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The Most Effective Medications for Arthritis Pain Relief

With over two decades of experience in medicine, Melissa Flagg writes patient education articles, keeping you informed about your health.

For many people, the symptoms of arthritis can be debilitating.

For many people, the symptoms of arthritis can be debilitating.

My Story

For many people, the symptoms of arthritis can be debilitating. Whether it’s rheumatoid arthritis or osteoarthritis, pain is pain, and any form of arthritis can be excruciating. I, myself, suffer from osteoarthritis and have a lifelong battle with chronic pain.

My battle started 13 years ago. I was left with a neck injury due to a car accident, and this injury gave me not only chronic neck pain but migraines as well. For 13 years, I have searched for the one medication or herb that would cure my pain. I did find one thing that alleviated all of my pain, but unfortunately, the government won’t let me or anyone else have it.

Arthritis Defined

Arthritis is a result of inflammation in the joints (for example the knees, elbows, neck, etc). There are over 100 different types of arthritis, the most common being osteoarthritis, also known as degenerative joint disease. It is typically a result of the aging process and normal wear and tear on the body’s joints, but it can also be a result of an injury like a car accident.

Rheumatoid arthritis is an autoimmune disease in which the body starts to attack its own tissue. It causes deformities in the hands and feet if not diagnosed and treated in the early stages of the disease. Although not painkillers, steroids, such as prednisone, are often used to control the inflammation caused by this disease.

Pain Management

There are several different types of prescription medications on the market for chronic pain caused by arthritis. Most of them only mask some of the pain, however.

The efficacy of the medication depends mainly on the type of arthritis the patient has and their body chemistry.

Painkillers (primarily opiates such as Vicodin or Ultram) usually only work well when coupled with another type of medication, either an anti-inflammatory or a muscle relaxant.

To better understand how pain medication works, let’s take a look at how pain sensations are transmitted to the brain.

How Pain Signals Travel Through the Brain

How the Body Feels Pain

Pain works in mysterious ways. Actually, pain works in a couple of different ways when it comes to the signals received by the brain, but I’m sure you don’t want a biochemistry course, so this is the simplified version.

There are two types of pain receptors. One receptor reports injuries to the brain, and the other reports everything else. Because of these two types of receptors, pain also comes in two types (and their names are so original):

  • First Pain: This pain sensation is quickly transmitted. It is a sharp pain, similar to a pinprick. It is usually a localized pain as well meaning it comes from a specific area of the body, like your finger, or lip (both of which are densely packed with these “first pain” receptors).
  • Second Pain: As its name suggests, second pain typically follows first pain. It has a slower onset but is longer lasting. Typically diffusely localized, it is usually a dull, throbbing, or burning sensation and continues after the stimulus that caused the pain is removed.

Our central nervous system has the ability to modify its perception of pain. This is why when you are working out, you don’t feel the back injury you just inflicted on yourself. You feel it the next day instead. This is also the brain’s “gateway” mechanism for pain. For example, if you have chronic pain in your leg, and you smash your hand with a bust of George Washington, your brain will register the pain in your hand, but your leg won’t hurt anymore.

Now that we know a little bit about the different pain receptors, let’s look at the different types of pain medications.

Tramadol 50mg, a mild opiate pain killer

Tramadol 50mg, a mild opiate pain killer

Opiate Painkillers

As their name suggests, these medications are meant to kill pain. They work primarily by binding to the opiate receptors in the brain which decreases the efficiency of the synapses to transmit the pain signals.

Most of the opiate painkillers are considered narcotics, but there are a few that are not. Some of the most well-known narcotic painkillers (with generic names in parenthesis) are:

  • Methadone
  • Duragesic (fentanyl)
  • Morphine
  • Vicodin (Hydrocodone/Acetaminophen)
  • Oxycontin (Oxycodone)
  • Percocet (Oxycodone/Acetaminophen)
  • Darvocet (Propoxyphene/Acetaminophen)
  • Codeine (Methylmorphine)

These medications work best on moderate to severe pain. For those who suffer chronic pain, these medications may not be the answer. After continued use over a long period of time, the body tends to develop a tolerance to the opiate painkillers. This leads to the need for higher dosages to gain relief. They also have the potential for abuse.

There is an opiate that is non-narcotic and has very little abuse potential. Ultram, also known by the generic name tramadol (my hubby calls it my damn-it-all), is surprisingly effective at alleviating pain. It works quite well on dental pain as well as moderate to severe chronic pain. This is the medication I take, but it does have side effects. In my case, the side effect is anorgasmia (yes, it’s what you think it is).

Ibuprofen, Voltaren gel and tramadol medications typically used to treat arthritis pain.

Ibuprofen, Voltaren gel and tramadol medications typically used to treat arthritis pain.


Nonsteroidal anti-inflammatory drugs, or NSAIDs, are probably the most common painkillers. They include over-the-counter medications such as aspirin, ibuprofen, and naproxen sodium (Aleve). These medications relieve pain by decreasing inflammation that causes the pain, and they actually work in about three different ways.

  • Reducing prostaglandin synthesis
  • Reduces the production of leukocyte-derived inflammatory mediators
  • NSAIDs that cross the blood-brain barrier inhibit the production of prostaglandins that produce pain in the grey matter of the spinal cord

Did your eyes glaze over yet? Essentially, all of the above means that NSAID medications decrease prostaglandin synthesis, or the creation of the locally acting messenger molecules, which prevents the pain signal from reaching the brain. They also decrease the immune system’s inflammatory response to injury and infection.

Some of the most common prescription NSAID medications are:

  • Indomethacin
  • Voltaren (diclofenac)
  • Voltaren Gel
  • Ibuprofen
  • Celebrex (Celecoxib)
  • Vioxx (rofecoxib) this drug was taken off the market due to its side effects
  • Bextra (valdecoxib)
  • Tylenol (Acetaminophen) usually used in combination with opiate painkillers
  • Feldene (piroxicam)

The NSAIDs work well on chronic pain because of their mechanism of action (how they work). They provide long-term pain relief when taken consistently by continually preventing the production of prostaglandins.


Antidepressants have become a popular treatment for chronic pain management. Granted, most patients suffering from chronic pain are usually depressed, but this isn’t the reason they are prescribed for pain relief.

They are usually used in tandem with other pain medication such as an opiate or NSAID, and provide an overall desensitization effect. The most common drugs prescribed for this purpose are tricyclic antidepressants such as:

  • Elavil (amitriptyline)
  • Norpress (nortriptyline)
  • Imipramil (imipramine)


These medications are used to decrease the excitability of neurons that cause seizures which in turn decreases the excitability of the pain receptors in the brain. Some of these medications are already used to treat chronic pain caused by diabetic neuropathy. These medications are:

  • Neurontin (gabapentin)
  • Lyrica (pregabalin)
  • Lamictal (lamotrigine)
  • Tegretol (carbamazepine)
  • Trileptal (oxcarbazepine)

You may have noticed I left out muscle relaxants. This is because when it comes to arthritis the muscles usually aren’t the problem (although sometimes they are as in my case). So, I’m limiting this article to the most common pain medications for arthritic sufferers.

So many meds! Living with chronic pain can mean your medicine cabinet looks like a pharmacy.

So many meds! Living with chronic pain can mean your medicine cabinet looks like a pharmacy.

Choosing the Right Medication for Your Arthritis and Chronic Pain

Choosing the right medication for you can be a process of trial and error. Prescribing medication is partly science and mostly an art form. Everyone’s body chemistry is different, and what works well for one person, may not work at all for someone else. While studies indicate a drug works for a certain demographic, results in a controlled study environment are far from results that would be found in clinical practice.

The most effective medications are the ones that work on your pain. If you try a medication and you feel it’s not working, tell your doctor. If you have side effects from a medication, make sure you make your doctor aware.

Sometimes a medication may help with the pain but have side effects that you can’t tolerate. This is when it becomes an art form; you may have to give up some pain relief to get rid of the side effects. Personally, I deal with the side effects of Ultram because the relief I get from the drug allows me to live a fairly normal life. Not everyone can say the same about their medication.

Your lifestyle also plays a role in how pain medication affects you. If you eat junk and never exercise, you can’t expect one little pill to get rid of all your pain.

For those who suffer from chronic pain, exercise can be very beneficial in alleviating some of it (although for many it’s painful to exercise).

It is imperative that you eat right, exercise, take your vitamins (vitamin C can be especially effective), and your medications as directed. Pain medications can’t help you if you don’t help yourself first.

This content is accurate and true to the best of the author’s knowledge and does not substitute for diagnosis, prognosis, treatment, prescription, and/or dietary advice from a licensed health professional. Drugs, supplements, and natural remedies may have dangerous side effects. If pregnant or nursing, consult with a qualified provider on an individual basis. Seek immediate help if you are experiencing a medical emergency.

© 2012 Mel Flagg COA OSC


jonnycomelately on September 21, 2018:

Francisco, and Hullo again Mellisa:

I have found that arthritic pain never totally goes away. However, since writing to you 6 years ago, and thus 77 now! - I have made some life changes which so far have been quite successful.

1st, I stopped all those tablets, even Panadol Osteo. They cost me money and were doing me no good at all.

2nd, on visits to South India and the Philippines, I found all of my hip, shoulder and finger pains ceased. Yes, ceased!. I looked through all the dietary changes and got down to cows milk and wheat bread were the items I had not consumed in those countries.

3rd step: tried excluding cows milk. (And I love it, cream, butter, cheese and all!)

That made no difference to my arthritis which had revived on return to Australia.

4th step: knock out wheat bread. And it worked!

Apparently, learned from the Internet, there are proteins in modern-grown wheat that can cross into the blood stream and end up in the joint spaces.

I DO NOT CLAIM any academic expertise in this field, or that it will work for everyone. But it's certainly reduced my arthritic problems and over-acidity in my stomach.

I have also severely cut back on sweet biscuits, shop-bought cookies, anything that is likely to contain mass-produced, modified wheat products.

Replace with rice alternatives or try older varieties of wheat, maybe properly fermented in a sour-dough fashion. Experiment for yourself.

If anyone wants to try it, good luck.

Francisco on September 20, 2018:

I am a diabetic and have recently been diagnosed with Rheumatoid arthritis I have been in pain and am currently taking ibuprofen and have taken naproxen in the past . They don't work and because I'm on medical getting opiate base medication is hard they do . My doctor is sending me to a specialist for Arthritis . How can I convey my pain and need for a opiate with out being judge as a drug addict . I know it sounds funny but I have taken Opiates in the past and they work . I can take 1600 milligram of Ibuprofen and still be in pain 10 milligram nor co and be okay not ready to run a marathon but okay . I enjoy fitness and having a active life and for the past month haven't been able to . Do you have any suggestions ?

Phyllis Garner on May 01, 2018:

Thanks for the info

Burke c on April 05, 2018:

Car stopped on top of me. Ruined my life 17yrs now. Severe chronic pain. Divorce disability arested for not being able to pay child support homeless starving whole galaxy of effects from. Opiate pain medication saved my life gave me normalcy not what govt says. Now after I’m painful amputee govt has convenient for them decided not allow us citizens to be normal in severe pain. Modern population control. Thank you so much for article

Mel Flagg COA OSC (author) from Rural Central Florida on September 09, 2012:

Thank you Brakel2!! So sorry you have the beginning of osteo. Even in the beginning it can be painful!

Audrey Selig from Oklahoma City, Oklahoma on September 09, 2012:

Great hub DOM. You have excellent knowledge of medication and diseases. Your article is well organized and easy to read. I have osteo but not severe yet. Your info should help many patients.

Mel Flagg COA OSC (author) from Rural Central Florida on September 09, 2012:

Oh thank you!! I love the story of your great-grandmother! We happen to agree with her. The scraps from everything we use from our garden go into our compost pile and we us it to plant new fruiting plants. When I replant them, I like to give them some of my "energy." But that's the pagan in me... :D

whowas on September 09, 2012:

Well, I can help you there. It is very simple. When the flowers have died and the petals fallen away, there remains an oval pod, reddish in color usually. It is the plant's seed pod. That's the rose-hip.

As soon as the plant is heavy with such fruit, pick'em. We have a tradition that we never pick more than half the fruits on a single plant and we always pour a bit of the previous year's syrup at the roots.

I don't know if it has any practical purpose but it is what our family has always done for generations and it sort of reminds us that there is a reciprocal relationship - if you take you must give - between living things. (I remember my great-grandmother once being pricked by a thorn when taking the hips and she smiled at me, wiping the spot of blood back on the branch and saying, "Blood for blood, fair enough." Which I didn't understand at the time.) Anyway, I digress.

The recipe for the syrup - well there are lots. But that is when to pick your rose-hips. :)

Mel Flagg COA OSC (author) from Rural Central Florida on September 09, 2012:

Ha! Brilliant idea. I will add a capsule now! I don't know why I didn't think of it. Thank you!!

I've never had rosehip syrup, but my vit C supplement is derived from rosehips. I've been wanting to try them, because I know you can eat them. I have a rose bush out in our backyard, but I never know when to pick the rosehips!

whowas on September 09, 2012:

Thank you. I'll go for those, then.

We always make rose-hip syrup which is good for Vitamin C, too - but the quantities we are talking about here clearly demand capsules of concentrated stuff.

That said, talking about capsules - an Amazon capsule in this hub would be useful for readers and helpful to you. Just a thought.

All the best to you always. :)

Mel Flagg COA OSC (author) from Rural Central Florida on September 09, 2012:

I get the 1,000mg capsules or tablets that you swallow. The chewable ones have all the sugar, but the ones you have to swallow are usually pure Vitamin C. Thankfully, they are also the cheapest ones! I found mine on amazon, 250 capsules for $9.99, although that sale is now over. :(

whowas on September 09, 2012:

Well, thank you so much, Daughter of Maat! That's almost 120 average sized oranges, so I guess supplements it has to be - but if they are mostly sugar, what would you recommend?

Mel Flagg COA OSC (author) from Rural Central Florida on September 09, 2012:

Here's a great site for Vit C info: While it is true the body can only process so much, that amount is actually quite huge. Also, keep in mind, if you're eating a lot of carbs, you won't absorb the vitamin C you intake. The Vitamin C molecule is almost identical to the glucose molecule, and both molecules are after the same receptors, but glucose gets priority. Those chewable vit C tabs? Useless, since they are primarily sugar! The other thing to keep in mind is that vit C has a very short half life. You could take 2000 mg a day, but that 2000mg will only stay in your system for four hours. So you have to take it throughout the day, you can't take it once and forget about it. I take 2000mg four times a day for a total of 8,000mg a day. :D

There, did all your research for ya ;) Just kidding...

whowas on September 09, 2012:

Thank you for the hint regarding vitamin C.

I'm pretty good diet-wise and eat lots of fresh, organic fruit and vegetables but I'll make a point of boosting my vitamin C intake - although I understand that there is only a certain amount that the body can metabolize in a given period. I'll do some research.

Thanks in any case for a great hub. I won't lose any sleep over what tomorrow may hold, however. Carpe Diem!

Mel Flagg COA OSC (author) from Rural Central Florida on September 09, 2012:

Thank you Whowas, I'm so sorry your grandmother had to suffer with arthritis. I only have osteoarthritis so I can only imagine the pain that she felt. But I'd have to agree that the emotional and mental effects of the disease are far worse than the pain itself.

Unfortunately, it is hereditary, but I've been doing some research, and it seems vitamin C may actually be the miracle "drug." So if you're not already, I'd start taking large doses of vitamin C. I take 8,000mg a day (more if I'm sick) and I have to say, I don't have as much pain as I used to.

whowas on September 08, 2012:

Very interesting and informative hub.

My late grandmother on my father's side was crippled by arthritis and while she struggled nobly on I know that she found the increasing limitations on what she could do with those twisted, painful hands a great emotional strain more than anything else.

There is some suggestion that certain types of arthritis can have an hereditary element and so this may be something that I have to 'look forward to' in my own future.

I hope this hub will prove useful to anyone else who suffers from this debilitating condition.

Mel Flagg COA OSC (author) from Rural Central Florida on September 04, 2012:

@fraidycat3 I have tried meditation, and I have received help from my spirit guide, but that's a work in progress. Mind over matter takes discipline, and sometimes the pain is just too much to concentrate.

fraidycat3 on September 03, 2012:

Just wondering if you heave received spiritual help/guidance? I'm starting to get first pains in fingers of osteo arthritis...

Mel Flagg COA OSC (author) from Rural Central Florida on July 11, 2012:

Thanks Pamela! I know what you mean about the painkillers. I was on vicodin for awhile, and I too was afraid of getting hooked on it. There are quite a few foods that exacerbate arthritis pain because they increase inflammation. I've found taking vitamin C and Niacin helps with the chronic inflammation. Exercise does make a big difference as well! If I don't workout, I get very stiff and that just makes things ten times worse!

Thanks for reading and commenting!

Pamela Oglesby from Sunny Florida on July 11, 2012:

This is a very well written hub what helps people understand the various treatment for arthritic pain. I have osteoarthritis and lupus arthritis. I have been on many of the above medications, plus corticosteroids and so forth. I have always been so afraid of getting hooked on pain killers that I strive to just take the edge off the pain. I have found that some foods make pain worse and also stretching each day seems to help.

Rated up and useful for a well-organized, informative hub.

Mel Flagg COA OSC (author) from Rural Central Florida on July 08, 2012:

Thank you Lord!! I'm not sure I'll finish the challenge on this try, but I will try again!

Joseph De Cross from New York on July 08, 2012:

Congrats on those 30/30. This is useful info for so many people that will have to make a quick decision and check with a physician, according to their needs. Hope you are doing better and keep them coming Daugther of Maat.


Mel Flagg COA OSC (author) from Rural Central Florida on July 08, 2012:

Oh thank you!! I'll go check that out right now!!

Civil War Bob from Glenside, Pennsylvania on July 08, 2012:

DoM...just checked, here's a url for you for Blue Emu that has a "view stores" section:

It looks like Publix would be your choice in Central Florida.

Mel Flagg COA OSC (author) from Rural Central Florida on July 07, 2012:

oh I hate that feeling. Like there's no hope for relief anytime soon. I'm so sorry Johnny! I know how much the cervical vertebrae can hurt, I've actually had an unusually bad couple of days and it's really hard to tolerate. I've gotten used to living with like a 7 maybe even an 8 on the pain scale everyday, but I've been way over 10 for the past 2 days, and I'm having a hard time dealing with it.

I've never had any luck with acetaminophen. Panadol Osteo is paracetamol right? Its essentially acetaminophen, but it just never worked for me. Voltaren is wicked strong, it's no wonder you had blood in the stool. I refuse to take voltaren pills, I'll only use the gel. I don't know if that's available in Australia or not, but you might want to check on it. I actually need to add it to this hub, it's a actually quite effective and only takes about an hour to kick in after application.

Thank you for your compliment, and my thoughts are with you. Chronic pain is horrible to have to suffer with, and I especially hate it when I hear good people are suffering from it.

jonnycomelately on July 07, 2012:

Thank you DOM. Great explanations and very reassuring coming from yourself, a fellow sufferer.

I have ankylosing spondylitis particularly in the cervical vertebrae, and I suspect it's advancing in the lumber spine, but I've not had X-Rays of that area for some time.

NSAIDs give me so much side-effect, like furry tongue, loss of taste, general ill feelings and some blood in the stool, that I am off them for good. I think Naproxen and Voltaren were tried.

I am just beginning to try Panadol Osteo, but can't say whether they are really any good yet. Just getting used to having some pain and learning to live with it seems the best way to go for the time being.

Mel Flagg COA OSC (author) from Rural Central Florida on July 07, 2012:

I'll have to check into that. Thank you!!

Civil War Bob from Glenside, Pennsylvania on July 07, 2012:

I'm pretty sure Blue Emu is over the counter, but not sure where in various areas. I think CVS carries it here in Pa.

Mel Flagg COA OSC (author) from Rural Central Florida on July 07, 2012:

Thank you Civil War Bob! I haven't heard of Blue Emu ointment. Is it available over the counter? I usually use voltaren gel if the pain gets so severe the painkillers won't touch it, and I've taken my ibuprofen limit for the day. Unfortunately, insurance doesn't like to pay for voltaren gel. So I'm in the market for a new ointment.

Civil War Bob from Glenside, Pennsylvania on July 07, 2012:

Good hub, DoM...up, useful, interesting. I've found Blue Emu ointment is good for local small amounts of joint pain. I've used in on my hands and knees and a buddy uses it on his neck right near the vertebrae. May your pain diminish!!

Zulma Burgos-Dudgeon from United Kingdom on July 07, 2012:

I know what you mean. Some days are better than others. So you enjoy the good days while you can. You get through the not so goods one knowing that they won't last forever.

Mel Flagg COA OSC (author) from Rural Central Florida on July 07, 2012:

@ phoenix ha ha ha, that's so funny, when I was working you don't know how many times I heard "just go ask Mel." :D

My patients were the same way. I often wondered how they could carry on like that when I knew their pain had to be much more severe than my own. It does put it in perspective, and I think gives you the courage to keep going. If they can do it, we certainly can!

Naproxen worked for me, but Ibuprofen works faster for me and I don't have to take as much of it. I try not to take it everyday though, my kidneys can't take it with the high blood pressure and all the other meds I take (hence my recent adoption of megadoses of vit C). There are days when the pain meds work beautifully and those are the days I cherish. THe lack of pain is invigorating, and I can get so much done! I need more of those...

Mel Flagg COA OSC (author) from Rural Central Florida on July 07, 2012:

@Debbie... do I know you? ;) lol The fatigue is horrible, and it comes with not only rheumatoid, but chronic pain in general I think. As you know, my neck is constantly hurting, and it just kinda wears you down. It's been really bad the past couple of days (think I twisted it lol) and I've been so tired! I think it took me about an hour to actually decide to get out of bed, it hurts just to sit up!

I promise to keep writing lol ;)

Zulma Burgos-Dudgeon from United Kingdom on July 07, 2012:

The next time my son asks me a science question, I'm just going to refer him to your hubs. I'm sure he would find them for more interesting than listening to a teacher droning away. :)

We have customers who come into the shop with hands like the ones pictured above. I can't help but cringe inwardly. And yet they carry on as normal and smile though I know they must be in pain. Puts my own issues into perspective.

Naproxen has been an absolute God-send for me. Before I started it my neck and lower back would be in constant pain and all my muscles were stiff making it awkward to move naturally. That's all changed now and I wouldn't dare skip a day. I never want to go through that again.

Voted up, useful and interesting.

Debbie miller on July 06, 2012:

Thank you DOM

Very Informative article I have rhemotoid Arthritis and it's not just the pain but also the fatigue !

Some days just getting out of bed is hard:( but always enjoy your articles :) keep writing

Mel Flagg COA OSC (author) from Rural Central Florida on July 06, 2012:

@Paula I know, I cringe every time I see someone with hands like that. I know how painful it is, because I have the arthritis in my neck. I can't imagine not being able to use my hands to type, or crochet, or hold my husbands hand. It's devastating.

@teacherjoe I'm deathly allergic to bee stings, but I know it does work for many people. I'm doing a natural arthritis remedy hub and I'll make sure to add that to the list.

@Rosie There are more treatments specifically for rheumatoid arthritis, so many that I thought they deserved a hub of their own, so stay tuned! :D

Rosie Rose from Toronto, Canada on July 06, 2012:

Hiya Daughter of Maat, my mother's hands were not quite the third photo, but close. I also got rheumatoid arthritis, very early stage, very little pain, similar to photo #1. I learned more about medications available from your hub, so thank you. Voted up and definitely very informative. Cheers!

Have a nice day,


teacherjoe52 on July 06, 2012:

A very simple, effective and fast way to relief is to use a honey bee sting on the affected area (provided you are not allergic to them.)

My family has been using this method for generations.

It is also popular in China.

Suzie from Carson City on July 06, 2012:

Oh DOM....I wanted to cry when I saw the pic of that terribly crippled up hand. Arthritis is so awful.. I suffer with it in my right wrist and left ankle...both areas due to prior severe injury.

I am most grateful for the valuable information in this hub. UP++

Mel Flagg COA OSC (author) from Rural Central Florida on July 06, 2012:

lmao were you're eyes kinda half open looking at the screen?? Head noddin' a bit... If it started to rain, I would've broken my laptop when my head hit the keyboard!!

Mel Flagg COA OSC (author) from Rural Central Florida on July 06, 2012:

Thanks Kelley! I had so many patients like your grandma when I worked in ophthalmology and they were always in so much pain. Very sad.

Terrye Toombs from Somewhere between Heaven and Hell without a road map. on July 06, 2012:

lol! I can' SO understand that. I wrote the cell phone hub half asleep. Still not sure it makes sense. :)

Mel Flagg COA OSC (author) from Rural Central Florida on July 06, 2012:

Thanks TT!! I'm glad it was coherent, I was tired today lol

kelleyward on July 06, 2012:

Enjoyed reading this. Congrats on #12 of 30. My grandma had arthritis where her fingers looked like the picture to the far right. It was so debilitating she couldn't do many normal things I take for granted. Thanks for writing this hub. Take care, Kelley

Terrye Toombs from Somewhere between Heaven and Hell without a road map. on July 06, 2012:

Great hub, DOM. This is a very interesting hub and you presented it well. Thank you for the information! VUM.