Pain?! If we have arthritis, or think we have it, we are inclined to think that the sole cause of our pain is "inflammation." Sometimes, this belief is further reinforced when the only treatment offered by our doctor is an "anti-inflammatory" medication. This assumption is not always a correct one.

  In the beginning, pain can be a friend because it signals something is wrong. But as time passes, the chronic nature and unpredictability of pain symptoms can make life miserable and seem out of control. The optimistic attitude we once had turns into frustration and hopelessness, so medication can seem like the answer. If we take over-the-counter pain medication or anti-inflammatories without understanding the reasons for the pain, we are only masking symptoms and not addressing the progressive nature of the disease. To make matters worse, anti-inflammatory medications do not alter the actual disease progression of arthritis.

  So, let's start at the beginning.

Causes of Arthritis Pain

   Pain caused by arthritis really comes from several sources. Understanding these sources can help us make informed day-to-day decisions, so we can live more comfortably and more actively and have more control over arthritis. In short, it can make us better arthritis "managers."

  The first source of arthritis pain, of which we are all painfully aware, is a result of the disease process or joint damage. In each major form of arthritis, however, a different joint tissue is involved.

  In rheumatoid arthritis, for example, the problem is chiefly "synovitis," or the inflammation of the synovial lining in the joint. Left unchecked, this inflammation can lead to further damage, mainly to precious cartilage, tendons and other soft-tissue structures. This inflammation must be reduced with medication. To preserve joint function, a treatment program should include joint protection, appropriate exercise, rest, heat and cold applications, and management of stress and depression.

  In ankylosing spondylitis, inflammation results where ligaments and tendons attach to the bone of the spine and to adjacent joints. This inflammation needs to be suppressed with medication, along with a regular and vigorous stretching program.

  On the other hand, osteoarthritis, also called "degenerative arthritis," is a problem of breakdown of the cartilage within the joint. Little, if any, inflammation exists. Osteoarthritis is helped by proper exercise and use of joints, and by making many of the lifestyle alterations recommended for the management of rheumatoid arthritis.

  Gout, another form of arthritis, can be controlled through changes in diet and with medication that corrects uric acid levels in the blood. As we see, each form of arthritis is different; pain management techniques and disease treatments differ depending on the kind and severity of the arthritis.

  But the different forms of arthritis aren't the only pain culprits. Another type of pain can be caused by weak or tense muscles. Although it is a natural response for the body to "favor" an injured or arthritic joint in an effort to protect it, this causes our muscles to become smaller and weaker. This weakness leads to further joint instability, and pain. To make matters worse, favoring a joint forces other joints to take on the extra load, thus increasing the stress on those joints, too.

  Other factors can cause pain in the arthritis patient as well. Increased pain can result when we believe we can "beat" or "ignore" arthritis. Many times, we do too much or we don't care for ourselves and our joints as well as we should, causing increased swelling, more joint damage and, therefore, more pain.

  Finally, fear and depression can increase arthritis pain. When we are afraid and depressed, everything seems worse.
Now that we understand that there are many causes of arthritis pain, the question becomes: How do we deal with it?

Pain Management Techniques

   In order to effectively manage arthritis pain, first you have to know what to do, and then you have to know when to do it.
Many times this means going to the doctor and being prepared to discuss the problem, ask questions and be involved with planning your treatment program. Professionals who focus on the management of arthritis usually will offer several techniques simultaneously to achieve the best possible results for short-term pain relief and long-term benefit.

  In addition to seeking medical attention, there are many other things we can do on our own to outsmart arthritis. In fact, your full participation is imperative if you want to live with arthritis successfully.

  Most of us realize that exercise is good for us, but people with arthritis are often unsure as to exactly what kind of exercise will help, how many repetitions to do, and how to exercise to reduce pain.

  Although aerobic exercises like walking, bicycling and swimming are important for good health, joints need full stretching movements to keep them flexible and strong. Range-of-motion exercises help maintain joint movement, relieve stiffness and restore flexibility. Done daily, they also help make muscles stronger.

  The key to success is gentle and regular exercise. It is possible to start your own exercise program, but it can be very helpful to begin by visiting with a physical therapist or an exercise trainer to ensure that the type and amount of exercise done is right for you. The best time to exercise is when you have the least pain and stiffness, and when you are not tired. Stiffness and fatigue go hand in hand with pain. It is our job to keep stiffness and fatigue in check. However, left unmanaged, they result in a vicious cycle, which can lead to more pain. For that reason, how you perform daily living activities is important as well. If done improperly, any activity can lead to joint abuse and destruction.

  There are times, however, when the quality of a person's life is so affected by the pain of arthritis that no amount of planning and rearranging of their lifestyle will relieve pain and immobility. That's when it's time to consider surgical correction. Surgical options for arthritis patients offer them the independence to perform again--to dance, to golf, to do what they did before, many times completely without pain.

  Successful management of arthritis is a multifaceted challenge and requires a well-rounded understanding in many areas to implement effective solutions. Management can be simplified through learning as much as possible and becoming a skillful communicator about our feelings and needs. It's our commitment to ourselves that leads us to workable answers and lifelong independence.

About the author:
Jan Revella, R.N., arthritis nurse specialist, is founder and director of Arthritis Education by Professionals, Inc., based in Phoenix, Arizona. She is among the most prominent speakers and educators on the subject of arthritis in the United States. Her mission is to empower people with arthritis to use knowledge as power when making decisions about their personal healthcare. Arthritis Education by Professionals, Inc. provides educational programs and services to people with arthritis.

7 Pain Management Tips

1. Respect pain.
2. Become aware of body position. Good posture makes a difference.
3. Control your weight.
4. Avoid remaining in one position for long periods; move frequently.
5. Find balance between rest and activity. It's OK to take a break.
6. Simplify daily chores by using assistive devices, and ease the strain through proper planning.
7. Ask for help when you need it.

Assistive Devices Lend a Helping Hand

  Assistive devices are products that make everyday tasks easier for people with arthritis and help protect your joints. Whether it's opening a tight jar or reaching a can on the top shelf, there is a handy device to help. For example:

Fingers/Thumbs
Doorknob turner
Electric scissors
Electric can opener
Fat-handled silverware
Jar opener
Playing card holder
Automatic card shuffler
Lamp switch adapter
Car door opener
Pop-top opener for soda cans
Key turner

Hips/Knees
Cane
Long-handled:
   Brush/comb
   Cleaning brush
   Dustpan
   Grabber/reacher
   Shoehorn
Dressing stick
Portable cushions
Sock aid
Shoe remover
Elastic shoelaces
Leg lifter
Bedcover pull-up

Back/Neck
Cane
Armrests
Lumbar roll
Elevated TV stand
Prism glasses to read or watch TV while lying flat
Adjustable writing board
Cervical pillow
Back and seat support for car
Swivel cushion for car seat
Foot rest

These products and more are carried by a variety of companies, including Functional Solutions/Independent Living Products:
(602) 249-0455, 1-800-377-8033 or www.ilp-online.com.
To find more companies, search the Web using the keywords "assistive devices" or "independent living products."

© Copyright 2005. Arthritis Education by Professionals, Inc.