A joint is the location where two bones meet. Arthralgia is the medical term for pain in these joints.

Most people experience joint pain at some time during their lives. Pain can be acute, due to a short-term injury or condition, but can also be chronic (long-term).

The many causes of joint pain include arthritis, fractures, other trauma, overuse, age-related degeneration and conditions ranging from Lyme disease to lupus to sickle cell anemia.

When a patient experiences joint pain, a physician may perform a physical examination to diagnose an underlying condition that may be causing the pain. Diagnostic tests that may be performed include blood tests, x-rays and joint fluid analysis.

In addition to lifestyle changes, such as regular exercise and weight loss, patients may be prescribed medications to alleviate pain.  Many medications are available to treat joint pain, such as acetaminophen and nonsteroidal anti-inflammatory drugs (NSAIDs). Corticosteroid injections into the joints can be a safe and effective way to help ease joint pain for some time.

Surgery may be required to alleviate some types of joint pain. Arthroscopy (insertion of a thin, flexible fiberoptic scope through a small incision in the skin) and arthroplasty (replacement of damaged joints with artificial joints) are common types of surgery performed on joints.

Some types of joint pain cannot be prevented. Others can be prevented by lifestyle modification and practicing good health habits.

A joint is the location where two bones meet. Arthralgia is the medical term for pain in these joints.

Joints are structures consisting of bone, muscles, synovium (a thin layer of tissue that lines the joint space), cartilage and ligaments. They are designed to bear weight and help the body move.  The many types of joints include the temporomandibular joint in the jaw, facet joints and intervertebral joints in the spine, the shoulders, the elbows, the wrists, the fingers, the hips, the knees, the ankles and the toes.

Most joints are synovial, lubricated by synovial fluid to ease movement. These joints allow varying degrees of movement, ranging from the mobility of the shoulder (a modified ball and socket) to the flexion and extension (bending and straightening) of the hinged distal interphalangeal joints in the fingertips. Some other synovial joints, such as those in the spine, permit limited movement. Fixed joints, such as those in the skull, are fused and do not allow movement.

Most people experience joint pain at some point in their lives. Patients can experience pain in either one joint or many joints. When patients experience pain in more than four joints, it is called polyarticular joint pain.

Patients may experience joint pain that is acute (a normal response to disease or trauma, sometimes defined as lasting less than six weeks), subacute or chronic (pain that persists after the cause’s expected resolution or is due to a chronic condition, sometimes defined as lasting three months or longer). Others experience pain only during certain physical activities.

Some patients can experience morning stiffness because immobility during sleep worsens some types of joint pain. Other kinds of joint pain are worsened by activity.

Arthralgia is different from arthritis, a common condition affecting 66 million Americans, or 1 in 3 adults, according to the Arthritis Foundation. Arthritis is the nation’s leading cause of disability, according to the U.S. Centers for Disease Control and Prevention (CDC).

Arthralgia is joint pain without inflammation, whereas many forms of arthritis do involve inflammation. However, joint pain is a common symptom for arthritis. It is important to note that osteoarthritis, the most common form of arthritis, does not involve systemic inflammation but does cause joint pain.

Experiencing joint pain does not usually constitute a medical emergency. However, if it is accompanied by certain symptoms, it can be indicative of an infection or other condition that may require immediate medical attention. Patients should contact a physician if:

• Joints are hot or swollen
  
  
• Joint pain is accompanied by fever, weight loss or malaise (a general feeling of discomfort, illness or lack of well-being)
  
  
• Joint pain is accompanied by a burning pain or paresthesia (sensation of tingling, pricking or numbness of the skin)

Many injuries, diseases and conditions can cause joint pain. They include:

• Unusual activity or overuse, including strains and sprains.
  
  
• Common infectious diseases. Conditions such as colds, flu and fifth disease (a viral condition that affects children) can cause muscle pain (myalgia) and joint pain.
  
  
• Wounds and trauma, such as fractures and whiplash.

• Athletic injuries, such as tennis elbow, golfer elbow and rotator cuff injury.
  
  
• Arthritis. This term is used to describe more than 100 diseases that cause pain, stiffness and swelling in the joints. Types of arthritis include:
  
  
• • Osteoarthritis. The most common form of arthritis, sometimes called degenerative joint disease. It may affect any joint and is characterized by a progressive breakdown of joint cartilage and formation of bone at the margins of the joint.
    
    
  • Rheumatoid arthritis. A chronic autoimmune disease characterized by inflammation of the lining (synovium) of small joints. It can lead to long-term joint damage.
    
    
  • Juvenile arthritis and juvenile rheumatoid arthritis.  Forms of arthritis that affect children.
    
    
  • Ankylosing spondylitis. Type of arthritis that causes pain and stiffness and primarily affects the spine, although other joints can be affected.
    
    
  • Gout. Caused by a buildup in the body of excessive uric acid, which forms crystals that deposit in the joints and cause inflammation. It results in sudden and severe attacks of pain and tenderness, redness, warmth and swelling in some joints. It usually affects one joint at a time, often the big toe.
    
    
  • Pseudogout. A disease that in some ways mimics gout but typically is characterized by knee pain.
    
    
  • Psoriatic arthritis. A condition that includes the skin disease psoriasis.
    
    
  • Reiter’s syndrome. A form of infectious arthritis. 

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• Tendinitis. Inflammation, irritation and swelling of a tendon (the fibrous structure that connects muscle to bone) can be caused by injury, overuse or age.
  
  
• Bursitis. Inflammation of the fluid-filled sac (bursa) that lies between a tendon and skin or between a tendon and bone can be caused by chronic overuse, trauma, rheumatoid arthritis, gout or infection.
  
  
• TMJ disorder. This condition involves pain where the lower jaw connects with the skull, caused by genetics, trauma, arthritis or other factors.
  
  
• Carpal tunnel syndrome. This condition can cause wrist pain. It occurs when the median nerve, which runs from the forearm into the hand, becomes pressed or squeezed at the wrist.

• Systemic lupus erythematosus (SLE). This autoimmune disease causes inflammation of the connective tissue, in particular membranes around joints.
  
   
• Fibromyalgia. This chronic disorder causes diffuse muscle ache, stiffness and fatigue. Patients have tender spots in specific areas on their body in places such as the neck, shoulders, back, hips, arms and legs that hurt when pressure is applied.
  
  
• Chronic fatigue syndrome. Pain in multiple joints without swelling or redness is a common symptom.
  
  
• Sjogren’s syndrome. This autoimmune disorder is often associated with rheumatoid arthritis and other rheumatic conditions and can cause debilitating joint pain.
  
  
• Lyme disease. Joint pain is common in early and late stages of this infectious tick-borne condition.
  
  
• Spinal stenosis. This narrowing of the passage for the spinal cord can cause pain in the back, neck, shoulders, legs and other joints.
  
  
• Osteoporosis. This common bone disorder is usually painless in early stages but may cause severe joint or back pain in late stages because of fractures.
  
  
• Cancer. Bone tumors, leukemia and other cancers can cause joint pain due to metastasis, or spreading of the cancer into the joint.
  
  
• Sickle cell anemia. A hereditary blood disease marked by pain in the joints, bones and elsewhere.
  
  
• Polymyalgia rheumatica. Pain and stiffness in the neck, shoulder and hips typify this condition.
  
  
• Sarcoidosis. This inflammatory disease can affect the joints and other body parts.
  
  
• Complex regional pain syndrome. This chronic condition usually affects the arms or legs.
  
  
• Infection of a joint. For example, a joint may be infected during surgery such as arthroplasty.
  
  
• Osteomyelitis. Acute or chronic bone infection is usually caused by bacteria.
  
  
• Meningitis. Inflammation of the membranes covering the brain and spinal cord, meningitis is usually caused by infection. It can cause neck pain or stiffness.
  
  
• Encephalitis. Inflammation of the brain. Symptoms can include stiffness or pain in the back or neck.
  
  
• Costochondritis. Inflammation of the cartilage connecting the ribs and sternum (breastbone), costochondritis is one of the more common causes of noncardiac chest pain.
  
  
• Scleroderma. This chronic disease can cause thickening, hardening or tightening of the skin, blood vessels and internal organs.

A physician may try to determine whether there is an underlying condition or disease that is causing the joint pain.

After reviewing the patient’s medical history and conducting a physical examination, the physician may ask the patient to describe the pain. Questions that may be asked in a pain assessment include:

• How long has the patient been experiencing pain?
• Is the pain constant, or does it come and go?
• Does resting make the joint pain worse or better?
• Does movement make the joint pain worse or better?

Physicians who suspect joint pain may be caused by an underlying injury, condition or disease may perform several tests. These may include blood tests, such as: 

• Inflammation tests. Erythrocyte sedimentation rate (ESR) and C-reactive protein test indicate whether inflammation is present. This can help a physician better diagnose and treat an underlying condition.
  
  
• Antinuclear antibody test (ANA). This test helps to determine whether a patient has an immune disorder such as systemic lupus erythematosus (SLE), rheumatoid arthritis or scleroderma.
  
  
• Rheumatoid factor test. Part of a blood test that is helpful in  diagnosing rheumatoid arthritis, Sjogren’s syndrome and other inflammatory conditions. Rheumatoid factor is found in the serum of about 80 percent of patients with rheumatoid arthritis.
  
  
• Antibodies to citrullinated peptides. Used to help diagnose rheumatoid arthritis.
  
  
• Serum uric acid concentration. Identifies the presence of uric acid, which helps to diagnose gout.
  
  
• Enzyme test. Above-normal levels of enzymes may indicate trauma or chronic rheumatic diseases such as sarcoidosis.
  

Other tests that may be performed include:

• Urine test (urinalysis). Testing urine samples can help physicians identify and monitor some diseases that cause joint pain, such as gout and lupus.
  
  
• X-ray. This can help a physician identify damage resulting from injury or another cause that could promote joint pain.
  
  
• Range-of-motion (ROM) testing (also called flexibility tests or goniometry). During this test, the patient may move the joint being tested or the physician may move the joint manually. Joint range may be measured with a protractor–like device called a goniometer.
  
  
• Arthrography. A test to help diagnose the cause of joint pain. An iodine solution is injected into the joint area to highlight the joint structures and several x-rays are taken.
  
  
• Joint aspiration and analysis. A test in which fluid is removed from the joint with a syringe and sent to a laboratory for analysis. Irregularities such as bacteria and crystals are noted under microscopic examination. Conditions such as bursitis, arthritis or injuries can cause fluid buildup, which causes swelling and pressure.
  
  
• MRI (magnetic resonance imaging). Test using powerful magnets to produce images on a computer screen and film. Sometimes an MRI is performed to identify joint damage resulting from injury, disease or another cause.

• CAT scan (computed axial tomography). Uses multiple x-ray images combined to provide a three–dimensional image of a body part. CAT scans can show good anatomical detail of bony structures, ligaments and muscles.
  
  
• Bone scans and other radionuclide imaging. Tests using radioactive tracers to highlight internal structures. Nuclear medicine may be used to detect conditions including osteomyelitis, small fractures that do not appear on x-rays, degenerative diseases such as arthritis, cancer and other causes of unexplained joint pain.
  
  
• Ultrasound. A painless, noninvasive test using sound waves to create images of internal structures, including joints. Ultrasound may be used in diagnosing conditions including tendinitis, bursitis, rotator cuff injuries, cancer, sarcoidosis, rheumatoid arthritis and osteoporosis. 

Patients experiencing joint pain can implement a number of lifestyle changes to help reduce pain. In some cases, these changes may also prevent joint pain. Patients are always advised to check with their physician to see which are right for them.  These recommendations may include:

• Getting regular exercise. Exercising can improve overall health and fitness. It also keeps joints moving and strengthens the muscles and bones around them.
  
  
• Using good body mechanics, posture and ergonomics. Joints can be protected by using proper techniques for movements such as bending and lifting. They can also be protected by avoiding activities that put excessive stress on the joints.
  
  
• Losing excess weight. Carrying extra pounds stresses the knees and other joints and can lead to early degeneration.
  
  
• Using heat, cold and water treatments. Thermotherapy, cryotherapy and hydrotherapy can often reduce joint pain. Cold packs numb the affected area, and heat relaxes the muscles and stimulates blood circulation.
  
  
• Getting enough sleep. Sleeping restores energy so pain can be better managed. It also rests joints to reduce pain and swelling.
  
  
• Relaxing. Relaxation can help reverse the effects of stress on the body, reducing pain.

In addition to these healthy lifestyle measures, a physician may recommend other steps:

• Physical therapy and manipulation therapy. These treatments can be helpful in treating joint pain, such as that caused by arthritis. For example, muscles in the thigh can become weak with chronic knee arthritis and may need to be strengthened.
  
  
• Walking aids including canes or walkers. A physician may prescribe these to relieve stress on certain joints, including knees.
  
  
• Occupational therapy. The many techniques used by occupational therapists include task simplification, energy conservation and instruction in adaptive equipment, for conditions ranging from acute trauma to chronic fatigue syndrome.
  
  
• Braces and splints.  There are many types of braces available that are helpful in unloading weights to certain joints, including knees. They can be bulky and difficult to wear long-term.  Sometimes, shoe wedges can also be inserted for certain types of arthritis to help with alignment and support. Splints may relieve wrist pain, such as that caused by carpal tunnel syndrome.

• Cognitive behavioral therapy. This treatment has patients replace negative thought patterns with positive ones. It may used with chronic sources of  pain ranging from arthritis to fibromyalgia.

Some types of joint pain may be treated effectively with analgesics or anti-inflammatory medications that help relieve pain and swelling. These are available without a prescription. Physicians should be consulted before these medications are administered to children.

Patients experiencing joint pain caused by an underlying disease or condition may receive treatment for the disease or condition. If a patient’s joint pain is caused by a bacterial infection, the patient may be given antibiotics to treat the infection. Viruses do not respond to antibiotics, but many diseases caused by viruses are treated with antiviral medications.

If joint pain is caused by arthritis, there are several medications that patients may take to relieve the pain. These medications are sometimes prescribed for joint pain not caused by arthritis. They include:

• Analgesics.  Acetaminophen has been suggested to be the "first-line" treatment for arthritic pain, especially in the elderly.  Chronic daily intake should be limited to 2,000 milligrams (mg) a day.  Dosing greater than 4,000 mg/day may lead to toxicity and liver failure.
  
  
• Nonsteroidal anti-inflammatory drugs (NSAIDs). Medications that help reduce stiffness and swelling. NSAIDs reduce production of prostaglandins (a group of lipid compounds derived from fatty acids), which help promote inflammation. These medications must be used with caution in patients with gastric ulcers and in the elderly.  Some of the newer NSAIDs called COX-2 inhibitors, which had been very effective for arthritis, have been taken off the market because of concerns about possible cardiovascular and other side effects.
  

• Corticosteroids. These medications may help alleviate pain by reducing swelling and inflammation.  These can be taken orally as tablets or injected directly into the affected joints. Risks of long-term use at high doses include diabetes and osteoporosis.
  
  
• Disease-modifying antirheumatic drugs (DMARDs). Medications to treat rheumatoid arthritis and related diseases. They reduce inflammation, slow the underlying disease process down and prevent joint damage.
  
  
• Biologic response modifiers (BRMs). Also called biologic agents, they are used to suppress inflammation due to arthritis.
  
  
• Antidepressants. The U.S. Food and Drug Administration (FDA) has approved the antidepressant duloxetine (Cymbalta) to treat nerve pain caused by diabetes. Some physicians also prescribe other antidepressants for chronic pain. The FDA has cautioned that antidepressants may increase the risk of suicidal thinking and behavior in children, adolescents and adults, and that people being treated with these drugs should be closely monitored for unusual changes in behavior.
  
  
• Topical pain relievers. Creams, rubs and sprays may be applied on the skin over joints.
  
  
• Opioids.  These strong analgesic medications can reduce pain by blocking pain signals traveling to the brain. These are typically used short–term or are reserved for severe pain that has failed other conservative treatment.
  
  
• Muscle relaxants. These medications alleviate pain by reducing muscle spasms that trigger pain signals.
  
  
• Anticonvulsants. Originally designed to treat seizures, they can also be used to treat some types of pain.
  
  
• Injection therapy. Injections of anesthetic, corticosteroid or other medications into joints or nerves surrounding joints of a painful area can be safely done. They can help reduce inflammation and pain at the source.  Injecting these medications can be an effective method to treat localized arthritic flares of joints occasionally.  A physician may use an x-ray-guided system, called fluoroscopy, when injection involves the spine or hip joints.

The FDA has approved injections of hyaluronic acid  to treat osteoarthritic knee pain, and recent research indicates this treatment can also relieve shoulder pain due to osteoarthritis. 

Joint pain that cannot be treated effectively with conservative treatments may require surgery. Common types of joint surgery include:

• Arthroscopy. A thin, flexible fiberoptic scope (arthroscope) is placed in a small opening of the skin. It allows the surgeon to view and remove loose particles of cartilage or bony spurs offering temporary relief from joint pain.
  
  
• Joint replacement (arthroplasty). Damaged joints are replaced with artificial joints. Joint replacement often alleviates pain and may restore joint motion and function. This may be a good choice when all treatment options have failed. Joint replacement has the potential to provide excellent functional outcome for many years.

• Synovectomy (removal of the synovium, the lining of the joint). This may reduce pain and swelling.
  
  
• Osteotomy. This surgical procedure is designed to correct alignment of certain joints, especially the knee.
  
  
• Spinal surgery. Several types of operations can ease some cases of back or neck pain. Vertebroplasty or kyphoplasty may be recommend in some cases for compression fractures caused by osteoporosis.
  
  
• Carpal tunnel release surgery. This procedure can relieve carpal tunnel syndrome.

Alternative treatments are available to alleviate joint pain. They include:

• Biofeedback. This technique trains people to improve their health by using signals from their own bodies. Practicing relaxation using biofeedback can help patients learn to control the body’s response to pain.
  
  
• Transcutaneous electrical nerve stimulation (TENS). Type of electrical therapy using a small device that directs mild electric pulses to nerves in the painful area. TENS works by blocking pain impulses through stimulation of large nerves.
  
  
• Therapeutic ultrasound. High-energy sound waves can bring comfort to painful joints and muscles. Modalities such as biofeedback, TENS and ultrasound therapy may be part of physical or occupational therapy.
  
  
• Glucosamine and chondroitin. Recent research has found these over-the-counter supplements may relieve pain in some people suffering from osteoarthritis.
  
  
• Acupuncture. This ancient Chinese practice involves inserting small, thin needles into specific spots on the skin. The needles may stimulate nerves to block pain signals. Acupressure is based on similar theories but avoids the use of needles.

Preparing questions in advance can help patients have more meaningful discussions with their physicians regarding their conditions. Patients may wish to ask their doctor the following questions about joint pain:

1. What is causing my joint pain?
   
   
2. If I have joint pain, does that mean I have arthritis?
   
   
3. I injured a joint when I was younger. Does that mean I will have joint pain when I am older?
   
   
4. If an infectious disease is causing my joint pain, will the pain disappear after the disease has been cured?
   
   
5. What tests are available to help determine the cause of my joint pain?
   
   
6. What can I expect from these tests?
   
   
7. What medications are available to alleviate joint pain?
   
   
8. What are the possible side effects of these medications?
   
   
9. Are there ways to relieve my joint pain without medication?
   
   
10. Under what circumstances may I consider surgery to alleviate joint pain?
    
    
11. Is there any way I can prevent joint pain?