Managing pain & Medication

“An unpleasant sensory and emotional experience associated with, or resembling that associated with, actual or potential tissue damage” 

Definition from International Association for the Study of Pain

 

When you have pain it is normal to try and protect the area and to rest, but when your joints and muscles are rested for an extended length of time, they start to become weaker.  You become less fit and tire easily, so when you exercise you may feel very stiff.  This in turn may increase your pain, so you’ll want to try and avoid any activity that causes this and so a vicious cycle is created.

 

The pain cycle

Long term conditions can sometimes leave people feeling low and depressed. Changes in bodily appearance can often affect the way a person feels too. Conditions such as arthritis often cause fatigue, which can make it more difficult to deal with pain. It is possible to be caught in a cycle of pain, depression and stress. This is very frustrating and can be upsetting. Learning to manage pain will help to break the cycle.

 

Most people with  arthritis will experience pain. This may be due to a number of reasons.  It may be due to that fact that because of muscle wasting excess strain is put on other joints. It may also be due joint damage.  For people with rheumatoid arthritis pain may be due to inflammation in a joint (synovitis).  In one person the cause of pain can differ between joints – this is why it can be difficult to find one therapy that is completely effective at relieving one person’s pain.

To appreciate how you experience pain, it is important to understand these two principles:

● everyone reacts to and manages pain differently

● how you deal with your pain can actually affect the way in which you feel it.

 

How you were brought up can make a difference to how you respond to pain.  During your childhood, how did your parents react to pain?  Were you allowed to show it, or was pain considered bad or embarrassing?  Were you able to feel comfortable showing you were in pain, and allowed to deal with it positively?  All these things, and a variety of other factors such as anxiety and fatigue, determine how your body will react chemically to pain and whether your nerves will transmit or block a potentially painful message.

Experiencing daily persistent pain from arthritis can be a real challenge, but it is one that many people have faced successfully. It may always be there, but you can work hard at not letting it interfere with your lifestyle. Try to re-focus yourself and shift your pain into a tiny corner of your life.

The amount of time you spend consciously thinking about pain will influence how much pain you feel. If you get locked into thinking continuously about your pain, you are probably experiencing it more severely than you would if you managed to turn your thoughts away from it. Try to distract yourself by doing something you really enjoy. Pain is your body’s message to you to take appropriate action, and not necessarily to stop all activity. Saving energy involves listening to your body for signals that it needs to rest, and pacing yourself to avoid exhaustion.

 

Some techniques to help manage pain

Pain is a very distressing experience and it can be difficult to ignore and just get on with life as normal. You are in the best position to understand your own pain experience and you are the best person to manage it. However because long term pain is often accompanied by loss of confidence, depression, anxiety and fatigue it can be difficult to feel motivated to make active changes to improve your situation.  Depending on how we think, what worries us, how we feel and what we do when we are in pain, we can increase or decrease our discomfort. There are many different ways of breaking the cycle:

 

Relaxation

One way to help deal with pain is relaxation. Sometimes when we rest, we do not have good quality rest because our brain continues to work and our muscles are tense. Relaxation exercises can increase the quality of rest, make the tense muscles relax and reduce pain.

Many people find relaxation an effective way of managing their pain. Relaxation helps to reduce stress and can produce a general sense of well-being. Various forms of relaxation are available and techniques can be easily used to complement pain-relieving medication. Listening to relaxation audio tracks is popular. Some approaches take you off on a scenic journey describing restful locations such as a beach ( guided imagery), while others focus on tensing and relaxing various parts of your body (progressive muscle relaxation) or use other visualization approaches. It’s worth trying a few different approaches to decide what works best for you. Self-directed forms of relaxation include meditation, which involves concentrating on breathing or a sound (called a mantra) that you repeat to yourself. Alternatively, specific breathing techniques can be used which, once mastered, can be performed on the spot to ease anxiety. You’ll probably need to attend a class to practice in order to perfect the technique, but the effectiveness of relaxation improves with practice.  Sometimes brief periods of relaxation that you can build into your activities are best.

 

 

Distraction

Another way to help deal with pain is distraction. Distraction works because it is difficult for the brain to focus on two things at once. This is why it is difficult to rub your head while you pat your stomach. Learning how to use distraction to break the pain cycle can be of great benefit. This method is especially good when you have to carry out short activities that you know are painful, such as walking up a flight of stairs. It is also useful when you have trouble falling asleep or are concerned by negative thoughts.

Distraction trains your mind to move its attention away from your pain. Our minds have difficulty focusing on more than one thing at a time, so if we can focus our thoughts on something other than the pain we can help the feelings of pain decrease. There are a number of ways to distract your thoughts:

 

a. One simple method is to really involve yourself in what you are doing. For example if you are cooking really concentrate on the feel and the smell of the vegetables as you cut them. Concentrate on the smell of the food as you cook it and the sounds of the sauce bubbling in the pot. Concentrating on what you are doing leaves less space in your brain to feel pain or other symptoms.

b. Focus on what you will do after doing whatever it is that you will find painful or uncomfortable. For example if climbing the stairs is painful focus on what you will do when you get to the top not how you are feeling as you are going up the stairs.

c. Play games in your head. For example think of a person’s name for every letter of the alphabet. If you get stuck on one letter go on to the next one. You can do this with anything, for example places, animals, cars. Remember the words to your favorite song or all the characters in your favorite TV programme.

Just by focusing on something else you can take your mind off your discomfort. When you go to the cinema, are gardening, reading, etc. you often forget the pain and other symptoms. Here you are actually using a method of distraction. It is good to be aware of this, because then you can use it actively when needed.

 

Visualization

Visualization is like a guided daydream, where you transport yourself to another time and place. You can achieve deep relaxation by imagining yourself in a peaceful and tranquil environment. With practice visualization will help you to relax and will help you manage your pain. For an example go to: http://www.howtocopewithpain.org/resources/relaxation-visualization-exercise.html

 

If you would like to learn more about pain, and living with pain, the following website is a great resource –  https://my.livewellwithpain.co.uk

Medications used for pain

It is uncommon to find a pain-relieving medicine that relieves all arthritis pain for any one person. The aim is to help control the pain so it has less effect on what you can do.

There are many different types of pain relief:

 

  • simple analgesia/painkillers
  • non-steroidal anti-inflammatories
  • opioid analgesia
  • steroids
  • Tens machine and alternative remedies

 

 

Watch the video below to see Prof. Woolf (consultant rheumatologist) talk about taking pain killers

 

 

Please refer to the pages on medications for osteoarthritis and rheumatoid arthritis  which talk about the different types of medications in more details.

 

 Some common questions

 

When is the best time of day to take my painkillers?

This very much depends on the sort of pain you are experiencing, and whether it is there most of the day or only at certain times. It is also easier to prevent pain than get rid of it once it has started. If you have pain most of the time, you may need to take painkillers or anti-inflammatories regularly throughout the day to have a constant pain-relieving effect.

If you only have pain at certain times of the day you should take your painkillers as and when needed. However, if certain activities tend to worsen your pain, you may wish to take painkillers 30 to 60 minutes beforehand to reduce the pain you experience.

If you find that your symptoms are worse first thing in the morning, it might be worth trying to take an anti-inflammatory shortly before you go to bed – if you do this, remember to have some food at the same time; this doesn’t need to be a meal so a light snack such as a piece of fruit or some crackers or biscuits would do.

 

Are the side effects worse than the benefit?

No, not in most people.  You will only be taking them if you are having pain that is affecting what you want and need to do.  You should only be using them if they are giving some worthwhile pain relief.  Most people do not get any side effects.

 

Will my body get used to them?

Paracetamol and anti-inflammatories will always work just as well no matter how long you take them for.  What does sometimes change is the severity of pain and the painkiller may no longer be effective enough for the more severe pain. Some people can get used to opiates and may need to adjust the dose to manage their pain.

 

“I do not want to be addicted to them”

People who use painkillers for arthritis pain do not get addicted to the types of painkillers used.  Even if you need strong opiate painkillers for severe pain, it is very unusual to become addicted to them.  The main thing is to not use a painkiller stronger than you need, or for longer than it is needed.

 

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