Dealing with pain

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Living with pain can be one of the hardest parts of having arthritis. The information below been written for you to understand the pain cycle and learn techniques that may help you cope with pain. Sources of further information are also included.

What causes pain?
Arthritis pain can be caused by:

• inflammation, the process that causes heat and swelling in your joints
• damage to the joints
• muscle tension, from trying to protect joints from painful movements.

For some conditions, such as fibromyalgia, the cause of the pain is not fully understood.

The pain cycle
Pain, stress, fatigue (tiredness) and depression all affect each other. For example, people who feel depressed or anxious have been found to be more sensitive to pain. This can make your pain feel worse, which can lead to a continuing cycle of fatigue and depression. The good news is that this pain cycle can be broken by using some of the strategies described below.

What can I do to manage my pain?
Pain may limit some of the things you do, but it doesn’t have to control your life. Your mind plays an important role in how you feel pain. Thinking of pain as a signal to take positive action rather than being scared or worried about it can be helpful. Also you can learn ways to manage your pain. What works for one person may not work for another, so you may have to try different techniques until you find what works best for you. Here are some things you can try:

Take medicines wisely. Many different types of medicines can help control the pain of arthritis. Your doctor or pharmacist can help you understand which medicines are right for you and how best to use them. See the Medicines and arthritis information sheet.

•Exercise. Research has shown that regular appropriate exercise can help reduce pain. It also keeps your joints moving, strengthens muscles to support your joints, reduces stress and improves sleep. A health professional (such as a physiotherapist) or your doctor can help you work out a program suitable for you. See the Pysical Activity information sheet.

•Use heat and cold.
The benefits of heat and cold for arthritis are yet to be proven by research. However these treatments are soothing and safe when used carefully. Heat relaxes your muscles and stimulates blood circulation. You could try a warm bath, or place a heat pack or hot water bottle over the painful area for 15 minutes. Cold numbs the painful area and reduces swelling. Applying cold treatments, such as ice packs, to the painful area for 15 minutes may be especially useful for hot, swollen joints, such as during a ‘flare’. You can repeat heat or cold treatments throughout the day. Make sure the temperature of your skin has returned to normal before re-applying, to prevent any tissue damage. Ask your doctor or physiotherapist whether heat or cold is best for you.

•Take care of your joints and save energy.
Looking after your joints during your daily activities can help reduce pain, stress and tiredness. It involves simple habits such as:
- avoiding activities that cause pain
- asking for help when you need it
- using special aids and gadgets to make tasks easier.
See the Saving energy information sheet.

•Massage. There are limited scientific studies that show massage reduces arthritis pain. However many people with arthritis find it a useful way to relax and reduce muscle tension. Make sure the massage therapist has experience working with people who have arthritis. You can find a qualified therapist by contacting the Australian Association of Massage Therapists at www.aamt.com.au or 1300 138 872, or the Institute of Registered Myotherapists of Australia at www.myotherapy.org.au or (03) 9418 3913.

•Acupuncture. Acupuncture is an ancient Chinese practice of putting small, thin needles into the skin at specific points on the body to block the pain signal. There are mixed results from studies of acupuncture for arthritis. However some people may find it useful alongside other proven treatments, such as medicines. The Australian Acupuncture and Chinese Medicine Association can help you find an accredited practitioner at www.acupuncture.org.au or 1300 725 334.

Transcutaneous electrical nerve stimulation (TENS). A TENS machine applies very mild electric pulses to block pain messages going from the painful area to your brain. TENS can be very useful for longer-term pain but does not work for all people. You should see a physiotherapist to trial a TENS machine, and to learn how to use it correctly, before you buy one.

• Mind techniques
- Relaxation: Relaxation techniques, such as deep breathing and visualisation (mental pictures), can help you reduce stress and muscle tension. These techniques need to be practised and you may have to try several methods before you find one that works for you. There are many CDs and books available from your local Arthritis Office or library to help you learn relaxation techniques.
- Distraction: Focusing your attention on something other than your pain can also help you cope with pain. This might involve exercising, reading, listening to music or other methods to take your mind away from your pain. Contact your local Arthritis Office for details of self management courses that can teach you these techniques. You may also find it useful to see a psychologist to learn other mind techniques to help you cope with pain. To find a psychologist contact the Australian Psychological Society on 1800 333 497 or visit www.psychology.org.au

There may not be a cure for your pain but you can learn to manage it. Try different techniques to find what works best for you.

To find a physiotherapist, talk to your doctor, see the Australian Physiotherapy Association website at www.physiotherapy.asn.au or look under ‘Physiotherapist’ in the Yellow Pages.

Books
Bernstein, Susan 2003, The Arthritis Foundation’s guide to pain management, Arthritis Foundation of America, Atlanta, GA.
Nicholas, Michael 2006, Manage your pain: Practical and positive ways of adapting to chronic pain, ABC Books, Sydney.

Websites
The Arthritis Research Campaign (UK) www.arc.org.uk
Arthritis Foundation (US) www.arthritis.org