Health Do you have a problem youd like answered? If so, write to us at: Inspire magazine, 1 Cambridge Technopark, Newmarket Road, Cambridge CB5 8PB or email inspire@arthritiscare.org.uk Ask the doctor Whether its a health niggle or emotional problem, Inspires dr sarah Jarvis gets straight to the point Q ive got osteoarthritis in my lower back and hips, as well as my spine. ive tried so many different painkillers, but they only work for a short time. ive also had steroid injections and found no benefit. what supplements would be best for me? im feeling depressed because of the pain. i am having some counselling and i think talking might help. what else might help me? e rayment, stevenage Q i have arthritis and have a terrible time sleeping because of the pain. im constantly exhausted and its really getting me down. what can i do? Jo Cummins, Warwick dr sarah Jarvis answers: The evidence for supplements is pretty conflicting, but overall they appear to be relatively safe, so may be worth a try. Doctors use a database called Cochrane to weigh up evidence from all the trials of many drugs and supplements. From this, it is deemed that chondroitin may help a bit. A brand of glucosamine called Rotta showed a small benefit in trials, but other brands didnt. Most people in the UK who use glucosamine take tablets, which werent found to offer benefit. However, there has been some positive data for a rosehip supplement called Gopo, both in osteoarthritis and rheumatoid arthritis. It appears to reduce pain and stiffness, and improves day-to-day functioning. You dont say what painkillers youve had, but youre correct to say that your body does sometimes become tolerant of medication, particularly opioid (codeine/morphine-related drugs), so they stop being as effective. That means you need higher doses, which in turn brings a higher risk of side effects. Severe and long-term back pain, in particular, often affects your spinal nerves. In this case, medications that damp down the pain signals from your nerves amitriptyline, gapapentin and pregabalin can be highly effective. Drowsiness is often a major limiting factor in tolerance, so your doctor will start with a low dose and titrate up over several weeks. Its also important to talk your problems through with someone you trust. This could be a family member, friend, carer, neighbour, health professional or someone at your local Arthritis Care branch. This is a positive step that you can take to work through depression associated with pain. To find your local branch or group, call Arthritis Cares free helpline on 0808 800 4050 or visit arthritiscare.org.uk dr sarah Jarvis answers: Insomnia is incredibly common about one in three people experience it, and its more likely if you have a long-term condition that causes pain. Sleep disturbance often starts because of a trigger, such as stress or a worsening of your pain. Unfortunately, even when the trigger has gone, you may find youre in a vicious cycle. If youre subconsciously worried about sleeping, there may be more adrenaline in your blood at bedtime because youre worried about insomnia and one of the major effects of adrenaline is increased alertness. Sleeping tablets are not the answer they have huge addictive potential and will make matters worse. Some anti-depressants cause drowsiness as a side effect, and are sometimes used at low doses for severe sleep problems. One of the most effective ways of addressing sleep problems is to use a behavioural approach to challenge your subconscious anxiety about insomnia. Every day for a week, keep a sleep diary of the time you go to bed and get up, the approximate time you got to sleep and the quality of your sleep (on a scale of one to five, where five is perfect sleep). Then spend a week looking at lifestyle issues that might be having an effect. You could: Cut out stimulants such as alcohol, caffeine, tea and chocolate Avoid eating too close to bedtime ideally leave at least two hours between eating and sleeping to allow your food time to digest Speak to your pharmacist about rescheduling the time you take tablets that could disrupt your sleep Other things you could try include: Making sure your bedroom is dark and quiet Thinking about investing in new bedding or pillows to make your bed more comfortable Leaving your phone and TV out of the bedroom, and not using them for at least an hour before you go to bed, as blue light can disrupt your sleep Avoiding digital alarm clocks as the light can disturb your quality of sleep Not taking daytime naps Not eating in bed Getting up at the same time every day to regulate your sleep cycle Finally, go back to your sleep diary and work out how much time you actually spend sleeping and only spend this much time in bed. You can increase the time you spend in bed once youre sleeping better. A great technique for falling asleep is to relax your body one bit at a time, as this will slowly wind your mind down. You could do this by trying some gentle yoga techniques with some relaxing music playing, focusing on one part of your body at a time. Using this sort of cognitive approach may not provide the quick fix of sleeping tablets, but its far more effective and safer in the long term. Our helpline is free, confidential and open to anyone with arthritis and their families. Call 0808 800 4050 the line is open Monday to Friday, 10am to 4pm. For a copy of our booklet, Healthy Eating and Arthritis, call the helpline, write to Publications Orders, Arthritis Care, Floor 4 Linen Court, 10 East Road, London, N1 6AD or click here to email.