If you have osteoarthritis or rheumatoid arthritis, the removal of rofecoxib (Vioxx) from the market because of reports linking it to heart attack and stroke took away one of your pain-relief options. You need a reliable painkiller-but does it have to be at the expense of your health? Absolutely not.

There are good alternatives. For centuries, herbs and other natural remedies have helped people cope with pain-without the unpleasant side effects and long-term health risks of many modern medications.

Natural painkillers, available at health-food stores, relieve arthritis pain, back pain and inflammation. Some deaden unpleasant sensations at the nerve itself. Others relax muscles or stimulate the release of endorphins, the brain's natural painkillers. Some painkillers strengthen affected joints. In some cases, they can take a bit longer to work than drugs, but they often provide all the pain relief you need.

Healing Herbs

The best include...*

Arnica, a homeopathic preparation that uses an ultra―diluted amount of the herb to stimulate pain relief is particularly effective at alleviating the soreness and stiffness of osteoarthritis and rheumatoid arthritis.

Typical dose: Follow label directions. Taken orally, in a 6X dilution, use three to four times a day... or in the stronger 30C dilution, once or twice daily Arnica can be applied topically (as a cream or tincture) over the painful joint and covered with a heating pad.

Black cohosh, a perennial herb native to North America Although it is often used to curb menopausal symptoms, black cohosh is particularly effective for heavy dull, aching rheumatoid arthritis and muscular pains.

Typical dose: 60 drops(approximately a standard teaspoon) of the tincture in 6 ounces of water three times a day. If you find that the herb causes mild stomach upset, take it with food.

Capsaicin, the active ingredient of cayenne pepper. It is an effective topical pain killer.

Typical dose: Apply the cream two to three times daily.

Hops, an herb that has a sedative effect. It can ease the nerve pain of rheumatoid arthritis.

Typical dose: One 300-or 500-milligram (mg) capsule two to three times daily...or 120 drops (approximately two teaspoons) of the liquid in 6 ounces of water three to four times daily.

Valerian, a perennial plant native to North America and Europe. Better known as a sleep aid, valerian also relaxes extremely painful muscle spasms that can accompany arthritis.

Typical dose: One 300-or 500mg capsule two to three times daily. If pain disrupts sleep, take one of the doses at bedtime.

Natural Anti-Inflammatories

Inflammation triggers the pain of rheumatoid arthritis and flare-ups of osteoarthritis.

Protease enzymes, derived from plants, arc often taken to aid digestion, but they are also potent anti-inflammatories.

Typical dose: Two 350-mg capsules three times a day between meals and two more capsules at bedtime.

Turmeric, a popular spice (it is a major ingredient in curry powder), and curcumin, one of its key constituents, fight inflammation.

Typical dose: 500 mg three times daily.

Food For Your Joints

Natural arthritis care not only fights today's pain-but also aims to reduce tomorrow's aches by strengthening joints. One way of doing this is good nutrition. Consume an assortment of vegetables and fruits, especially green, leafy vegetables and antioxidant sources, such as carrots, broccoli, blueberries and cherries. Include cold-water fish, such as salmon, mackerel and halibut, at least three times a week.

Caution: Some people who have rheumatoid arthritis find that vegetables and fruits of the nightshade family (tomatoes, eggplant, green peppers, potatoes, etc) worsen their symptoms.

If you have rheumatoid arthritis: Eliminate these foods from your diet for four to six weeks. Then reintroduce them one at a time to see if they worsen symptoms.

The following supplements are key for anyone who has arthritis...

Vitamin C is a critical nutrient for the development of new joint tissue.

Typical dose: 2,000 to 5,000 mg daily in two divided doses at breakfast and dinner. Lower the dose if you develop diarrhea.

Minerals are essential for strong bones and healthy joints.

Typical doses: Calcium (1,000 mg a day)... magnesium (500 mg a day)...and a multimineral supplement that contains manganese, zinc and boron.

Essential fatty acids help control the natural chemicals that cause inflammation.

Typical dose: 1,000 mg of fish oil daily.

Glucosamine sulfate, derived from crab, lobster or shrimp shells, and chondroitin sulfate, usually derived from shark cartilage, can be taken separately or together to supply the nutritional building blocks that are needed for new cartilage.

Typical dose: 1,500 mg daily, which often can be reduced to 500 mg when symptoms improve.

Important: It can take six to eight weeks for glucosamine and chondroitin to take full effect.

At-Home Physical Therapy

In addition to taking natural painkillers, try these therapies...

Hot/cold therapy. Alternately applying heat and cold increases and decreases blood flow to the joints, flushing out lactic acid, which irritates nerve endings.

What to do: First apply a heating pad on top of a moistened towel (place the heating pad in a waterproof bag for safety) to the painful joint for 10 minutes. Then, for two minutes, use a towel that has been moistened with cold water and chilled in the refrigerator. Repeat three or four times daily for acute pain.

Exercise. Physical activity increases blood flow, which reduces pain in the long-term and helps improve the mobility of arthritic joints. But arthritis pain and concerns about joint injury can make people reluctant to exercise.

Solution: Do stretching exercises, yoga or tai chi in a warm room or warm pool-the warmth relaxes the muscles and eases pain. Exercising in a pool also reduces the impact on the joints.

Mind Over Pain

Stress-reduction techniques reduce the pain caused by arthritis and allow natural remedies to work more effectively.

Visualization is particularly helpful.

What to do: Sit quietly in a place where you will not be disturbed, and play whatever music you find most relaxing. Close your eyes and imagine what your pain looks like, then visualize a scenario in which the pain becomes weaker and weaker.

Example: You might see the pain as a hot, red spot. Visualize it fading, cooling and gradually turning into a soft and soothing shade of blue. For best results, repeat this exercise daily for at least 10 minutes.

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