Understanding Chronic Pain
Long-lasting pain can affect all aspects of your life – but relief is possible.
Chronic pain – a common problem for people with arthritis and other rheumatic conditions like fibromyalgia – doesn’t just hurt. It can drain your ability to work, enjoy life and be active. Often, it leads to ongoing problems with sleep, fatigue, depression and anxiety. These factors interconnect, such that difficulties with any of them make the others worse.
People with arthritis can have both acute and chronic pain. Acute pain happens when you have an active injury; it lasts for days or weeks until the injury is healed. Chronic pain persists for three months or longer. A flaring knee joint, for example, can cause acute pain, but the same person may have issues with pain, fatigue and low function for months or years after that joint quiets down.
Ongoing disease can cause ongoing pain. “If inflammation in the joints continues and is not controlled, individuals can continue to experience pain, from the inflammation itself, the damage it’s causing or both,” explains Yvonne C. Lee, MD, assistant professor of medicine at Brigham and Women’s Hospital in Boston.
It’s also possible that, if disease is controlled but has left permanent joint damage, that damage may also contribute to chronic pain, though Lee notes scientists are still working to understand this aspect of chronic pain.
Other Ways Pain Becomes Chronic
Scientists think, in some people, acute pain sensitizes the central nervous system and leads to chronic pain.
“We still don’t fully understand how acute pain becomes chronic, but it’s thought that an untreated acute stimulus, such as pain, inflammation or both may lead to changes in the way the brain and spinal cord regulate pain,” explains Lee. “These changes may cause individuals to feel pain even in the absence of an obvious reason, such as tissue damage.”
Many factors besides inflammation and joint damage go into the development of chronic pain in arthritis. People’s emotions and psychology, for example, can also contribute.
Depression and anxiety can amp up physical sensations, worsening pain and its effects on function. If you have issues with anxiety or a tendency to focus on the worst case scenario (psychologists call this catastrophizing), you’re more likely to develop chronic pain, more intense pain and have a harder time coping with it.
There are likely many other contributing factors, says Anne-Marie Malfait, MD, PhD, professor of medicine and biochemistry at Rush University Medical Center in Chicago. Studies consistently show, for example, the amount of joint damage in people with osteoarthritis (OA) doesn’t always match how much pain they feel.
Dr. Malfait, who heads a lab studying pain pathways in OA, thinks it’s possible the difference may lie in the levels of soft tissue damage in some people – damage that’s too subtle to show up on X-ray.
Getting arthritis under control is the first step in treating chronic pain. The next is working with your doctors and other specialists to develop a comprehensive pain management plan targeting the unique factors influencing your chronic pain.
“Pain is often multifactorial in origin. Thus, I think it is important for physicians to separately identify each possible cause of pain, rather than assuming all pain is a symptom of the rheumatic disease,” says Dr. Lee.
In addition to arthritis medications, such a plan might include drugs or other treatments designed specifically to treat pain, sleep or mood; complementary or alternative therapies; and talk therapy.
Improve sleep. Sleep problems are common among people with rheumatic diseases. Pain can disturb sleep, and vice versa. Practicing good sleep hygiene – avoiding caffeine, alcohol and screen time before bed, for example – can improve sleep.
Track pain and its effects. Keeping track of when pain strikes and how it affects you may help you and your doctor pinpoint causes and solutions. You can use a notebook or one of the many available online tools or smartphone apps.
Work on the mind-body connection. Cognitive behavioral therapy (CBT) – talk therapy aimed at changing negative thought patterns – can ease chronic pain in arthritis and fibromyalgia. Mind-body activities, such as tai chi or yoga, may also reduce discomfort in people with musculoskeletal conditions.
Consider a multidisciplinary plain clinic. Although a rheumatologist or primary care physician can often help manage pain, some people need more specialized care. If pain is still running your life after working closely with your doctor to improve it, consider a consult with experts at a multidisciplinary pain clinic.
These clinics offer a range of interventions, including medications, biofeedback, nerve blocks, injections, CBT, massage, acupuncture, and other complementary treatments.
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