What is pain?

Pain is usually a protective mechanism that alerts your brain when your body is being harmed in some way. The nerves in that area send signals through the spinal cord to the brain. The brain locates the injury and triggers a healing process.

Pain signals may be triggered by:

• physical injury or damage to your body – for example, a sprained ankle or damage that occurs as part of a longer-term condition such as osteoarthritis
• chemicals produced within the body itself that can irritate the nerve endings – this may be linked to an infection, an overuse injury or a flare-up of a long-term illness such as rheumatoid arthritis
• damage to nerves that causes them to be more sensitive to pain signals and even non-painful stimuli that now can cause pain. This type of “nerve” pain is known as neuropathic pain.

Analgesics or pain-relieving medications can be taken to reduce the experience of pain by blocking or reducing pain signals to the brain.

Pain can be complex as it does not occur in isolation, but is influenced by many things such as stress, your mood (anxiety and depression),  and your past experiences. For example, people who are depressed are more sensitive to pain. And the presence of poorly controlled long-term pain increases the risk of becoming depressed.

What is long-term pain?

Doctors define long-term (or ‘chronic’) pain as pain that’s lasted for more than 12 weeks or that’s lasted for longer than would be expected for the type of injury or level of damage.

For people living with RA, your RA is the potential cause of ongoing pain and so it is important to not only relieve your pain, but also manage your underlying condition to minimise inflammation and damage to your joints.

Because our bodies are ‘programmed’ to understand pain as a warning sign, our natural reaction is often to protect the affected area from further harm – perhaps by resting it completely, by using it less than usual or by supporting it.

After a time, lack of use leads to weakening of the muscles. As we become less fit, we tire more easily and become more prone to strains and sprains, resulting in further pain. This can easily become a vicious circle.

This is why remaining active and getting help with a safe exercise program is an important part of managing your RA. A physiotherapist or exercise physiologist will be able to help you.

How can pain affect you?

Other problems linked to long-term pain may include:

• sleep problems
• reduced physical activity
• difficulty with everyday activities
• reduced involvement in family and social activities
• difficulty concentrating or remembering things
• symptoms such as fatigue or weight gain
• side-effects from medications
• missing work, difficulties at work, or having to retire early
• changes in your relationships or sex life.

Your rheumatologist, GP and extended healthcare team can help you manage and cope with the different aspects of long-term pain. So ask for their help

Pain medications

Most of the medicines used to treat pain from rheumatoid arthritis fall into one of the following categories:

• analgesics or pain releivers
• non-steroidal anti-inflammatory drugs
• corticosteroids
• Disease modifying anti-rheumatic drugs (DMARDs)

Finding the right pain medications is about striking a balance between the benefits and the possible side-effects. These will vary from person to person and will also depend on how long they’re used for. 

Adapted with thanks from Versus Arthritis.