Living with pain can be the hardest part of having arthritis. It’s easy to start avoiding activities because they’re painful or because you think they may be damaging your joints. You may start losing confidence and feel that life is no longer enjoyable.
Pain is a normal, complex human experience. Short-term acute pain is very useful – it’s a signal that you need to protect whatever part of your body is hurting. Chronic or persistent pain that lasts longer than three months is a different story. It doesn’t always signal continuing harm or damage; it may just mean that the nerve pathways have become sensitised and your brain is overprotecting you.
The degree of pain does not necessarily relate to the severity of injury or joint damage. Pain doesn’t show up on X-rays or scans! And chronic pain may not respond to standard medical treatment.
We also know that pain, stress, fatigue or depression often make pain worse and create what can feel like a never-ending cycle of pain.
The good news is that this cycle can be broken. The first step is acceptance, which doesn’t mean giving up. It’s about recognising that you can take control and learn how you can better manage pain yourself. Everybody is different, so be prepared to try various techniques until you find what works best for you.
Pain may limit some of the things you do but it doesn’t have to control your life.
What causes pain?
Pain due to RA can be caused by:
- Inflammation, the process that causes heat and swelling in your joints.
- Damage to the joints.
- Muscle tension, from trying to protect joints from painful movements.
There may not be a cure for your pain but you can learn to manage it. Try different techniques to find what works best for you.
Pain can be a vicious cycle
The experience of pain is very personal. That is because pain does not occur in isolation but is influenced by many things such as stress, fatigue (tiredness) your mood (anxiety and depression). For example, people who feel depressed or anxious have been found to be more sensitive to pain. This can make your pain feel worse, which can lead to a continuing cycle of fatigue and depression.
The good news is that this pain cycle can be broken by using some of the strategies described below.
What can I do to manage my pain?
Pain may limit some of the things you do, but it doesn’t have to control your life. Your mind plays an important role in how you feel pain. Thinking of pain as a signal to take positive action rather than being scared or worried about it can be helpful. Also you can learn ways to manage your pain. What works for one person may not work for another, so you may have to try different techniques until you find what works best for you.
The four Ps
These strategies will help you manage your energy levels and your pain:
Pacing – Do you do too much on ‘good’ days and spend ‘bad’ days recovering? Pacing is about taking a ‘little and often’ approach, not tackling activities all at once. Know your limits (or set a timer), change jobs frequently and take regular breaks.
Planning – work out what you need to do each day or week but remember to be flexible. Plan rest times, break tasks into smaller chunks and decide what you can delegate to others.
Priorities – set realistic goals and don’t be too hard on yourself. Decide what you have to do today, what you could do today and what you would like to do today but is not essential. Learn to say no, and ask for help when you need it.
Posture – poor posture increases fatigue. Good posture protects your joints and reduces tension on muscles. Try to be aware of how your body and don’t hold any one position for too long. Keep moving!
Here are some things you can try:
- Take medicines wisely. Many different types of medicines can help control the pain of RA. Your doctor or pharmacist can help you understand which medicines are right for you and how best to use them.
- Exercise. Research has shown that regular appropriate physical activity can help reduce pain. It also keeps your joints moving, strengthens muscles to support your joints, reduces stress and improves sleep. A health professional (e.g. a physiotherapist or exercise physiologist) or your doctor can help you work out a program that includes gentle exercise and stretching that is suitable for you.
- Use heat and cold. The benefits of heat and cold for arthritis are yet to be proven by research. However, these treatments are soothing and safe when used carefully. Heat relaxes your muscles and stimulates blood circulation. You could try a warm bath, or place a heat pack or hot water bottle over the painful area for 15 minutes. Cold numbs the painful area and reduces swelling. Applying cold treatments, such as ice packs, to the painful area for 15 minutes may be especially useful for hot, swollen joints, such as during a ‘flare’. You can repeat heat or cold treatments throughout the day. Make sure the temperature of your skin has returned to normal before re-applying, to prevent any tissue damage. Ask your doctor or physiotherapist whether heat or cold is best for you.
- Take care of your joints and save energy. Looking after your joints during your daily activities can help reduce pain, stress and tiredness. It involves simple habits such as: – avoiding activities that cause pain – asking for help when you need it – using special aids and gadgets to make tasks easier. See Fatigue and arthritis.
- Massage. There are limited scientific studies that show massage may temporarily improve pain and mobility of joints and muscles. Make sure the massage therapist has experience working with people who have arthritis.
- Acupuncture. Acupuncture is an ancient Chinese practice of putting small, thin needles into the skin at specific points on the body to block the pain signal. There is limited evidence about the effectiveness of acupuncture in RA. However some people may find it useful alongside other proven treatments, such as medicines.
- Transcutaneous electrical nerve stimulation (TENS). A TENS machine applies very mild electric pulses to block pain messages going from the painful area to your brain. TENS can be useful for longer-term pain but does not work for all people. See a physiotherapist to trial a TENS machine, and to learn how to use it correctly, before you buy one.
- Mind-based approaches. A trained professional, such as a psychologist, can help you learn relaxation and pain coping skills so you can better manage your pain. Some of these techniques include:
- Deep Breathing
- Distraction: Doing something that requires you to be thinking of something other than your pain, e.g. a hobby, listening to music, watching a movie, reading a book.
- Relaxation: Relaxation techniques, such as deep breathing, guided imagery (mental pictures) and progressive muscle relaxation, can help you reduce stress and muscle tension. These techniques need to be practiced and you may have to try several methods before you find one that works for you. You may find it helpful to also use audio books, apps, webinars, or other types of techniques that are available in books or on CD to help you learn relaxation techniques. Aunty Dee, All Right? and Groov are three different apps available to help you on the health and wellbeing front.
- Mindfulness Based Stress Reduction: This is a structured program developed at the University of Massachusetts Medical School. It helps you become aware of thoughts that may be exaggerated or unhelpful and then how to respond to them.
Contact Arthritis NZ for details of self management courses that can teach you these techniques. You may also find it useful to see a psychologist to learn other mind techniques to help you cope with pain.
CONTACT ARTHRITIS NZ FOR MORE INFORMATION AND SUPPORT SERVICES.