and acetaminophen, then progressing to prescription strength non-steroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen and celecoxib, and continuing all the way to narcotics, which block the brain’s receptors of pain signals. Over time, each of these drugs either stop being as effective or stop being effective at all. In addition, they frequently cause side effects, such as stomach irritation, ulcers, kidney and liver damage, and in the case of narcotics, drug addiction and erratic behavior, as well as the array of psycho-spiritual-social issues associated with these.

More modern technologies are in development, including injections of cortisone, platelets or cartilage growth factors, to activate the body’s healing mechanism and return the cartilage back to its previous shape. Indeed, science is evolving and may offer tremendous promise in the future. However, none of these approaches are without significant risks.

Injections, for example, run the risk of bacterial infection, bleeding and direct injury to ligaments, tendons, muscles or nerves. In addition, considering that arthritis typically affects many body parts simultaneously, injections may not be the most efficient response to arthritis. Then there is surgery, such as hip replacement or spinal fusion. In the best case scenarios, surgery provides pain relief and increased mobility. Even in these cases, however, replaced joints often fail after 10 or 15 years, and the surgical procedure needs to be repeated. In addition, there are serious risks and side effects of surgery, including blood loss, infection, disability, chronic pain and even death.

Overall, while conventional medicine provides an effective stop-gap measure for arthritis, and while it is certainly may be reasonable to utilize pharmaceuticals, injections or surgery in such cases, conventional medicine fails to prevent or eliminate the root problem of arthritis, and furthermore, it adds a host of new problems to the mix. Even in the case where doctors simply recommend that patients exercise and maintain a healthy weight, since obesity exacerbates symptoms, doctors do not always do an adequate job of guiding patients on how to exercise, when arthritis makes physical movement painful.

What is the Slow Medicine approach to arthritis?
When we are stressed out, our sympathetic nervous system is activated, putting us into fight-or-flight mode, which stimulates the adrenal glands and, in turn, sets off a systemic inflammatory response throughout the body. This worsens any existing inflammatory conditions, including arthritis, is a disease of chronic inflammation. Therefore, a key to dealing with arthritis is an anti-inflammatory lifestyle — one which activates what is effectively the sympathetic nervous system’s shut-off switch: the parasympathetic nervous system, also known as the rest-and-digest mode.

An anti-inflammatory lifestyle is cultivated through engaging with anything that nourishes, soothes and heals us. Given the interconnected threads between body, mind, heart and soul, the parasympathetic nervous system can be activated on the physical, mental, emotional or spiritual levels — through eating nutrient-dense, whole foods; reading thought-provoking books; spending time with those who make us feel secure and loved; or meditating and praying. By going to our happy place on all these levels simultaneously — for example, going for a walk (physical) in the forest (spiritual) with a close friend (emotional) and enjoying a meaningful conversation (mental), we amplify the impact of each act, in a synergistic effect that I refer to as “healthy multitasking.”

On the physical level, Slow Medicine additionally guides individuals on a balanced approach to strengthening muscles and joints but not overusing them — for example, walking on a dirt trail, instead of jogging on a cement sidewalk, or gardening, instead of lifting weights. Whether preventing or managing arthritis, it is never too late to become mindful of how to move in ways that support the body instead of erode it.