“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.

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:


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.


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:

  • 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.
  • 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.
  • 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 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://livewellwithpain.co.uk/resources-for-people-with-pain/

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 below tabs on medications for osteoarthritis and rheumatoid arthritis  which talk about the different types of medications in more details.

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.

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.

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.

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.

Hard days, try and see the positives in what you can achieve rather than focusing on what you can’t

Having a long term illness like arthritis can impact your life in many ways changing how much you can do, your moods, your relationships, your finances, your plans for the future and your very sense of who you are.  Chronic illness can require long-term adjustments to your life.  One way to tackle this is “self management”.  Self management means taking an active role in managing your arthritis and learning new attitudes and skills to help you effectively respond to the challenges it poses.  Self-management is about using resources available to you to help manage your arthritis.  It helps to encourage an attitude whereby you accept how your arthritis affects you, but do not allow it to control you: your arthritis is after all just one part of who you are.

Educating yourself about your arthritis and the support that is available to you is a simple but powerful step to regain control of your life, even if you have had your arthritis for years. When people have a better understanding of their arthritis and how to manage it, this can help to maintain or enhance their overall health and happiness. There is much you can do for yourself.

  • Be determined – life is about living
  • focus on what you can do, not what you can’t
  • adapt the way you do things so you can continue to do them
  • get help from wherever available
  • learn new tips to enable you to live your life more easily
  • communicate with your family who can be supportive and understanding
  • ask questions – get as much information as you can
  • build good relationships with the health professionals treating you
  • have confidence – you need to believe you will come through it, even if you can’t see how

When you have arthritis it is important to look after yourself to reduce further damage to your joints. This might mean learning new ways of carrying out everyday tasks to reduce the stress on your joints. To help protect your joints you should:

  • plan ahead – save harder tasks for later in the day when you might be feeling less stiff or sore
  • pace yourself throughout the day
  • notice which positions and movements make you stiff
  • avoid straining joints by doing things awkwardly
  • avoid being in one position for a long time
  • keep active, but balance activity with rest
  • maintain a healthy balance diet

Being overweight puts significant stress on your joints, as well as increasing other health risks such as heart disease, diabetes and cancer.  The NHS offers support and plans to help with weight loss and can be found here: https://www.nhs.uk/live-well/healthy-weight/start-the-nhs-weight-loss-plan/

To protect your joints you might want to think about how you carry out everyday tasks such as washing, dressing and going to work. There are some simple changes you can make to minimise the risk of damaging your joints:

  • Use larger, stronger joints – push doors open with your shoulder rather than your hand and/or use your forearms/elbow joints to pick up items.
  • Spread the weight of an object over many joints – use both hands to carry your shopping or use a shoulder bag.
  • Avoid gripping things too tightly – hold items as loosely as possible or expand your grip with padding.
  • Shift rather than lift items – slide heavy pans along a kitchen unit.
  • Consider flexible working – starting earlier or later in the day to avoid the rush hour.
  • Try not to sit in the same position all day – take regular breaks and move around.

An occupational therapist can assess you in your home or workplace and suggest simple adaptations to the way you do things to reduce the chances of damaging your joints. They can also suggest special equipment that you can buy to make some tasks easier.  Patients who are under the Rheumatology team can be referred to a rheumatology specialist occupational therapist.  See the Versus Research website for more information on how to look after your joints: Click Here

Local Self Help Resources

Escape Pain Logo

ESCAPE-pain is a programme for people with chronic joint pain of the knees and/or hips, that offers self-management and coping strategies with an exercise course individualised for each participant. It helps people understand their condition, teaches them simple things they can help themselves with, and takes them through a progressive exercise programme so they learn how to cope with pain better.

The ESCAPE-pain website https://escape-pain.org/

ESCAPE- pain is a six-week group-based course which is offered in locations across Cornwall. To find a local class please go to https://escape-pain.org/find-a-local-class

NHS Cornwall Partnership Logo

The Expert Patient Programme provides training and support for adults who are living with a long-term health condition, to manage their condition better on a daily basis, by running self   management courses.  Through the programme, people are helped to manage their condition, develop confidence in daily management of their specific condition, meet others to share similar   experiences and help them to develop more effective relationships with healthcare professionals.  The courses are delivered by a team of trained volunteers who themselves have a long term condition and run over six weekly sessions of two and half hours.

People who have attended the course report feeling more confident and more in control of their life and better able to manage their symptoms and enjoy an improved quality of life. They also are able to work more effectively with health care professionals.

Expert Patients Programme Courses look at a number of topics including:

  • dealing with pain, sleep and extreme tiredness
  • falls prevention
  • appropriate exercise
  • relaxation techniques and stress
  • healthy eating
  • communicating with family, friends and professionals
  • planning for the future

The aim is to give people the confidence to take more responsibility to self-manage their health, while encouraging them to work collaboratively with health and social care professionals.

The Expert Patient Programme team run 6-8 courses a year, across the whole county, with the locality and dates depending on venues and availability of tutors. People with long term conditions are encouraged  to self refer.

Courses are available throughout the year. For further information, please call 01579 373500 or mobile 07824 598626 or go to: https://www.cornwallft.nhs.uk/expert-patient-programme

Below are some links to other websites you may find helpful in regards to self management:





Medications used for Rheumatoid Arthritis (RA)

See the source image

Please note – this information is taken from Versus Arthritis, and the British National Formulary.  By clicking on the blue highlighted drug names, you will be taken to the Versus Arthritis website for further information.

There are four main groups of medications that are used to help treat rheumatoid arthritis. These are:

  • painkillers
  • non-steroidal anti-inflammatory drugs (NSAIDs)
  • disease-modifyng anti-rheumatic drugs (DMARDs)
  • steroids (also known as corticosteroids)

Many people with rheumatoid arthritis need to take more than one medication.  This is because different medications work in different ways.

Your medication treatments may be changed from time to time. This can depend on how bad your symptoms are, or because something relating to your condition has changed.  Your specialist will work with you to decide which treatments and medications may suit you best.  The majority of these medications can only be started by a rheumatology specialist, but your GP will support any ongoing prescriptions and monitoring, once you are settled on a regime.

Medications may be available under several different names, which can be confusing. Each drug has an approved name – sometimes called a generic name.  Manufacturers often give their own brand or trade name to the drug as well. For example, Nurofen is a brand name for ibuprofen.  The approved name should always be on the pharmacist’s label, even if a brand name appears on the packaging. Check with your doctor, rheumatology nurse specialist or pharmacist if you’re not sure about anything.

Disease-modifying anti-rheumatic drugs (DMARDS)

There are three types of DMARD:

  • conventional synthetic DMARDs (sometimes called csDMARDs)
  • biological therapies (sometimes called bDMARDs).
  • targeted synthetic DMARDs (sometimes called tsDMARDS).

As well as considering your RA, medical history, current medications, lifestyle and preference will effect which medications may suit you best.  Some medications require regular bloods tests, where others not so much.  Some people may struggle with taking tablets, so medications that are available in liquid or injection form may be more appropriate.  All options will be discussed with you , so a joint decision can be made between yourself and your specialist.

Many medications used to manage RA may take a few months to take effect, excluding steroids and most painkillers/anti-inflammatory’s.  It is important to keep taking your medication during this time.  If you do have any problems with the medication, such as undesired side effects, or have questions about how to take the medication, either discuss these with your pharmacist or contact your rheumatology team.

The list below shows the most common medications available for the treatment of rheumatoid arthritis, although new medications are being developed all the time.  If you click on the drug name, you will be taken to the Versus Arthritis website, where many questions can be answered with the information you will find there.




Methotrexate tablets (also available as injections)







Injections and infusions


Certilizumab Pegol










Image of a steroid injection

Steroids are sometimes known by their full name: corticosteroids.  Corticosteroids help to reduce the pain, stiffness and inflammation caused by rheumatoid arthritis.  The most commonly used is Prednisolone.

They can be used as:

  • a tablet
  • an injection directly into a painful joint
  • an injection into your muscle

They’re usually used to provide immediate short-term pain relief. This could be during a flare-up or while you’re waiting for your DMARD medication to start working.  Corticosteroids are normally only used in this way because long-term use of corticosteroids can have serious side effects, including weight gain, osteoporosis, eye problems and thinning of the skin to name a few.

You shouldn’t stop taking your steroid tablets or alter the dose unless advised to by your doctor. It can be dangerous to stop steroids suddenly.

Non-steroidal anti-inflammatory drugs (NSAIDS)

NSAIDs can be used to help control symptoms of pain, swelling or stiffness. They can be used in combination with painkillers.  NSAIDs start working within a few hours, with the effects felt for a few hours to a whole day.  Ibuprofen is a commonly prescribed NSAID.

NSAIDs can be taken as a:

  • tablet
  • capsule
  • liquid
  • suppository to be inserted into your bottom
  • cream or gel