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Arthritis Today

Understanding Chronic Pain

For some people, chronic pain that may come with arthritis is its own disease. The good news is there’s hope for relief.

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Chronic pain lasts for months or years and affects a person daily or even just regularly. Compared to acute pain, chronic pain is harder to treat and manage. For many patients, it becomes its own problem. It can limit the person’s ability to work or do daily tasks, like clean the house, dress or drive a car. The impact of chronic pain can be wide reaching and devastating.

Most people view pain as having an underlying cause; once you treat the cause, the pain should disappear. Accordingly, getting rheumatoid arthritis (RA) under control by taking disease-modifying drugs (DMARDs or biologics) should eliminate the joint pain. And replacing a joint damaged by osteoarthritis (OA) should eliminate pain in that joint.

Often, these measures work and eliminate or significantly reduce the pain. But as many people with well-controlled RA or artificial joints know, pain often lingers. Why that happens is not well understood, and effective treatment can be hard to find.

Chronic Pain and Brain

Recent research shows that chronic pain changes the brain itself. Doctors now believe that chronic pain turns independent, essentially becoming its own disease. Its home isn’t in the joint that may have been its initial starting point. If you have inflammation in RA that hurts over long periods of time, that pain message is being sent to the brain continuously. The neurons that carry the message begin to change and may become more efficient messengers. The result? Your brain may begin to misread a small message of pain as a big one. Doctors call this “centralized pain.”

About 20 percent of patients with OA who have had their knee or hip replaced continue to have chronic pain. The pain has likely become centralized—it is no longer caused by the inflammation or injury. Now the pain is driven by dysfunction in the central nervous system (CNS). The same applies to fibromyalgia pain; once thought to originate in the ligaments and soft tissues, it is now believed to be directed by the CNS as well.

How to Get Help With Chronic Pain

More doctors now understand the importance of treating chronic pain as its own disease. Your doctor can help you find treatments that address the changes in the brain in addition to treating the condition that jump-started your pain. Here is how you can help your doctor find the right treatment for you.

Don’t tough it out. Chronic pain is pain that has lasted three months or longer, or pain that persists beyond the expected healing time of an injury. Take steps to stop pain before it becomes chronic. Immediate, short-term pain is much easier to treat. Some people don’t want to add more medications. They are worried about multiple side effects or feel like they can handle the pain. But knowing how pain affects the brain, it may be wiser to take pain relievers just enough to prevent the brain changes from untreated pain.

Give your doctor details. Make your pain a priority. If you don’t say it bothers you, your doctor may not focus on it. Tell him where the pain is, how it feels, and how long it’s been there. Also mention what you cannot do with your pain. For example, ‘I can’t brush my hair or shower.’ Consider keeping a pain diary where you can write down how you feel each day and discuss it with your doctor during your appointment.

Ask about CNS meds. Some antidepressant medications such as duloxetine (Cymbalta) and certain epilepsy drugs such as pregabalin (Lyrica) are now being successfully used to treat chronic pain conditions. Chemicals called norepinephrine and serotonin play a role in the body’s pain-inhibition system. Some antidepressants increase those chemicals, so you have less pain. Pregabalin was the first FDA-approved drug for treating fibromyalgia. In people with fibromyalgia, it changes the way pain signals are processed in the brain, leading to less pain.

Consider a pain center. If you’re not getting pain relief, ask your doctor to refer you to a pain center. Look for a one that has a mix of physicians, like an anesthesiologist, a physiatrist, psychiatrist, physical therapists, and psychologists.

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