Managing pain from arthritis
Pain Management
What’s the Impact of Living with Pain?
Coping with pain can be the hardest part of having arthritis. Pain can interfere with your activities at home, on vacation, and at work. It can even prevent you from getting enough sleep because of night-time pain.
Constant or frequently reoccurring pain can:
“Trick” your brain so that it is always expecting pain
Bring on other physical symptoms
Cause emotional changes and distress
Negatively change your lifestyle
Lead to anxiety, “the blues,” and depression, making pain worse and harder to treat
Why is Pain from Arthritis Different?
The kind of pain that develops from arthritis is called chronic pain. Chronic pain is pain that lasts more than three months. It isn’t as easy to relieve as acute or “short term” pain.
Over time, chronic pain can become hard to treat and can result in a chronic pain syndrome, where it feels impossible to escape the pain. Chronic pain syndrome can lead to anxiety, the blues, and even depression, which can make controlling pain even more challenging. Often when you cannot escape the pain, you move less and your overall health worsens. Many people experience weight gain, increased pressure on the joints, worsening heart health, diabetes, and other conditions. Finding a way to manage chronic pain is critical to your overall health.
What causes arthritis pain?
The kind of pain that develops from arthritis is called chronic pain. Chronic pain is pain that lasts more than three months. It isn’t as easy to relieve as acute or “short term” pain.
Over time, chronic pain can become hard to treat and can result in a chronic pain syndrome, where it feels impossible to escape the pain. Chronic pain syndrome can lead to anxiety, the blues, and even depression, which can make controlling pain even more challenging. Often when you cannot escape the pain, you move less and your overall health worsens. Many people experience weight gain, increased pressure on the joints, worsening heart health, diabetes, and other conditions. Finding a way to manage chronic pain is critical to your overall health.
Everyone’s Pain is Different
Just as there are different types of arthritis, there are also different interpretations of pain. People with the same level of joint degeneration can have different experiences with pain. Your own pain may vary from day-to-day and affect different joints or body parts on any given day. It is normal to have “good times” and “bad times.” What works for one person might not work for someone else, so creating a personal pain management plan is critical.
Gender Differences in Pain
Women are more likely to experience pain and disability associated with arthritis. Research shows that women’s experience of pain tends to be greater. They report pain more frequently and have a lower tolerance to painful stimuli.
To successfully treat pain, women may need to add treatments that focus on complementary and alternative therapies, and other mind-body treatments for pain, anxiety, and depression
Strategies to Cope with Pain
How to Develop Plans to Manage Your Pain
Developing a personalized pain management plan is critical to staying healthy and living the life you want. The goals of treatment are to:
Control pain
Decrease joint stiffness
Improve joint movement and range of motion
Slow down the progression of wear and tear in the joint
Maintain a healthy body weight or lose weight (if overweight)
Strengthen your muscles which act as “shock absorbers”
A comprehensive chronic pain management plan should include education about the arthritis pain/mind-body connection and a combination of treatments including:
Mobility, movement, and activity
Nutrition and weight management
Common treatments for pain
Attention to emotional wellbeing and the mind-body connection
Complementary and alternative therapies
Pain Management Part 1:
Mobility, Movement, and Activity
One of the most beneficial things you can do to manage your arthritis pain is to simply move. Exercise is a treatment for arthritis and slows the progression of wear.
Most activity plans can be started independently and continued at home. Involving family and friends will increase your chances of keeping up with a new activity or routine.
The Wellness Center can help you create a safe and easy-to-follow activity plan, and can provide your plan in both printed and online formats.
With access to thousands of helpful exercises, our team will work with you to identify movement that is effective and enjoyable. To view an example plan, scan the QR code you see here, or visit medbridgego.com and enter the code: VDMGPWG7.
Additionally, the AMD3 Foundation has developed the “Move to Mobility” educational video series. This video series shows safe exercise routines you can start today. Visit www.amd3.org to watch.
Pain Management Part 2:
Nutrition and Weight Management
Another key to managing your pain is achieving and staying at your recommended weight. Benefits include easing pain by reducing stress on your joint and enhancing your overall feeling of well-being. The Wellness Center can help you develop a safe and simple weight-loss program. There is no “arthritis diet,” but in general, you should eat a balanced diet.
Pain Management Part 3:
Common Treatments for Arthritis Pain
Scan QR Code for an example activity plan:
Ask the Wellness Center for the “Recipe Book for Everything About Bone and Joint Health,” for more information on the anti-inflammatory diet and how calcium and vitamin D impact your bone health. It includes tips on healthy eating and provides recipes that follow those recommendations.
The Wellness Center can also provide you with a “Pre-Op Nutritional Go Guide.” This guide provides details on how to improve your nutrition before and after surgery.
Analgesics and NSAIDs
Acetaminophen (Tylenol) is a non-opioid analgesic that reduces swelling. Non-steroidal anti-inflammatory drugs (NSAIDs) also help reduce joint pain stiffness, and swelling, and can be taken with Tylenol. NSAIDs available over-the-counter include aspirin, ibuprofen, and naproxen sodium. The Wellness Center or your PCP can review your medical history and current medications to be sure analgesics or NSAIDs are safe for you. NEVER take narcotic medicines to treat arthritis pain.
Topical Pain Relievers
Topical pain relievers are applied to the skin over a painful joint. These are available over-the-counter as creams, gels, patches, rubs, or sprays. Talk with your PCP or the Wellness Center if you are considering using a topical pain reliever.
Injections
Joint injections are often used by people with arthritis and can be very effective in relieving pain for several weeks to months. There are many types of joint injections:
Cortisone/Corticosteroid injections work by treating the inflammation that causes pain and swelling.
The effects of a cortisone injection can last from 3-12 months, or longer.
All insurances cover this injection.
Since this injection is a steroid medicine, it has a higher efficacy for bone-on-bone (end stage) arthritis.
Hyaluronic acid injections deliver lubricating fluid into the joint. The goal is to temporarily lubricate the joint, thereby decreasing inflammation and pain, and improve function.
For this injection to have any anti-inflammatory effect, at least some cartilage must still be present in the joint.
When the joint is bone-on-bone there is little to no effect in relieving pain from these lubricating injections.
Platelet-rich plasma (PRP) injections are offered by the Bone and Joint Center as an additional non-operative treatment for the pain from knee and hip arthritis.
Platelets contain hundreds of proteins called growth factors, which are important in healing injuries and reducing inflammation.
PRP is a “biologic” natural anti-inflammatory, so you can continue to receive these injections for as long as they relieve your pain.
Cryoanalgesia treatments use freezing cold to disrupt the pain transmitting portion of nerves to produce an immediate, long lasting “block” of those pain sensors.
Cryoanalgesia leaves all muscle function intact.
Cryoanalgesia is for knee pain from arthritis and the effect on the nerve is temporary. The pain relief from cryoanalgesia can last 6-9 months and can be repeated at 3 month intervals if needed.
Remember, injections will NOT make the degeneration worse. Injections treat inflammation which causes pain and won’t accelerate the inflammation.
Assistive Devices
Assistive devices can help decrease your pain and improve your ability to move. They may include canes and walkers. Braces are not usually suggested, as they may cause unnecessary muscle weakness.
Pain Management Part 4:
Attention to Emotional Wellness and Mind-Body Connection
Think of pain as a signal that can be changed by taking positive actions. Small changes in attitude and outlook about the pain you experience can help reframe your mindset. Below are a few exercises to strengthen your emotional wellness and mind-body connection.
Keep a positive attitude.
Don’t allow pain to control your life. Work to control your pain by:
Thinking positive thoughts and having a sense of humor
Eating a balanced diet and exercising regularly
Surrounding yourself with positive people
Enjoying activities with friends and family
Distract yourself. The amount of time you spend thinking about pain has a lot to do with how much pain you feel. One way to take your mind off pain is to focus on something else. The more you focus on a hobby or other activity, the less you’ll think about pain.
Shift your perspective. Think of pain as your body’s message to do something different. For example, if your pain is worse after sitting for a long time, your body may be telling you to get up and move around.
Practice positive self-talk. What we say to ourselves often affects what we do and how we look at life. Practice turning your negative statements around.
Change your habits. Try doing something positive in place of an old pain-escaping habit. Instead of reaching for another dose of pain medicine, reach for an ice pack or warm compress. Instead of saying “my knees are killing me,” say “Going for a walk usually loosens them up. I’ll try that.”
Keep track of what works and what doesn’t. Make a chart or journal of the pain-control methods you’ve tried and track ones that work best for you.
Pain Management Part 5:
Complementary and Alternative Medicine Therapies
The complex nature of pain and its unique interpretation by the brain of each person means that complementary and alternative pain management strategies should be explored and worked into your personal pain management plan. Complementary and alternative medicine (CAM) therapies are usually combined with conventional treatments to manage and enhance emotional and mental health.
Examples of Complementary and Alternative Medicine Therapies
Acupuncture, the practice of inserting fine needles into the body along several points, has been shown to control pain. The needles may stimulate nerves to block pain signals.
Biofeedback uses sensitive equipment to help you become more aware of your body’s reaction to stress and pain. If you practice relaxation while using biofeedback, you can learn to control some of your body’s responses to pain. Watch the video “What is Biofeedback?” to learn more.
Hot and cold treatments can reduce the pain and stiffness of arthritis. Cold packs numb the sore area and reduce inflammation and swelling and can be especially good for pain flare-ups. Heat relaxes your muscles and stimulates blood circulation. We always say, “Heat before, ice afterwards.” Usually applied directly to the painful joint, heat may be more useful for chronic pain or for “warming up” before exercising. Cold packs may provide relief from acute pain or for after exercising.
Massage can help soothe arthritis pain, improve joint function, and ease stress and anxiety. It brings warmth and relaxation to the painful area. You can massage your own muscles, or you can go to a massage therapist.
Yoga can be used as a way to exercise gently, as well as to reduce tension and improve joint flexibility. You can find many programs on YouTube or at the local gym or community center. Watch Series 2-Episode 2: Establish an Effective Yoga Practice from the AMD3 Foundation to learn more.
Tai Chi is an ancient martial art originating from China. Tai Chi is a gentle, meditative form of exercise that has been shown to reduce chronic pain, improve balance, and help prevent fractures in patients with osteoporosis.
Meditation apps Through meditation, we can build up areas of our brain and actually rewire it to enhance positive traits like focus and decision making, and diminish the less positive ones, like fear and stress. Apps like “Headspace” and “Calm” help keep you centered and relaxed.
Relaxation techniques can help you manage physical pain and emotional tension. Stressful situations can increase the perception of pain. Techniques like diaphragmatic breathing and progressive muscle relaxation can help manage stress and the pain it causes.
How to do Diaphragmatic Breathing:
Sit comfortably with your knees bent and your shoulders, head, and neck relaxed.
Place one hand on your upper chest and the other just below your rib cage.
Breathe in slowly through your nose so that your stomach moves out against your hand. The hand on your chest should remain as still as possible.
Tighten your stomach muscles, letting them fall inward as you exhale through pursed lips. The hand on your upper chest must remain as still as possible.
How to do Progressive Muscle Relaxation:
While inhaling, contract one muscle group (for example, your upper thighs) for 5-10 seconds, then exhale and suddenly release the tension in that muscle group.
Give yourself 10-20 seconds to relax, and then move to the next muscle group.
While releasing the tension, try to focus on the changes you feel when the muscle group is relaxed. Imagery may be helpful in conjunction with the release of tension, such as imagining that stressful feelings are flowing out of your body as you relax each muscle group.
Gradually work your way up the body contracting and relaxing muscle groups. Start with your hands, arms, upper body, and lower body.
Additional Resources
Watch the following videos where Dr. Tony DiGioia talks about pain and how to manage it: