I. The main causes of osteoarthritis, rheumatoid arthritis and gout are the three common causes of joint pain. Osteoarthritis is a degenerative disease of the local joints, characterized by progressive damage to the articular cartilage of the synovial joints. Rheumatoid arthritis is a chronic systemic disease of unknown etiology, characterized by persistent inflammation of the synovial membranes of the surrounding joints. Gout is an inflammatory lesion caused by the deposition of uric acid in the joint tissue. These diseases are usually chronic and persistent pain that patients tolerate to some degree, but when acutely exacerbated, the pain is often unbearable, even when they cannot move at all. Second, the purpose of systemic treatment of arthritis pain is a manifestation of the disease, the key to treating pain is to treat the original disease, but in some diseases pain is the main manifestation, and the disease itself is difficult to eradicate, the treatment of pain is particularly important. In October of this year, a press conference was held in Beijing by the Chinese Medical Association’s Pain Branch on the establishment of a new first-level discipline of pain in the Chinese hospital system, marking the importance of pain medicine as a first-level discipline on an equal footing with internal, external, gynecological and pediatric disciplines. In light of this, pain control has become the most important aspect of arthritis treatment. Given the importance of the joint to the patient’s mobility, restoring or maintaining joint function is one of the most important goals in the treatment of arthralgia. Treatment should be global in nature and should always focus on the preservation of function. When systemic treatment fails to control pain then surgery may be considered depending on the patient’s condition. In fact, one of the major goals of joint replacement is to relieve pain. The goals of systemic therapy are to: reduce pain and joint stiffness; increase joint mobility; control inflammation; restore joint function as much as possible; and prevent or correct deformities. For patients with osteoarthritis, disease progression can be delayed. For patients with rheumatoid arthritis, since there is no cure, the important thing is to restore the patient’s function and improve the patient’s quality of life III. Principles of arthritis pain management Treatment of arthritis pain should follow the principles of treating the primary disease, relieving the progression of the disease, assessing the pain condition, and treating the pain in a graded manner. There are three kinds of commonly used painkillers, simple painkillers – only simple pain relief effect without anti-inflammatory function; non-steroidal anti-inflammatory drugs – with both anti-inflammatory and analgesic effects, suitable for inflammatory pain, and divided into traditional type (NSAIDs) and new type ( COX-2 inhibitors) two kinds of painkillers; opioids, strong agents including, for example, morphine, fentanyl, etc., weak agents such as tramadol, synthetic agents such as acetaminophen and oxycodone. These three types of drugs are basically divided into three levels, and the severity of the pain varies with the drug of choice. If the joint pain is caused by osteoarthritis and rheumatoid arthritis, non-steroidal anti-inflammatory drugs are recommended. There are many types of drugs in this class with similar efficacy, and the same patient may have different sensitivities to different drugs. When suffering from gastric ulcers or risk factors, COX-2 inhibitors can be used, which is a new type of NSAID, the biggest advantage of which is to reduce the occurrence of gastrointestinal adverse reactions, which is significantly better than other drugs in this regard. These drugs are more expensive and can be used in combination with other traditional NSAIDs and acid suppressants to achieve similar results. For moderate to severe arthritis pain, acetaminophen (other names: Benadryl; Piriton; acetaminophen; paracetamol; Tylenol painkillers) is mostly used, which has few adverse effects, is easy to purchase, and is inexpensive and brings little economic pressure for long-term treatment. In patients with severe arthritis, when the use of NSAIDs cannot be controlled, the use of opioids, often referred to as narcotics, is recommended, but opioids are addictive and should not be used for a long time. Therefore, it is generally considered that artificial joint replacement surgery should be performed when the pain is such that it can only be controlled by opioids. It is best to perform it before the deformity and muscle function deteriorate seriously. Fourth, other complementary therapies (cartilage-nourishing drugs, joint cavity injection lubricants, etc.) For osteoarthritis, in the early stages of the disease can still be alleviated by cartilage-nourishing drugs, glucosamine is one of the important components of cartilage that can be synthesized by the body itself. As we age, degenerative changes occur in the joints, the cartilage wears away, and our own synthesized glucosamine is gradually insufficient for repair, which accelerates the progression of the disease. Supplementation with glucosamine products derived from crab and shrimp shells, which are similar to human cartilage components, can help cartilage repair and relieve pain to some extent. Hormones, often injected locally into the joint cavity to combat acute inflammation, can be effective in relieving painful symptoms and are mostly used for short periods of time and in small doses, and should not be used systemically. Topical application of creams or plasters, ointments, lotions, and gels, with ingredients such as menthol, salicylic acid, and diclofenac, can provide temporary relief of joint pain. However, long-term application may create tolerance to this type of therapy and the effect will gradually decrease. Hyaluronic acid is injected into the joint cavity and is an important component of joint fluid that is refined using biochemical technology. Hyaluronic acid is injected directly into the joint cavity to increase the lubrication and viscosity of the joint fluid, reduce pressure and cartilage wear, and improve the nutritional status of the joint cartilage to help repair the diseased cartilage, which is a direct and effective method of conservative treatment. Physical therapy includes local heat, electrotherapy, traction, hydrotherapy, and training of lower extremity muscles. Heat therapy and electrotherapy can improve blood circulation in the joints, improve stiffness, and relieve inflammation and pain. It should be noted that the main purpose of heat therapy is to relieve symptoms and make the patient feel “comfortable”. Excessive heat therapy can aggravate the synovial inflammation of the joint, which is not conducive to controlling the progression of the disease. When arthritis is already affecting movement, knee pads, elbow pads or braces should be used to reduce joint pressure. Canes and walkers can reduce the pressure on the joints, keep the gait stable and prevent falls, and avoid joint deformation caused by improper application of force. V. Exercise therapy Regarding exercise therapy, many patients and even some doctors have misunderstandings in their understanding, which the authors will discuss in the future. Exercise is the most effective long-term way to improve joint function and slow down the progression of the disease. Exercise can increase bone density, muscle strength and flexibility, help stabilize joints, reduce joint stiffness in the morning, improve balance and endurance, and control weight, and more importantly, exercise can improve the function of other systems throughout the body, such as the cardiovascular system, respiratory system, and digestive system. “If you are in too much pain to go out and exercise, don’t forget to do some soft stretching exercises and gradually increase the amount of exercise after the pain is relieved or the condition is stabilized.