“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:
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:
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://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:
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.
Some common questions
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.
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:
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:
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 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
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:
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:
https://www.healthycornwall.org.uk/
https://www.arthritisaction.org.uk
https://www.versusarthritis.org/about-arthritis/managing-symptoms/
Medications used for Rheumatoid Arthritis (RA)
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:
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:
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.
Tablets
Methotrexate tablets (also available as injections)
Injections and infusions
Steroids
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:
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: