Managing & Understanding The Pain From Chronic Inflammation
by Dr. C.H. Weaver M.D. Medically reviewed 9/1/2018
Chronic pain is the number one symptom of individuals with RA, AS and PsA, and it can take a physical and emotional toll on your life. If you’re living with one of these conditions, you’re likely living with pain—and managing pain has become a big part of your day-to-day life. No one should have to live in misery as a result of chronic pain. Importantly many affected individuals have found ways to successfully manage pain and you can, too.
Pain is a matter of perception and it is influenced by the cognitive and emotional centers in the brain. Pain is subjective and everyone experiences pain differently, which can make it hard to describe or quantify. Some people will have severe pain, while others have more moderate pain. Some have constant pain, while others experience sporadic pain flares.Pain can ebb and flow depending on the current level of disease activity. Furthermore pain can be influenced by stress, poor sleep, hormonal changes, and the inflammation that can result from too much activity or even some foods.
Communicating About Pain
One of the most important things you can do is communicate clearly about your pain—both with your doctors and with those close to you. No one can possibly understand the level of pain you feel, but it’s important to attempt to quantify your pain in order to help your doctor determine the best course of action for managing your pain. Communicating with your family and friends about your pain can help you to enlist their support so that you can avoid activities that exacerbate your pain.When communicating with your doctors, be direct and honest and provide both a quantitative and qualitative description of the pain. In other words, describe the intensity level of the pain, but also provide information about how the pain has impacted your life. For example:
- Quantitative description: “On a scale of one-to-ten, it’s a level eight and I can’t sleep more than three hours at a time.”
- Qualitative description: “I can’t deal with my kids without yelling at them; I feel alienated by friends and family; I can no longer do the things I love to do.”
Maintaining a Pain Log
Keeping a pain log is an excellent way to track your pain and provide detailed information for the doctors who are helping to treat it. A pain log can provide the “big picture” in terms of your pain. You can use a standard pain log, such as the one provided by the American Pain Foundation, or create your own. There are even online pain management tools such as Track and React, that help you track your pain and share the information with your doctors.A pain log helps you to see the patterns of your pain and identify triggers and pain relievers. A good pain log will include information about the intensity, duration, and characteristics of your pain. It should also include information about how the pain impacts your daily life, what makes the pain worse, and what makes the pain better. By tracking your pain, you may be better able to prevent it and/or treat it.
Coping with and Preventing Pain
Unfortunately, pain is sometimes an inevitable part of living with these conditions and it is important to find ways to cope with it. Everyone is unique and experiences and copes with pain differently. Below are some suggestions:
Stretching and Range-of-Motion Exercises: Gentle range-of-motion and stretching exercises can help prevent stiffness and prepare your body for the day. Some people like to begin the day with a few stretches.
Heat Therapy: Heat therapy can help relax muscles and stimulate blood flow in the area of the joint. Heating pads, microwavable compresses, warm baths, hot water bottles, and electric blankets are some good forms of heat therapy.
- Some people benefit from using an electric blanket to help warm the body and joints prior to getting out of bed.
- Some experts recommend getting directly into a shower or warm bath in the morning to warm up the body and joints.
Cold Therapy: Cold packs or ice can help reduce inflammation and numb the pain of aching joints. Cold therapy is particularly useful during a flare-up.
Exercise: It may seem counter intuitive, but exercise is important for preventing and managing pain. It can help alleviate joint pain and stiffness, increase your flexibility, improve your sleep, and boost your endurance. Some research indicates that the endorphins released during exercise have an analgesic effect and can inhibit pain. Learn more about exercise.
Variety: Vary your activity frequently throughout the day. If you spend prolonged periods of time sitting, be sure to get up for frequent stretch breaks or trips to the water fountain. Staying in one position for too long can exacerbate pain and stiffness.
Diet: Some research indicates that avoiding saturated fats and increasing intake of omega-3 fatty acids can help reduce joint inflammation. In addition, maintaining a healthy weight can reduce stress and strain on your joints. Learn more about diet.
Medication: Some pain requires over-the-counter or prescription medication. Prescription corticosteroids such as prednisone can help relieve pain by reducing inflammation. Other medications help slow progression and relieve pain and swelling. Talk with your physician about the treatment options that are best for you.
Sleep: It’s a vicious cycle—pain interferes with sleep and lack of sleep exacerbates pain. In fact, sleep loss has been shown to exacerbate pain, depression, and fatigue in many patients.1 Make healthy sleep a priority to reduce stress, maintain optimal health, and manage pain. If you are having prolonged difficulties getting quality sleep, make it a priority to discuss this with your physician.
Massage: Massage can provide relief to sore muscles and joints. It promotes relaxation and also causes a release of endorphins, which are naturally produced hormones that act as painkillers. Massage is not for everyone. Some people with RA find that massage actually exacerbates their pain; however, others find it to be soothing. Look for a licensed massage therapist with experience treating chronic pain.
Occupational Therapy: Occupational therapy focuses on helping you to continue performing your normal activities of daily living. An occupational therapist can help you avoid pain by providing alternative ways to perform tasks in order to minimize the stress placed on joints. Occupational therapists sometimes provide assistive devices, such as specially designed kitchen tools, to help promote independent function.
Physical Therapy: Physical therapy stimulates the muscles, bones, and joints through exercise and other methods. The goal of physical therapy is to keep you moving and develop strength, tone, and overall fitness. By keeping you moving, physical therapy can help prevent and manage pain.
Relaxation Techniques: Pain can take an emotional toll on your health. It is often linked to stress, anxiety, and depression. Relaxation techniques such as meditation, guided imagery, deep breathing, laughter therapy, and more can provide much needed relief from pain. Learn more about relaxation techniques.
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1 Irwin MR, Olmstead R, Carrillo C, et al. Sleep loss exacerbates fatigue, depression, and pain in rheumatoid arthritis. Sleep. 2012; 35(4): 537-543.