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Pain and Stress

There are many things you can do to help relieve the pain of arthritis. Even though arthritis is a chronic disease and may last a long time, there is a great deal that can be done to control and reduce the associated problems of pain and stress.

The unpredictable course of arthritis, the many misconceptions and negative attitudes in the community, the unseen nature of pain and the seeming lack of understanding of friends and family may all help to contribute to a person's feeling of helplessness.

A great deal of misunderstanding about arthritis has been due to this mistaken belief that "nothing can be done". The positive answer is that "something can be done" and that there are many resources available to help you.

PAIN AND ARTHRITIS

Pain from arthritis can be felt in a variety of ways and has several causes.

• Inflammation is present to varying degrees in all types of arthritis. It is a process that causes swelling, redness, local heat and loss of movement.
• Joints damaged or worn by the disease process can also cause pain. Both of these types of pain can lead to a third kind.
• This is the pain from irritable or tense muscles that can hold and protect joints from painful movements. It is the brain that eventually receives and interprets pain messages from the body.

THE PAIN/STRESS CYCLE

Learning to manage pain and stress in a positive way by setting up a Pain Management Plan can help break this cycle.

Pain, stress, fatigue and depression are all closely connected and each very much affects the others.

Stress comes in many forms but is best defined as a response the body makes when called upon to make too many changes. Its coping mechanisms become out of balance. Apart from the many stressful demands in our daily lives, people with arthritis face the additional stress of pain, the worries of medical expenses, employment and their concerns for the future.

Symptoms of stress may include increased pain depression, fatigue, loss of appetite, difficulty in sleeping and feelings of tenseness and anxiety. They vary, of course, from person to person and from time to time. For the person with arthritis increased stress can lead to a continuing cycle of increased pain, depression and fatigue.

THE PAIN GATE

Many scientists think that the way pain control methods help reduce pain is by directly closing or blocking what is called the "pain gate". Located in the spinal cord, this "gate" can prevent pain signals from reaching the brain where they are recognised as pain. Stress and focusing on pain and fatigue, seem to keep the gate open. It appears however that even simple measures such as the use of heat or cold, physiotherapy, or even maintaining a positive attitude, can help close the gate.

Scientists have also discovered that the body can produce a morphine like (pain block) substance known as endorphins that help close the pain gate naturally. Endorphins appear to be released through massage, heat and cold, physical therapy, medications and exercise.

Again, a positive attitude also appears to play a vitally important role in their production.

BREAKING THE CYCLE

There is no one answer to the management of pain in arthritis. It will vary for each individual and may consist of a combination of several different methods at various times. The methods used may change with the disease activity, a person's lifestyle and his or her overall needs. But the cycle can nearly always be broken.

Scientific developments have led to more effective medications to control the inflammation and the pain of arthritis. Where there is severe pain from a diseased or damaged joint, its replacement can provide a totally new lease of life. For the majority of people however there are many successful pain management techniques that can be used from exercise, massage and relaxation to heat and cold treatments. These methods can help them to remain active and maintain a quality lifestyle while managing their pain in a positive manner.

A good partnership with your general practitioner and health care team will help in discussing the options most suitable for you.

MEDICATIONS

Medication may be required to assist with pain control and to reduce inflammation when it exists. Paracetamol is frequently prescribed to control pain. It has no ill effect on the stomach. It is particularly useful in non-inflammatory painful conditions like osteoarthritis if an adequate dose is used.

When a doctor finds inflammation, or paracetamol alone is inadequate, Non-Steroidal Anti-Inflammatory Drugs (NSAIDs) may be prescribed. Dosage rules may be prescribed. Dosage rules should be accurately followed as these drugs have the potential to cause damage to the stomach and gastrointestinal tract especially in people with a past history of peptic ulcer.

For severe inflammation, such as occurs in the disease rheumatoid arthritis, powerful drugs known as Slow Acting Anti-Rheumatic Drugs (SAARDs) may be prescribed. Separate pamphlets detailing the use of precautions for NSAIDs and SAARDs are available from the Arthritis Foundation.

HEAT AND COLD

Heat or cold treatments can reduce the stiffness and pain of arthritis. Physiotherapists are particularly skilled in administering different heat treatments such as Diathermy and Ultrasound. There are many effective home treatments such as warm baths or showers, heat pads, hot packs, electric blankets or even a simple hot water bottle.

Pain can sometimes be relieved by applications of cold. This is especially good for acutely inflamed joints.

Remember, it will help to talk to your doctor or your physiotherapist about the most effective and safest way to use heat or cold.

EXERCISE

Proper exercise is a vital component in an overall arthritis and pain management plan. Exercise keeps muscles strong, bones healthy and joints mobile. It stretches the joint structures to relieve stiffness and pain and maintain or restore flexibility.

People with arthritis find exercising in warm water (hydrotherapy) is particularly comfortable. Buoyancy reduces the weight of the body on the joints and the warmth helps relax muscles.

Exercising with arthritis means learning to listen to your body signals and using appropriate stretching exercises as part of a suitable fitness program. There are many exercise programs and resources available from the Arthritis Foundation.

RELAXATION

Specific relaxation techniques help reverse the effects of stress and reduce levels of pain. Relaxation needs to be practised and you may have to try several different methods before you find the one that suits you best.

Techniques from simply breathing deeply. quietening the mind and letting go of the body to using imagery (mental pictures) and visualisation can be learnt with a little guidance. There are many audio tapes and books available on this topic through the Resource Centre and opportunities for learning and practice through Arthritis Foundation courses.

MASSAGE

Massage is one of the oldest forms of therapy and can sometimes be overlooked as a useful tool. Massage by a sensitive masseur is a very effective way of relaxing muscles and reducing the pain of arthritis.

Self massage involves massaging or kneading the muscles in a painful area. You can massage stiff, tight muscles in the neck, arm or leg whilst sitting or whilst taking a bath. The use of menthol gels or "heat" rubs can make the massaging easier, produce a counter irritant to distract from the pain and increase blood flow. They do not penetrate and should always be removed before using local heat!

TAKE CARE OF YOUR JOINTS
AND SAVE ENERGY

Taking care of your joints and saving energy helps reduce pain and lessens the fatigue of stress. It means developing simple daily habits such as:

• Balancing rest with activity
• Simplifying your work
• Respecting pain
• Being aware of your body postures and working positions
• Controlling body weight
• Asking for help when necessary
• Using especially designed aids and gadgets to make tasks easier. Independent Living Centres in most capital cities display the latest aids to daily living.

SPLINTS

Splints can be especially designed by physiotherapists or occupational therapists to rest particularly painful or inflamed joints. There are also many splints available from pharmacists and surgical supply agencies.

TENS
(Transcutaneous Electrical Nerve Stimulation)

TENS is the name given to any form of transcutaneous electrical stimulation. A TENS unit is a small battery operated apparatus that stimulates nerves in the painful area by low level electrical impulses. Different forms of TENS units have been developed and are used specifically by physiotherapists. Various units for use in the home are also available commercially. It is advisable to discuss their use with your doctor before buying one.

ACUPUNCTURE

Acupuncture is an ancient Chinese therapy which many orthodox medical practitioners now administer. A lot of people have found it a useful form of pain management.

SURGERY

Most people with arthritis will never have surgery. However, the simple procedure of arthroscopy is now available to allow the surgeon to view and repair the inside of a joint. Where joints are more severely damaged, joint replacement can effectively relieve pain and restore movement.

YOUR PAIN AND STRESS
MANAGEMENT PLAN

There are many options available to people with arthritis to help them set up a successful Pain and Stress Management Plan. It is always important to remember that keeping a positive attitude and becoming well informed about all the choices available is the best way to set yourself up to become a successful self-manager.

Your Health Care Team of doctors, specialists, community nurses, physiotherapists, occupational therapists, podiatrists and pharmacists all have skills and knowledge to help you make your informed treatment choices.

Pain Clinics, in most major hospitals bring together a network of specialists, counsellors and technologies that focus on expert pain.

Community Health Centres and other agencies in your area conduct stress management and relaxation classes.