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Pain Management

Pain Management

What is pain? 

Pain is something you feel physically and emotionally – it is not pleasant and is due to a perception of real or potential damage to your body. 

How does your body process pain?

While pain may start at different places in your body, all pain is perceived and processed by your brain. Pain is your body’s warning system alerting you to harm. The pain signal travels through your nerves (usually - but not always - starting from those nerves close to the source of harm), up your spinal cord to your brain. Your brain then interprets the pain signal based on its intensity and location, as well as a variety of other information such as your surroundings, previous injury experience, your beliefs, your emotional state, and many other factors. You feel the pain after your brain has processed all of this information.

Pain is personal

When your brain processes a pain signal, it considers many factors that are personal to you. As a result, you feel pain differently from everyone else - even from people who may have the same disease or injury as you. Just like your experience with arthritis can be very different from someone else’s, the same goes for the pain you experience. This also means that pain treatments (including medications and other interventions) that work for one person may not work for another, or may work differently.

There is a strong mind-body connection in pain. Your emotions and thoughts play a large role in how you experience pain, and pain can affect all aspects of your life

Types of pain

Acute pain is short-term pain that serves to protect you and prevents more damage by changing your behavior. Some examples are pain because of an injury, surgery, or a toothache. Usually this pain goes away when the damaged part of your body heals or no longer needs protection, or the unpleasant stimulus has been removed.

Chronic pain (also called persistent pain) lasts longer than acute pain, typically for more than three months. People who live with chronic diseases often live with chronic pain. This type of pain does not necessarily mean that damage is occurring – even though it might feel that way. While chronic pain is not fully understood, we know that it is sometimes caused by a problem with one or more nerves and the way they send pain messages to the brain.

Some people with chronic pain also experience ‘pain sensitization,’ which is basically your body turning up the volume on your pain and distorting it. This often leads to a heightened sensitivity to pain and touch. 

For more information on pain sensitization and ways to help ‘turn down the volume’, visit our online module “Managing Chronic Pain”. 

When you live with chronic pain, you are seldom entirely without pain, but you will have good days when you feel less pain and bad days when you feel more. Pacing yourself and your activities and tracking how you feel from day to day will help you learn to understand your pain. These approaches will also help you maintain a schedule so you can better predict what your days with pain will be like. 

To help keep track of your symptoms and get a handle on your pain, try our “Daily Symptom Tracker”.

Where does arthritis pain come from?

While we continue to study the mechanisms of pain in the body, we know that most arthritis pain typically arises from one or more of these sources:

  • Inflammation – pressure on nerves in and around joints due to swelling
  • Joint damage – damage to tissues in and around joints, nerves and/or surrounding tissues due to injury or prolonged inflammation
  • Pain sensitization – prolonged pain can lead the body to send pain signals to the brain, even in the absence of a specific ongoing pain source

Some of the factors that can contribute to your experience of arthritis pain – how it feels to you – include:

  • Physical activity – joint strain from either excessive or insufficient physical activity
  • Muscle tension – muscles may be tense because of stress, insufficient physical activity or poor posture
  • Fatigue – exhaustion from managing chronic pain, lack of mobility or poor sleep due to pain can erode coping skills
  • Anxiety and/or depression – stress and low mood can increase the perception of pain and decrease your capacity to cope
  • Too much focus on pain – strong body-mind connection means that focusing on your pain can increase pain sensitivity and reduce coping skills
  • Attitude and belief system – your outlook on life can directly impact the level of pain you experience, and your ability to cope with it
  • Social environment and support – people who feel the support and understanding of strong family and social networks feel less overwhelmed and better able to cope with their pain than people without that support

The pain cycle

Chronic pain may be affected by the following:

  • Physical problems caused by injury, disease or surgery
  • Tense muscles (which may actually be your body’s reaction to protect injured joints)
  • Psychological stress
  • Depression or other negative emotions and feelings
  • Fatigue
Pain.png

Your experience of pain is influenced by the factors above – as they feed into one another, they can prolong and amplify your pain. If you are able to break the cycle by addressing even one or two of the factors, it is possible to achieve some significant relief from your pain. We will focus next on items that can help you manage your pain.

No one knows your pain as well as you. While different health care professionals may help, you are the best person to manage your pain: to know when a treatment is working or not working, and to know when to reach out for help. You may find it useful to track your symptoms, pace yourself, and try different approaches to managing your pain.

Each treatment strategy may work differently based on the type of pain you are experiencing, or the type of arthritis you have. We have divided this section into short-term pain relief and long-term pain management strategies to help you understand the options. Short-term pain relief is meant to reduce the pain intensity you are experiencing at that moment, while long-term pain management aims to reduce the effects of pain with time, which requires you to be involved and committed.

Short-term pain relief strategies


Heat

Heat can be used to relax tight muscles with hot packs, warm baths/showers, a heating pad or electric blanket, or a hot water bottle. Heat should not be used on an inflamed joint. 

Cold

Cold can be used to decrease inflammation of an inflamed joint (unlike heat) with gel packs, a bag of ice cubes, or a pack of frozen vegetables or fruit (do not eat after use). Cold compresses must not be applied directly to your skin, so make sure there is a layer of clothing or a towel between your skin and the compress.

For more information about using heat and cold therapy, check our online resource Managing Chronic Pain.

Visualization

Visualization is about redirecting your attention to a positive memory or sensation, which may trigger the release of endorphins – your body’s natural pain relievers. Examples include remembering all of the details around a favorite picture (where it was taken, what happened, etc.) or imagining yourself picking your favorite fruit, carefully choosing it, examining its texture, how it smells, cutting it up, eating and tasting it.

Distraction

Like visualization, distraction shifts your attention from pain to another topic, taking advantage of the fact that your mind has trouble focusing on more than one thing at a time. The goal is to occupy your brain with a detailed task. Some examples of distraction might include counting in multiples of an odd number, remembering all the words of a song, reciting the alphabet backwards, etc. Remember not to ignore your pain completely since it also protects you from harm.

Muscle relaxation

Muscle relaxation reduces pain by releasing tension and helps you sleep well. To learn more about muscle relaxation principles and some exercises, check out Managing Chronic Pain

Massage therapy

A registered massage therapist uses techniques to work on muscle and other soft tissue to help your muscles relax and feel better, and improve blood flow which can aid with healing. 

Acupuncture

Acupuncture, a form of traditional Chinese medicine, includes stimulation of specific points on the body by inserting thin needles through the skin. If you choose this type of treatment, make sure that you visit a trained professional who uses sterile needles. 

TENS Therapy

A TENS device (short for Transcutaneous Electrical Nerve Stimulation) uses small electrodes placed on the body to stimulate muscle and nerve tissues, helping increase blood flow and reduce pain. Often administered by a physiotherapist or other health practitioner, it can also be performed at home by experienced users.

Long-term pain management strategies

Long-term pain management strategies aim to reduce the effects of pain over time, which requires you to be involved and committed.

Physical Activity/Exercise

Pain may cause you to avoid physical activity, out of fear of re-injury, or because movement makes your pain worse, or because you are tired.

There are many benefits to physical activity/ exercise if you are living with chronic pain. A regular routine can increase your strength, your energy and your flexibility. Research shows that physical activity helps people manage their pain.

Getting started
There are a few basic principles that will help you get started:

  1. Consult with your health care team about physical activity/ exercise that will work for you given your personal situation
  2. Start slowly and pace yourself
  3. Find activities you enjoy since you are more likely to stick with these in the long term
  4. Exercise with a friend
  5. Remember to warm up before exercise and cool down afterwards


Setting achievable goals related to physical activity will help you gain some control over your pain. For more information on setting goals, check out Managing Chronic Pain.

Types of Physical Activity/ Exercise
There are three major types of physical activities/exercise, and all are important. Depending on your needs and abilities, you may emphasize one type over another – a physiotherapist or other health care professional can help you determine your specific needs.

Stretching & range of motion
These exercises are especially important for people with arthritis and/or chronic pain as they are at greater risk of losing flexibility. These exercises should be done daily and can help reduce morning stiffness if completed upon waking or right after a bath or shower. While you may have to limit the range of motion of an inflamed joint when you are experiencing a flare, these exercises do help circulation and the maintenance of joint mobility. 

Strengthening
These exercises use resistance to increase muscle strength and control as well as bone strength, and help reduce the risk of injury. These are important for posture and joint protection. 

Endurance or aerobic
These are exercises that increase your heart rate and involve the use of large muscle groups in rhythmic or repetitive movements. These exercises also make you breathe faster and work harder than you normally do throughout the day. 

For tips on all three of these activity types along with some specific examples of exercises, check out Managing Chronic Pain

If you have arthritis
While activity is important, always listen to your body, especially if you are experiencing a flare or if a specific joint or area is swollen or inflamed. A rule of thumb is that if your arthritis pain is greater two hours after physical activity, you have probably overdone it. Rather than stopping the activity altogether, the next time that you do the activity, cut back on the intensity and/or the amount of time spend on the activity and listen to your body again. A good rule of thumb in deciding on the level of intensity of exercise is to “start low and go slow.” Remember that you know your body best and it’s important to listen to the signals it sends you.

Posture

Proper posture and positioning help prevent pain and are important especially when you tend to stay in one position for long periods of time. 

Meditation/mindfulness

Meditation seeks to bring clarity and tranquillity to the mind and body to achieve a heightened level of awareness. Mindfulness is a key aspect of meditation that focuses one's awareness on the present moment, while calmly acknowledging and accepting one's feelings, thoughts, and bodily sensations.

You can learn more about mindfulness-based stress reduction and chronic pain here.

Surgery

Surgery may be an option to help lessen pain and restore function when joints have been severely damaged by arthritis. This is a decision that you will make together with your health care professional(s).

Short-term pain relief & long-term pain management strategies

Physical therapy

Physiotherapists and/or occupational therapists work with you to help your symptoms, pain, and mobility, prescribe exercises (to reduce stiffness, increase strength, gain energy and improve fitness), advise on activities (to decrease stress on joints), and recommend tools and devices (to support and protect joints).

Spinal manipulation (chiropractic)

This technique is applied using hands or a device to generate a specific amount of force to a joint to restore joint mobility, with the goals of relieving pain and improving function. This treatment should only be provided by a trained health care professional.  

Joint protection

Joint protection may include wearing splints and braces or using assistive devices to help with gripping and reaching, decrease pain, slow the progression of joint damage and deformity, and make everyday tasks easier.

Other strategies

There are many unconventional treatments advertised (particularly online) that claim to help with chronic pain, though these generally have little or no scientific evidence about their effectiveness. Before you try these types of treatments, it is important to seek guidance from your doctor or another health care professional.

Medications for pain relief

Medications can be very important in helping you manage your arthritis and chronic pain. Your doctor or pharmacist will work with you to ensure you are on the most appropriate medications for your circumstances. Do not ignore severe and/or prolonged joint pain as it may be a sign that you have inflammation or damage that requires medical attention.

NOTE: To learn more about specific medications, check out Arthritis Medications: A Reference Guide

Non-prescription medicines

These are also called over-the-counter or OTC medicines since you can buy them without a doctor’s prescription. If you are frequently using OTC pain relievers, talk to your doctor or pharmacist. Just because you do not need a prescription for OTC pain relievers, this does not mean they are less harmful and it is important to never exceed the recommended dosages. You can also read more about nonprescription medications here

Prescription medicines

Sometimes OTC medications do not work well enough to treat your arthritis pain. If you and your doctor determine that is the case you may be prescribed another type of pain medication, such as a non-steroidal anti-inflammatory drug (NSAID). These medications may be more effective, but also have risks, especially after prolonged use. You can read more about these types of medications here.

Questions to ask

Speak with your doctor or pharmacist about the medication that is most appropriate for you. While you might not have time at your doctor’s appointment to get answers to all the questions you have about your medication(s), your pharmacist has specialized knowledge about medications and will be able to answer many of your questions. For a list of questions to consider asking your pharmacist, check out Managing Chronic Pain.

Who you can talk to about your arthritis pain

There are many health care professionals in addition to your doctor and your pharmacist that you may wish to talk to about your arthritis pain. These may include an occupational therapist, physiotherapist,  or counselor. Depending on where you live, you may also be able to access a pain clinic, which is a clinic that is typically led by a specialist such as an anesthesiologist who focuses on treating pain. You may also find it helpful to join a support group to talk to others who live with chronic pain, and learn more from them about their successful coping strategies. 

The Arthritis Society offers Chronic Pain Management Workshops, which expand on these tips, and offer an opportunity to connect with others who are dealing with similar challenges. For more information, and to find a workshop.