| What is pain?
Pain is your body's alarm system. Pain tells you something is wrong. When part of your body is injured or damaged nerves in that area release chemical signals. Other nerves act like tiny telephone wires and send these signals to your brain where they are recognized as pain. Pain "tells" you that you need to do something. For example if you touch a hot stove the pain signal makes you pull away your hand to prevent further injury. This type of pain is useful because it is your body's way of protecting you from further injury.
Long-lasting (chronic) pain for example the pain of arthritis is a bit different. While chronic pain is also an alarm that tells you something is wrong it often isn't sufficiently relieved when you treat it. Controlling this type of pain is important since it can disrupt your life.
The methods used to control short-term (acute) pain such as strong painkillers are not useful for controlling the chronic pain of arthritis. Other methods such as those listed in this article can help.
What causes arthritis pain?
Many different diseases and conditions cause chronic pain. One of the most common is arthritis a group of diseases that cause inflammation of the joints. Other common types of chronic pain are backache muscle pain headache and sore feet.
Arthritis pain is caused by:
Everyone's arthritis pain is different. A neighbor with the same kind of arthritis may feel a different kind of pain. Even your own arthritis and pain vary from time to time. There are no easy answers or magic solutions to relieve arthritis pain. What works for some people may not work for others so you probably won't need to try all the ways to help control pain described here. Through trial and error you will discover some ways that work for you.
People react differently to pain for many reasons.
Emotional and social reasons
Your fears about pain previous experiences with pain and your attitude about your condition can affect how you react to pain and how much pain you feel. Your cultural and religious background and the way people around you react to pain may also affect how you react to pain.
In addition the emotional ups and downs of arthritis may affect your pain. If you feel depressed and stressed your pain may seem worse. You may get caught in a cycle of pain depression and stress that makes everything seem harder to handle.
The sensitivity of your nervous system and the severity of your arthritis determine how your body reacts chemically to pain. These factors also determine whether your nerves will send or block a pain signal.
Despite these differences you can learn to better manage your pain. Many people with arthritis have discovered that with will power skill and practice it is possible to take the pain in stride.
There are many ways to help control pain. Some pain control methods focus on emotional and social factors. Other methods focus on physical factors. Using a combination of methods is often the best way to control your pain.
Pain is commonIf you live with pain you are not alone. In a recent poll (based on a national survey of 2 002 adults aged 18 and older conduction by The Gallup Organization from May 21-June 9 1999) nine out of ten Americans reported they have pain at least once a month and for 15 percent of them the pain is severe.
Pain can be managed
Many people believe pain is just a part of getting older and that they just have to "grin and bear it." But pain is not necessarily something you have to live with--it's okay to admit that you have pain and to take action to relieve it.
Pain doesn't have to be a part of daily life. By taking action to reduce pain you may find that even routine tasks that have become difficult--like bending down or opening a jar--become easier.
Even though pain may interfere with work relationships and daily life few Americans talk to their doctors about it. Did you know:
| What blocks pain signals?
Many scientists think pain control methods help reduce pain by blocking pain signals. Pain signals are sent through a complex system of nerves in the brain and spinal cord.
There are many things that can block these signals and thus prevent the pain message from reaching your brain.
Pain signals are blocked by chemicals made by the brain called endorphins. There are several things that can cause the brain to produce endorphins. These include "natural" controls such as your own thoughts and emotions or "outside" controls such as medicines.
A father driving with his children is hurt in a car accident. The father is so worried about his children that he doesn't feel the pain from his own broken arm. The concern for his children somehow blocked the pain signal and kept the pain from affecting him.
Certain medicines such as morphine imitate the body's endorphins and block the pain signal. Other pain control methods such as heat and cold treatments physical therapy exercise relaxation and massage can stimulate the body to release its own endorphins or to block the pain signal in other ways.
| Can pain be controlled?
There are many things you can do to help control your arthritis pain. The goals of these methods are to control pain by:
The methods listed here will work differently for different people. So some methods may work for you but some may not. Some methods are things you can do for yourself. Others require help from your doctor or other health professionals. Talk to your doctor about these methods. With a little practice you will find the right ones for you.
Your mind plays an important role in how you feel pain and in how you respond to illness. People with arthritis often feel helpless and depressed about their condition. With these feelings come decreased activity poor self-esteem and increased pain. So building a sense of control by adjusting your thoughts and actions is an important part of pain management.
Below are some ways you can take control of your thoughts and actions to help control your pain. Thinking differently may not get rid of your pain entirely but having a more positive attitude can help. Many of these methods are easier said than done. But with practice and patience you can master them too.
Research your condition
Try to learn what causes your pain and how to control it.
Learn about treatment options
Find out about available medications. When taking medicine be sure to follow your doctor's instructions and read the directions that come with the medication. Alternative therapy can also be an option.
Through exercise you can help manage your pain and ease symptoms of chronic pain such as the pain from osteoarthritis. A doctor may recommend an exercise program or refer you to a specialist such as a physical therapist or occupational therapist.
Protect your body
Ask a doctor about how to do routine tasks in a way that reduces stress on joints. Listen to your body when it signals that it needs rest.
Keep a positive attitude
Having arthritis and the pain that goes with it can lead to a life built around pain and sickness. One way to reduce your pain is to build your life around wellness not pain or sickness. Live what is called a "wellness lifestyle." This means to think positive thoughts keep a sense of humor eat a balanced diet exercise every day and enjoy activities with others. It also means following your treatment plan taking your medication properly and practicing relaxation.
Arthritis can limit you but it doesn't have to control your life. Talk to your doctor nurse or therapist about how you can make your life more healthy. Get involved in a favorite activity or hobby. Remind yourself of what you can do rather than what you can't do. You'll feel better and your pain will not seem as severe.
Don't dwell on your pain
How often do you think about your pain? The amount of time you spend focusing on it has a great deal to do with how much discomfort you feel. People who dwell on their pain usually say their pain is worse than those people who don't dwell on it. One way to take your mind off the pain is to focus on someone or something else. Whether it's going to the movies visiting with family or friends volunteering or dancing follow through on planned activities. It will boost spirits and might even block some of those pain signals.
Everyone has the ability to be distracted. The more you focus your attention on something outside of your body the less you will be aware of physical discomfort. For example get involved in an activity or hobby you enjoy develop a new interest or get involved with helping others. If you can't help but think about the pain try to think about it differently. Think of the pain as your body's message to do something different.
Change your pain habits
It's easy to slip into the habit of drinking alcohol or taking more medicines to escape your pain. If you answer "yes" to any of the questions below you may need to find new ways to handle your pain.
Changing your pain habits will help you feel better. One way to make a change is to do something positive in place of the old habit and to reward yourself. Discuss these habits with your doctor nurse or other health care workers who specialize in pain management. Ask them to help you find new ways to cope with your pain.
Create a pain management plan
You can make a chart of your own pain control methods. This will help you keep track of which methods you have used and which ones work best for you. Adapt it often. Post it where you can refer to it often such as on your refrigerator or medicine cabinet.
Share your successes and frustrations with others--whether it's with family friends loved ones or others that have pain. Find out about support groups in the community and learn how others are overcoming their pain. Don't hesitate to ask for help when you need it.
Take control of your pain so it doesn't control you.
| Talking to a doctor about pain Health care team
To help manage pain you may want to consult a primary care physician nurse pharmacist physical therapist or other health care professional. You may be referred to a rheumatologist a doctor who specializes in treating arthritis.
Gaining control through communication
Even though pain may interfere with work relationships and daily life few Americans talk to their doctors about it. Did you know:
One of the best ways to gain control of pain is to talk to a doctor about it. Unlike a broken leg pain cannot be seen in an x-ray or identified by a medical test. What a patient says may be the only way the doctor will know about the pain. And because people experience and respond to pain differently how a patient describes pain is the best way for the doctor to understand what the patient is feeling. Only then can the doctor help the patient treat the pain.
Remember the patient and the doctor should share the same goal--reducing the patient's pain.
This page has information on ways to understand pain keep track of it and describe it to a health care provider--whether a doctor nurse pharmacist or other medical professional.
Patients may want to consider asking a friend or family member to accompany them to the doctor's office. He or she can take notes or help listen to what the doctor says. Remember that pain not only affects the person suffering with it but it may also affect the people around them.
It may also be helpful to prepare in advance by writing down symptoms allergies medicines previous medical procedures and conditions or diseases and to show this list to the doctor.
By being prepared to describe pain to the doctor patients can make the most of their doctor visits. Thinking about these questions before a doctor's appointment may help patients explain their pain to doctors:
What makes the pain feel better or worse:
During a doctor visit
Here are some tips and suggested questions for a patient visiting a doctor about pain.
Ask the doctor:
Take notes to help remember what the doctor said.
If patients still have questions about the pain or the treatment plan after the doctor visit they should call the doctor back.
| Hot and cold treatments
Using either heat or cold treatments can reduce the stiffness and pain of arthritis.
Cold packs numb the sore area. They are especially good for severe joint pain and swelling caused by a flare (a period during which disease symptoms return or become worse). Heat treatments relax your muscles. You can use dry heat methods such as a heating pad or heat lamp or moist heat methods such as a bath or hydrocollator pack.
Tips for heat
| Tips for cold
Place a cold pack or ice bag on the painful area. You can buy these at the drug store or you can make one by wrapping a towel around a bag of frozen vegetables.
Before and after treatments
Before using heat or cold:
After using heat or cold:
Use heat or cold safely
|Exercise and wise use of joints
Another key to coping with pain is to follow an exercise program designed by your doctor or physical therapist.
Your exercise program should include special range-of-motion exercises to help keep your joints movable. It should also include general fitness exercise such as swimming or walking. These help keep your heart lungs bones and muscles strong. Exercise also helps relieve stiffness and gives you an improved sense of well-being. Here are some tips to help you exercise properly:
Using joints wisely and saving energy
Using your joints wisely means doing everyday tasks in ways that reduce the stress on painful joints. Saving your energy means "listening" to your body for signals that it needs to rest. It also means learning to pace yourself so you don't become too tired. Here are a few guidelines for using your joints wisely and for saving your energy:
Pain and stress
People who are in pain experience both physical and emotional stress.
Pain and stress have similar effects on the body. Muscles become tight and breathing becomes fast and shallow. Heart rate and blood pressure go up. Relaxing can help you reverse these effects. It gives you a sense of control and well-being and makes it easier to manage pain.
What is relaxation?
Relaxation is more than just sitting back reading or watching TV. It involves learning ways to calm and control your body and mind. Relaxation does not come easily especially if you are in pain. It takes practice. The best time to use relaxation skills to manage your pain is before the pain becomes too intense.
Some people find it very difficult to relax. They feel they don't have time to practice it or they don't believe it will help them. Others feel embarrassed for taking the time. With a little practice most people get some relief from relaxation.
There is no best way to learn how to relax. Everyone responds differently to different techniques. Try some of the methods below until you find some that work for you.
Guided imagery uses your mind to focus on pleasant images. First begin by breathing slowly and deeply. Think of yourself in a place where you feel comfortable safe and relaxed. This may be a favorite vacation spot or a porch swing in your own backyard. Create all the details--the colors sounds smells and how it feels. These images take your mind away from pain and focuses it on something more pleasant.
Prayer is very relaxing and comforting for some people. You may want to make a tape recording of a soothing inspirational message.
Hypnosis is a form of deep relaxation in which your attention is focused internally--away from the usual thoughts and anxieties. You'll need to work with a professional trained in hypnosis who has been referred by your doctor. Some psychologists counselors or social workers who are trained in hypnosis may be able to teach you how to safely hypnotize yourself. Suggestions for positive change seem to be more easily accepted while a person is quiet and relaxed. Most people who find hypnosis helpful in relieving pain report it as soothing and enjoyable as well.
Biofeedback uses sensitive electrical equipment to help you be more aware of your body's reaction to stress and pain and to learn how to control your body's physical reactions. The equipment monitors your heart rate blood pressure skin temperature or muscle tension. These body signals are shown on a screen or gauge so you can see how your body is reacting. Biofeedback helps you learn how you feel when your muscles are tense or relaxed. If you do a relaxation technique while using the equipment you can learn to control some of your body's responses to pain. One advantage to biofeedback is that it shows you that you have the ability to relax.
Relaxation audio tapes help guide you through the relaxation process. These tapes provide directions for relaxation so you don't have to concentrate on remembering the instructions. Many professional tapes are available for purchase. You might also want to make your own tape of your favorite relaxation routine.
Tips for relaxation
| Counseling and other support
Health care team
Any major disturbance in your life--such as illness or chronic pain--may make you feel anxious depressed angry or even hopeless.
This is your first place to turn for help. The team includes your doctor and a nurse. It may also include an occupational therapist or a physical therapist a social worker counselor psychologist and a pharmacist.
Talk to the members of the team about ways to cope with pain. They may be able to help you find services in your area. Don't be afraid to suggest to your doctor a pain management idea of your own or one from this program. You know yourself and your pain better than anyone.
Many people become depressed when they have severe pain. Some people feel so bad they cannot sleep or eat. In these cases therapy or counseling may help.
Some people are afraid to admit they need help. They believe that others will think they are crazy if they talk to a professional about their problems. But it's smart to get help when you need it. If you have the symptoms of depression--poor sleep changes in appetite crying sad thoughts--talk with your doctor.
Some psychologists or counselors are specially trained to work with the emotional side of chronic health problems like arthritis. These people can also teach you how to manage stress. Pain is stressful. If you have increased stress you may feel more pain. So learning to manage stress can also help you manage your pain.
Sharing your feelings and experiences with a group can make living with arthritis easier. The basic goal of a support group is to give you a way to share and learn about arthritis. A group also helps you to feel understood and can give you new ideas to help cope with problems. It can also help you feel good about yourself because you'll be helping others in the group.
Groups may be run by professionals or they may be self-help groups led by people with arthritis. Some groups focus on pain control. Others have no certain topic but work with people who have different types of problems. Ask your doctor about local groups for people with arthritis or people with pain. Sometimes you can help yourself with the help of others like you.
Pain clinicsPain clinics specialize in treating pain. They may be located in a hospital or may operate independently. Some clinics treat all types of pain. Others specialize in treating certain types of pain. And some clinics specialize in certain types of treatments. The clinics can't cure your health condition but they may help you to learn better pain management skills. Ask your doctor about pain clinics in your area.
|Other pain management techniques
SplintsIf a joint is very swollen and painful your doctor or therapist may suggest you use a splint to rest the joint (see figure 2). This helps reduce swelling and pain. Your doctor may recommend that you wear the splint during certain activities all day or only at night. This depends on how severe the swelling or pain is.
Getting a good night's sleep restores your energy so you can better cope with the pain. It also rests your joints to reduce the pain and swelling. Only you know how much sleep your body needs so get into the habit of listening to your body. If you feel tired and ache after lunch every day for example take a brief nap. This can help restore your energy and spirits.
If you have trouble sleeping at night try relaxing quietly in the afternoon rather than taking a nap. Here are some other tips to help you sleep better:
Do not take sleeping pills unless your doctor recommends them.
Massage and topical lotions
Massage increases blood flow and brings warmth to the sore area. You can massage your own muscles or you can ask your doctor to recommend a professional who is trained to give massages. If you have arthritis in your shoulders elbows wrists or fingers you may not be able to give yourself a massage.
When giving yourself a massage use lotion or oil to help your hands glide over your skin. Menthol gels also provide a comforting tingle that can further ease the painful area.
Topical "deep-heating" rubs may contain medicines that block the sensation of pain. Or they may increase blood flow in the skin where they are applied and distract attention from the painful muscle or joint. Usually these ointments do not penetrate very deeply into the skin. Therefore claims that the active ingredients go directly to the joints and relieve pain are not true.
Tips for safe massage:
Transcutaneous electrical nerve stimulation (TENS)
TENS helps reduce pain for some people with arthritis. It is a small device that uses mild electric pulses to stimulate the nerves in the painful area. This blocks the pain message in several ways.
To use a TENS machine electrodes are taped on the skin near the painful area. These electrodes are connected by wire to a small battery-operated stimulator. TENS doesn't hurt but it may cause some tingling. Usually it feels like vibration or tapping. TENS works for some people but not for others. Talk to your doctor or therapist about whether TENS might help you.
1330 West Peachtree Street
Atlanta GA 30309
American College of Rheumatology
American Chronic Pain Association
P.O. Box 850
Rocklin CA 95677-0850
American Pain Foundation
111 South Calvert Street Suite 2700
Baltimore MD 21202
National Institute of Arthritis and Musculoskeletal and Skin Diseases
1 AMS Circle
Bethesda MD 20892
Some of this material may also be available in an Arthritis Foundation brochure. Contact the Washington/Alaska Chapter Helpline: (800) 542-0295. If dialing from outside of WA and AK contact the National Helpline: (800) 283-7800.
Adapted from the pamphlet originally prepared for the Arthritis Foundation by Robert L. Swezey MD FACP FACR and Beth A. Ziebell PhD. This material is protected by copyright.