Managing the Pain of RA Pain is one of the main and most debilitating symptoms of rheumatoid arthritis. It is usually the symptom that brings people to your doctor in the first place. It is our body’s way of telling us that something is wrong. For those with rheumatoid arthritis, pain can be disruptive, interrupting daily tasks and leading to avoidance of activities that were once enjoyed. Fortunately, as well as taking pain-relief medication, there are a number of pain management techniques that can help you control your pain. Causes of pain Most forms of arthritis are associated with pain that can be divided into two general categories: acute and chronic. Acute pain is temporary and lasts a few minutes. However, the pain associated with rheumatoid arthritis is usually chronic and ranges from mild to severe, and can last weeks, months and sometimes even years. Factors that contribute to the pain include swelling within the joint, the amount of heat or redness present, or damage that has occurred within the joint. The purpose of pain is to warn us that an injury is occurring. Often, the intensity of pain refers well to the extent of damage. However, this is not always the case. It is also possible to have an injury without any pain or alternatively have pain without any injury. Each individual experiences a different threshold and tolerance to pain. A number of physical and emotional factors can influence the level of pain you experience. These can include depression, anxiety, and even hypersensitivity at the affected sites due to inflammation and tissue injury. Personality, age, gender and culture have also been examined to see if they change a person’s perception of pain. Measuring pain in rheumatoid arthritis As pain is a unique experience and is also subjective, the best way for a doctor to measure your pain is by asking you to describe the level of pain on a scale of 1 to 10. It is important that you are open and detailed when answering questions from your doctor so that they get a clear picture of the pain you are experiencing. Your doctor may ask you to keep a diary and record your symptoms. You will need to be able to describe the type of pain you experience (dull, stabbing, throbbing etc.) and keep note of the times when you experience the pain. Also, be sure to mention if the pain interfered with your daily activities and note what caused it to get better or worse. This information will help your doctor gain an important insight into your condition and will give them a basis for a treatment plan. Important steps to managing pain Because pain is your own, you need to discover for yourself what medical and non-medical treatments best manage your pain. Pain is a complex phenomenon involving physical and emotional factors. For these reasons, pain is difficult to manage. So it is important for your doctor and you to come up with strategies for blocking these factors to reduce pain aswell as treating the underlying inflammation. Medication Painkillers or analgesics such as aspirin can help to relieve pain, but do not treat the underlying inflammation and provide short-term pain relief. Drugs called non-steroidal anti-inflammatory drugs (NSAIDs) can also be used to treat the pain associated with arthritis. They work by reducing the pain and swelling and can be used either short or long-term. Both analgesics and NSAIDs only treat only the symptoms of the disease. Other medication such as disease-modifying anti-rheumatic drugs (DMARDs) and newer treatment options called biologics, are used to treat the underlying cause of the disease. These provide long-term pain relief and prevent joint damage. Ask your doctor about your medication and keep a record of how your medication affects you. Non-medicinal techniques to relieve pain Some simple non-medicinal pain strategies such as rest and energy conservation, sleep and relaxation can achieve dramatic results in alleviating your pain. Distraction Relief from pain through total absorption in an activity has been described as being helpful to some people. This technique is known as distraction. If you are totally absorbed in something enjoyable that requires your complete and undivided attention, there’s no room in your mind for anything else. TENS In addition to physical activity, your physiotherapist may also administer TENS (Transcutaneous Electrical Nerve Stimulation). This is a small device that directs mild electric pulses to nerve endings that lie beneath the skin in the painful area. TNS may relieve some arthritis pain by encouraging the body to produce higher levels of its own natural pain killing chemicals called endorphins. Heat and Cold Having a hot shower or placing a heated pad on painful areas can help to relieve pain temporarily. Alternatively an ice pack or a bag of frozen peas wrapped in a towel could also be effective. You should discuss with your doctor or physiotherapist whether heat or cold would be best for your rheumatoid arthritis. Massage Massage can also reduce pain, inflammation and encourage the body to produce endorphins. With rheumatoid arthritis, it is not recommended that massage be carried out when joints are inflamed as it could worsen your condition. Complementary Therapies Some people may decide to use complementary therapies alongside conventional medication. These therapies, which can be effective in managing pain relief, include acupuncture, Alexander technique, aromatherapy, homeopathy and reflexology. You should always ask your doctor’s advice before trying a complementary therapy, and let the complementary therapist know about any prescribed medicine you are taking. sychiatry Chronic pain may be the reason for depression. It may be necessary to treat the depression in situation where pain relief is difficult to treat. Physical Therapy Exercise can be used to treat pain, promote healing, and restore movement. Swimming, walking and low impact aerobic activity is important for reducing pain and stiffness. Pain Management There are strong links between the severity and impact of pain and function. The restriction in range of movement and function caused by rheumatoid arthritis often increases the impact of pain. Pain Management uses cognitive therapy as well as physical therapy in order to regain function lost. Surgery Surgery is only necessary if pain is so severe that it cannot be controlled using drugs. Further Information Arthritis Ireland (www.arthritisireland.ie) runs regular workshops (‘Breaking the Pain Cycle’) which deals with understanding the pain cycle and discovering ways to manage pain.