Smoke a joint a day, that’s why they call it joint pain

March 29, 2019 10:51 AM

After a recent conversation with my boyfriend about marijuana and pain relief (him: “... but I don’t HAVE pain every day”) I realized that my weird persistent joint pain is becoming an issue. I talked to a doctor this week who didn’t have much to say; trying to figure out what might be wrong and what to say to the doctor next time.

As much background as I can think of:
* I’m a 29 year old woman
* My grandma had some type of arthritis (and diabetes)
* I’m on 25mg sertraline for anxiety/stomach problems
* I take Zyrtec everyday for allergies and Nasacort as needed, for seasonal allergies
* I’ve been exercising regularly since last November, with light weights/bodyweights, Couch to 5k, and a weekly spin class. Sometimes I overdo it a bit but generally as a non-athletic person I baby myself
* I’ve probably notice this joint pain/inflammation for the last 5 years or so
* I have pretty bad seasonal allergies, no other chronic health issues
* I drink several cups of tea a day, starting off with matcha and then switching to steeped green or black tea later in the day, occasionally a sugar free Red Bull or soda
* I have a glass of wine every day, but the pain started before that habit

Symptoms:
* After a run, my tendons in my feet and knees are always sore and tight for a few days. It makes it hard to be consistent because of the malaise (muscle soreness is satisfying, joint pain not as much). I did Couch to 5k a few years ago successfully but stopped running because my ankles and feet were always tight and sore, I could sometimes hear grinding, and I thought I was fucking my tendons up. Sometimes I get some pelvic soreness after spin but usually not.
* After I drink my first cup of tea in the morning my joints are all snap crackle pop. If I don’t drink any form of caffeine, they are significantly less so.
* Weed helps, a lot! Haven’t tried CBD.
* I gained 50lb about three years ago. Since then, I’ve been on a reduced calorie diet and lost about 30lb (no yo-yoing, again, I tend to go easy on myself, Ms. Slow and Steady). I’m still on the diet and my BMI is at the high end of normal. I recently had a body composition scan and my body fat percentage is about 33%.

My main concerns are that something is wrong with me (arthritis, RA) and that I’m making it worse with caffeine and/or too high-impact exercise. I want to keep exercising, particularly running, because sweating my anxieties out helps a ton with mood regulation. I also want to keep exercising and dieting because I want to bring my body fat percentage down. I deeply love caffeine, as a person with diagnosed dysthymia, but I gave up coffee a few years ago because it was giving me mad acid reflux. I still get a little stomach upset if I have too much tea. I’m also very curious whether any of my medications can lead to stomach problems or joint pain, as I’ve been on them for several years now, which could be a coincidence or could be covering up the cause.

Anyway, have you had a similar sounding issue? Or do you have any theories, suggestions, ways to approach my doctor? Is this normal aging stuff? Am I doing anything that sounds bad for me? My doctor didn’t have much to say, just told me to come back if the pain becomes “every day” (it’s not, but exercise and/or caffeine are surefire triggers).

posted by stoneandstar to Health & Fitness (21 answers total)

If I were in your shoes, I'd get a referral to a rheumatologist if possible. This sounds outside the problem-solving scope of a GP.
posted by juniperesque at 11:00 AM on March 29, 2019 [6 favorites]

You might consider replacing running with a more low-impact cardio (like swimming or more spin class) and see if that changes things. I get pretty bad ankle and knee pain from frequent high-impact cardio like dance classes or running, just the way my joints are I think.
posted by sallybrown at 11:24 AM on March 29, 2019

Response by poster: Forgot to add something— I also get a lot of clicking + some vague achiness when turning my head, in the upper back/cervical spine. Especially after caffeine.
posted by stoneandstar at 11:26 AM on March 29, 2019

Are you stretching before and after exercise? That could help with the tightness.
posted by blurker at 11:55 AM on March 29, 2019

Response by poster: I stretch after, not before, as I read that ore-workout stretching can lead to more damage. Not sure on the proof behind that.
posted by stoneandstar at 12:13 PM on March 29, 2019 [1 favorite]

I think your "mad acid reflux" could be at the root of your problems, because acid reflux can be caused by the ulcer bacterium, Helicobacter pylori, and treating Helicobacter has been shown to help some people with arthritis:

Eradication of Helicobacter pylori may reduce disease severity in rheumatoid arthritis.
…
CONCLUSIONS:
Our data suggest that H. pylori infection is implicated in the pathogenesis of rheumatoid arthritis, in that its eradication may induce a significant improvement of disease activity over 24 months. H. pylori eradication seems to be advantageous in infected rheumatoid arthritis patients, but controlled studies are needed.

posted by jamjam at 12:15 PM on March 29, 2019 [1 favorite]

Response by poster: Quick, final comment: I’ve been tested for h. Pylori once and it came back negative.
posted by stoneandstar at 12:16 PM on March 29, 2019

Get your joint pain evaluated by a physiotherapist in a sports medicine clinic. They can probably help get you active comfortably.

Also, I would go back to the doctor that manages your anxiety and discuss your symptoms with him or her. I believe that you are in pain, please don't interpret this suggestion as the pain being "all in your head" or trying to dismiss you. It's hard to get that sentiment across, what you are feeling is real and worthy of medical treatment. That said, I also believe that you can create a feedback loop in your body that exacerbates your pain. The snap/crackle/popping is usually not harmful. However, if you are hyper-aware of the audible stimuli this can create a pain sensation almost out of habit. Pain management strategies derived from psychological approaches may help.

I would explore physiotherapy and psychology/psychiatry before pursuing rheumatology, at your young age you might not need that treatment as a first line approach.
posted by crazycanuck at 12:39 PM on March 29, 2019

Best answer: IANAD, IANAMD, etc. Are you sure you’re not dehydrated? Pretty much everything you listed (antihistamines, caffeine, alcohol, weed) dry you out, which can cause joint pain. In any case, it’s cheap and easy to up your water intake for a bit to see if that helps.
posted by estelahe at 12:44 PM on March 29, 2019 [1 favorite]

Anecdotal: I had joint pain pretty much all the time when I had undiagnosed celiac disease. I think your instinct about inflammation and maybe something autoimmune is worth following up on. Maybe with a rheumatologist?

Does the joint pain last all day? Does it feel better after you stretch? Don't give up exercising in the meantime (within reason)--it's such a good habit to have and exercise itself is anti-inflammatory. The dehydration angle is worth exploring too. Easy to do that while you wait for an appointment!
posted by purple_bird at 2:25 PM on March 29, 2019

Hi - I have RA and some of your symptoms sound like a lighter version of mine. You should see your doctor and ask for a rheumatology referral. The meds for this - and for other things it could be - have come a long way and could really help you stay active long-term and lower your pain.

You've said that caffeine seems to have a pretty intense and quick impact. What about other highly acidic foods, like tomatoes, chocolate, citrus, or alcohol? You may want to look into cutting down on acidic foods for a bit and then see how that changes things.

You can memail me if you want, I'm happy to talk to you about this more if you have other questions.
posted by bile and syntax at 2:48 PM on March 29, 2019

Have you been tested for Lyme disease?
posted by sciencegeek at 2:55 PM on March 29, 2019

Before I got to your More Inside I assumed you were a woman, and a young woman. And hey, I'm right. Why do I know? Because doctors don't take us seriously.

Priority one is finding a doctor, preferably a GP to start, that believes you. However it wouldn't hurt to go straight to a rheumatologist if you can. If you don't have the ability to doctor shop and have a man you can bring with you, it generally gets you believed faster.

There is an overwhelming sexism, ageism, and ableism in medicine (not to mention fat-phobia and racism.)

I can't tell you the number of doctors who told me nothing was wrong. The reality is quite the opposite.

Things like joint pain and inflammation can have SO many causes, especially auto immune conditions that are difficult to diagnose. So the absolute best course of action is to find someone who cares, wants to do tests, and send you to specialists. Take in notes, ask direct questions, don't underplay symptoms.
"I am in pain nearly every day. It has continued for years. It affects my quality and function of life. What are we going to explore to find a diagnosis?"
If they don't have an answer or somewhere to direct you, then get a new doctor.
posted by Crystalinne at 2:57 PM on March 29, 2019 [3 favorites]

I have ankylosing spondylitis, so that's where my mind usually goes when I read these vague rheumatoid complaint questions. The defining feature is the SI joint and lumbar spine inflammation/pain/fusion, but there are many other symptoms, including neck issues, recurrent tendinitis, and arthritic pain in the extremities. Women are underdiagnosed because we tend to display more of those peripheral symptoms and look less textbook on the low back/SI stuff (not to mention sexism in the medical industry, of course). I'd get a referral to a rheumatologist.

If it is AS, the good news is that exercise is the best possible thing you can be doing for it! Just modulate your intensity to prevent flare-ups and listen to your body if you need to back off. You'll see all kinds of advice about what exercise you should or shouldn't do, but I think anything you can do regularly that keeps you feeling good is the right choice. And with a diagnosis, you'd start taking meds that would make all that easier, too. Good luck!
posted by hollyholly at 4:00 PM on March 29, 2019 [1 favorite]

Just a practical tip: it can be cheaper and faster to see your GP (or gyn! but they can be harder to get in to see in the first place) and have them order bloodwork with inflammation panel, then take the results to a rheum or whoever you see next based on the results.
posted by Lyn Never at 4:20 PM on March 29, 2019

Lyn Never's bloodwork suggestion is a good one, but many GPs are unaware that you can have bloodwork that looks ok with many of these conditions, and they may try to use that as an excuse to *not* refer you to a rheumatologist.
posted by hollyholly at 4:24 PM on March 29, 2019 [3 favorites]

Yeah I have psoriatic arthritis with a lot of similarities (it got much worse in my late 20s after I gained a bunch of weight, caffeine and weed are how I manage the pain and brain fog.) I also recommend a rheum - an arthritis specialist if possible - but you will probably have to go through your gp first because rheumatologists are in short supply.

Psoriatic is one of the conditions that affects tendons in particular- if you are prone to rashes, excema, anything like that, mention it to your doc. I got properly diagnosed when a doc finally put my joint pain and my dry, flaky ears together.
posted by restless_nomad at 6:13 PM on March 29, 2019 [2 favorites]

IANAD I have some form of autoimmune disease with joint pain, inflammation, fatigue and some other stuff. The reflux should be treatable, get tested again for h. pylori, and talk to the doc about a course of antibiotics. A doctor told me to eat more fiber for reflux, kind of counter-intuitive, but it helped over time. Coffee/ caffeine has health benefits but can make reflux worse.

I realized I'm lactose-intolerant. The enzyme pills are not adequate so I gave up all dairy. My arthritis and inflammation improved a lot. Anecdata, but I would look into testing by removing certain foods from your diet for a month or more. I had a recent failure to restrict dairy, ate ice cream for a week or so and cheese. A week later, my inflammation was worse, etc. I miss dairy, but it has been worth it to me to alter my diet permanently, except when I screw up. Good luck
posted by theora55 at 8:16 PM on March 29, 2019

Oh also I get reflux when I eat gluten, and it makes my joint pain worse. Sorry :/
posted by restless_nomad at 6:56 AM on March 30, 2019

Best answer: This is familiar to me, but eh... I’ve had a lot of joint and tendon pain over my life, and some other stuff that one would think might interest a rheumatologist, but mostly normal or nonspecific enough blood results. Which combined with mild/moderate hypermobility = “sucks to be you, do physio whenever something goes wrong”. At least where I live. (Where if it’s not obviously RA, you’re SOL.) Now (in my early 40s), I deal with cartilage degeneration and OA, which is also a “sucks to be you” situation. As in they can’t do anything about progression. There’s just physio, bracing and rest when necessary, NSAIDS, gel injections (which are $$ and may or may not work), and eventual joint replacement if/when things get bad enough.

Try your luck with a rheumatologist, also see a sports med.

My real advice is to not take any chances now. Injuries in youth can lead to OA later on. If you have evidence that your body’s funny, be gentle with it, don’t try to be a hero. I did a lot of damage to myself with C25K, amazingly. (With great supportive shoes, too.)

If I could talk to younger me, I’d say, stick to walking (with great shoes), hiking, easy swimming, Pilates, light weights. Actually a physio DID tell me that after my first bout of plantar fasciitis, but I didn’t listen, so I understand if you want to tell me to take a hike. Which by the way is actually decent cardio if you get some hills. And it helps with anxiety because o the breathing and rhythm and nature etc.
posted by cotton dress sock at 7:21 PM on March 30, 2019 [1 favorite]

Best answer: Couple of questions. Do you have any psoriasis at all? Pitting in your finger nails? Irritation from time to time in your umbilicus (belly button)? Do you have toes that appear sausage like, typically adjacent to big toe and middle and are painful from time to time? Are the arches of your feet pain filled at times? Are your tendons ever swollen, Achilles tendons in particular? Dry eyes at times? Labored breathing at times as in exhausted breathing? And significant stiffness in the lower back in the morning requiring some time to "warm up" to get moving? Any cardiac arrhythmias?

I have Psoriatic Arthritis, one of the Spondyloarthropathies. The above were the symptoms I developed, that emerged over a period of three months after I had hyper-extended my shoulder exercising. An additional complaint was near total body muscular pain, a really annoying aching that made me want to constantly stretch and move to relieve the pain. One hint is a grand parent or parent that might have arthritis - find out which kind and get more details. Frankly, you are going to be what your parents are physiologically. Their maladies may become your maladies as you age. It's the genes you know, the 75/25 roll of the dice. I found my paternal grand mother had the same kinds of symptoms as did my paternal uncle and my father to a degree as he aged - lucky me.

The diagnosis is generally to rule out other conditions. PA is an RA negative type arthritis. But there are a plethora of arthritis type auto immune disorders out there.

The one thing I did to put my arthritis in a general remission was to change my diet, and radically. I'm one of those where eliminating the nightshade family of veggies really did the trick (Note: the article is from a Web site of the individual who developed, in his experience related to horses and cattle, the link between nightshades and arthritic conditions in people - it's corny but worth a read. It worked for him and apparently many others and certainly worked for me - it was and is my experience.) I used to have awful indigestion, extreme acid re-flux, etc. and the above mentioned symptoms before eliminating nightshades. Sadly these are all the foods we most love, Irish potatoes, tomatoes, garden peepers including hot, bell peppers and pimento type, egg plant and oddly tobacco. It's easy to substitute other foods, it's just that one misses those foods so much. But I was nearly pain free in about nine months. From 6 grams of ibuprofen for extreme pain in my feet (arches in particular and Achilles tendons which were nearly twice the normal size), knees, hips, shoulders, elbows, hands, fingers to nearly no pain, essentially. You can Google nightshades and arthritis or the term Solanaceae (the plant family name, for an interesting side note, look up the toxic effects of the typical Solanaceae poisoning); some dismiss the whole idea diet has any effect. Well, I can say for others, diet certainly does have an effect. I should add, while my arthritic symptoms improved dramatically, the psoriasis skin issues have been more intractable, a real slog. UV therapy and sunshine helps immensely.

One thing you mentioned is morning tea and then some pain. Black teas have a component oxalic acid. Spinach also has oxalic acid. I used to have flares when I would eat spinach, kale and Swiss chard so stopped. Oxalates may also be linked to vulvodynia, which is characterized by chronic, unexplained vaginal pain though this may not be what you refer to regarding intermittent pelvic pain. In the morning, other than teas, do you eat potatoes, or items with pepper sauces, ketchup, etc?

It can be helpful to see a rheumatologist, but mine looked at me like I was out of my mind when I explained the diminished/improved symptoms after eliminating nightshades. Her solution was naproxen, sulfazine, and an old line treatment minocin and then the possibility of ever more serious meds including methotrexate. That was one reason I sought any alternative I could and I lucked out. The meds I mentioned are most effective with "reactive type arthritis" that is, due to some kind of health insult - I had experienced strep throat in my late thirties and that can be a trigger for the body to step up an auto immune response. Sulfazine is effective as an anti-inflammatory and minocin is minocycline which has unexplained anti-inflammatory effects helpful in treating arthritic conditions (old type, coinservative therapy).

It is important you take action and get to the bottom of the joint issues. Untreated, joint damage can progress. I lucky limited the condition and slowed the progression. One reality though is, once you have an arthritic "process" ongoing, you will always have it.

Sorry to go into such detail. Thought this might be helpful. I wish you the best of luck.
posted by WinstonJulia at 3:13 AM on April 17, 2019 [1 favorite]