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What is arthritis pain?
The two most common forms of arthritis are osteoarthritis and rheumatoid arthritis (RA). Osteoarthritis is a type of arthritis caused by the breakdown of cartilage. Cartilage is a flexible type of tissue in joints that normally "cushions" the ends of the bones that make up a joint and helps the joint move more easily. In osteoarthritis, damage to cartilage impairs its function and leads to joint pain and stiffness.
RA is a chronic autoimmune disease that causes inflammation and deformity of the joints. Other problems throughout the body (systemic problems) may also develop, including inflammation of blood vessels (vasculitis), the development of bumps (called rheumatoid nodules) in various parts of the body, lung disease, blood disorders and weakening of the bones (osteoporosis).
What causes arthritis pain?
Pain is the body's warning system, alerting you something is wrong. The pain of arthritis has different causes, including irritation of joint tissue, irritation of joint tendons or ligaments muscle strain and fatigue. How these factors are combined contributes to the intensity of the pain.
The pain of arthritis varies greatly from person to person for reasons that doctors do not yet understand. Swelling within the joint, the amount of inflammation (which causes heat and redness) and damage within the joint are factors that may contribute to pain. Activity also can affect joint pain. If you have osteoarthritis, your joints are most likely to hurt after periods of inactivity (for example, when you get up in the morning) or after prolonged overuse.
Everyone has a different level of tolerance for pain. Even in the same person, this tolerance can vary at different times of the day. Factors affecting tolerance include depression, anxiety and hypersensitivity at the affected joints due to inflammation and tissue injury.
Using heat and cold for arthritis pain
For short-term pain relief try applying heat or cold to the aching joint. The decision to use either heat or cold for arthritis pain depends on what's causing your pain and how well you respond to each method. You should discuss this with your doctor or physical therapist before deciding if this will work for you.
Applying heat relaxes muscles and helps relieve aches due in part to muscle tension. It also stimulates blood circulation, which helps irritated tissues heal. In contrast, application of something cold to a joint numbs the area and, thus, reduces pain.
To apply heat, you can soak in a warm bath, Jacuzzi or whirlpool, or take a warm shower. You can use an electric blanket at night and turn it up higher just before getting out of bed, to reduce morning stiffness. You also can use a hot water bottle or hot pack wrapped in a towel on painful joints. Be sure to avoid being burned by not getting the heat source too hot, by leaving it on for only 15 minutes or less, and by using the towel as a protective layer for your skin.
To apply cold, get a cold pack from the drugstore or wrap a towel around a bag of frozen vegetables, then place it on the painful joint. Leave it on for only 15 minutes or less, and be sure to protect your skin. If you have poor circulation, diabetes, nerve disease or Raynaud's syndrome, don't use cold for arthritis pain. Raynaud's syndrome is a widespread constriction of small arteries that are aggravated by cold. Poor blood supply can lead to ulcerations or even gangrene.
Reducing pain by reducing stress
Stress can be caused not only by troublesome situations, but also by happy yet demanding occasions (such as a wedding) or by a common ailment like a cold. When you can, eliminate causes of stress (get a flu shot to reduce your chances of getting the flu, leave work before or after rush hour). Other causes of stress can't be avoided. In these cases, relaxation techniques may help.
Relaxation techniques are most effective if you choose a quiet time and place where you won't be interrupted and make yourself as comfortable as possible. Try breathing deeply, deliberately tighten and release different muscle groups one by one, starting from your feet and lower legs and working up. Imagine yourself in your favorite setting doing your favorite activity, and allow yourself to enjoy the positive feelings associated with this place and activity. Relaxation audiotapes and videos describing these and other techniques can help you get the most out of relaxation.
Reducing pain by reducing fatigue of rheumatoid arthritis
Being overtired can make it harder for you to cope with arthritis pain and can even increase your pain. Make sure you get enough sleep. A nap during the day may help too. Look critically at the things you feel you have to do and see if they really all need to be done today, or if there are ways your family, friends or colleagues can help you. Joining a support group for people with arthritis may help to ease feelings of isolation or frustration if you are experiencing them.
Exercise regularly and appropriately, and follow an evening routine that helps you relax and feel ready for sleep. These measures help increase your energy level and give you better sleep. During the day, pace yourself by balancing periods of activity with periods of rest or at least less physically demanding activity.
Preventing pain by protecting your joints
Joint protection strategies can help you minimize or avoid pain caused by overusing a joint. When a joint is more painful than usual, take that as a sign that you have overdone it. Next time you're in the same situation, look for another way to get your task done or ask for help. Stand or sit up straight to keep your joints in optimal positions. Don't stay in one position too long before getting up and gently stretching to avoid stiffness.
Use your stronger and larger joints for weight-bearing tasks. If you have to carry an object, don't do it by putting all the weight on your fingertips. Use your forearm instead. Cut back on prolonged activities that you know are going to put too much stress on your joints, or take more frequent rests - for example, during a long walk.
Exercise as your doctor or physical therapist tells you so you can keep your muscles strong, since muscle fatigue contributes to pain and discomfort, and leaves you less able to cope. Range of motion exercises may help. These exercises involve moving your joints gently through their range of motion. They help keep joints mobile and strengthen the muscles around a joint, thus preventing pain. Speak with your doctor or physical therapist to see if they may benefit you.
Reducing joint stress (and pain) of rheumatoid arthritis by making daily life easier
Assistive devices can make ordinary tasks easier and help you avoid putting stress on your joints. These devices can be purchased at medical or home-health supply stores, or (in some cases) made at home. Ask your doctor or physical therapist for help if you need more information about what types of assistive devices are available or how to find them.
Besides taking advantage of assistive devices, there are a number of ways you can make your daily routine easier and less stressful for your joints. Here are a few strategies to think about:
- Holding a pen or pencil is easier if it has a built-up grip. You can buy large-grip pens and rubber grips for pencils. Or you can wrap a rubber band around a pen or pencil.
- "Reachers" are long-handled devices that help you extend your reach. Depending on how they are designed, they can help you reach down to pick up paper, small items or metal items on the floor, or they can help you reach up to get hanging objects.
- Instead of trying to manipulate a dust cloth, try a dust sock. Spray the sock with furniture polish (or just dampen it with water) and pull it over your hand, then dust without curling your fingers.
- Consider replacing your traditional doorknobs with lever handles - they are easier to open. Lever faucets are also easier to turn than the traditional kind.
- If you drop pins when sewing, use a magnetized reacher to pick them up. You can make your own by gluing a magnet to the end of a yardstick.
- If you are sewing a button back on, tape it in place first with Scotch tape. That way, you don't have to hold it in place while you're sewing it back on.
- When threading a needle, stick it in a stiff lump of children's clay (still in the container) to hold it still for threading. Put it on the counter at eye level. You can also use an apple, banana or potato if you don't have clay and discard it afterwards.
- If you have trouble holding the handles of brooms, shovels, rakes and mops, buy some foam pipe insulation at a hardware store, slip it over the handles, and tape or rubber-band it in place.
- Hang your necklaces on a closet tie or belt rack to avoid having to untangle them in the jewelry box.
Keeping a positive attitude
Perhaps the most effective self-care strategy is focusing on the things you enjoy rather than on the limitations of arthritis. If you believe in your ability to cope with arthritis -- and you don't hesitate to ask for support when you need it -- you are more likely to find yourself to be more resourceful than you ever knew you were in maintaining the interests, activities and lifestyle you want to have without being stopped by arthritis.
This article was reviewed and updated June 2007.
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