Tools to Manage Pain

In part two of this two-part series on pain, we discussed the different types of pain and why understanding what type you’re experiencing is important to make sure you get the right treatment. In this episode, a psychologist who specializes in pain and a rheumatologist discuss some strategies to reduce or control various types of pain, whether it’s from an injury, nerve damage, or inflammation. 

About This Episode

In the first of our two-part series on pain, we focused on the various types of pain. In this episode, our guest expert, Dr. John Sturgeon, points out that one organ is involved in every kind of pain: the brain, which interprets pain signals and tells the body how to respond. He explains how the mind and emotions like anxiety impact pain and how they fuel each other — and he offers strategies to manage both. He also discusses psychotherapy techniques that might belong in your pain management toolbox, and ways to set yourself up to successfully control chronic pain.

In the second segment of this episode, Dr. John Davis offers guidance on what types of medications and other treatments are best for each of the different types of pain, and what patients should be aware of when deciding what treatment to try.

About the Guest Co-Host

Sarah Cloud

Sarah has lived with osteoarthritis (OA) since the age of 19, after several injuries to her knees and hips led to her discharge from the Army. In 2019, she was diagnosed with rheumatoid arthritis (RA) and Ehlers-Danlos syndrome (EDS). Her adult son, Chris, lives with juvenile idiopathic arthritis (JIA), subtype of enthesitis-related arthritis, and ankylosing spondylitis (AS). Sarah’s husband, Mike, also lives with AS. Every member of the Cloud family has a form of arthritis, even the dogs. These days, you will find Sarah and her family happily settled in the Ozarks, Missouri, near family. Sarah has an associate degree in business management, health care finance and patient navigation, and is currently completing her bachelor’s degree while working full-time in health care administration.  Sarah is also a staunch supporter of the Arthritis Foundation’s mission and has served in several leadership roles over the years, most recently as a Platinum Ambassador and member of the Patient Leadership Council. 

 

About the Guests

John "Drew" Sturgeon, PhD

Dr. Sturgeon is a licensed clinical psychologist and clinical assistant professor in the Department of Anesthesiology at the University of Michigan School of Medicine. He uses a combination of cognitive-behavioral therapy, Acceptance and Commitment Therapy (ACT), and emotion- and meditation-focused approaches to pain management to treat people with chronic pain. His research interests include resilience in chronic pain, fatigue and social factors in the experience of pain.

 

John Davis III, MD, MS

Dr. Davis is Practice Chair of the Division of Rheumatology at Mayo Clinic and professor of medicine at Mayo Clinic College of Medicine and Science in Rochester, Minn. He is also active in rheumatoid arthritis research, focusing in part on enhancing shared decision-making, the role of the microbiome in inflammatory arthritis, and discovering new biomarkers in inflammatory arthritis.


Additional Resources

Part One - Understanding Types of Pain

Types of Pain and The Body Article

Take Control of Pain

Vim Pain Management App

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PODCAST OPEN:              

You’re listening to the Live Yes! With Arthritis podcast, created by the Arthritis Foundation to help people with arthritis — and the people who love them — live their best lives. If you’re dealing with chronic pain, this podcast is for you. You may have arthritis, but it doesn’t have you. Here, learn how you can take control. Our host is Rebecca Gillett, an arthritis patient and occupational therapist, who is joined by others to help you live your Yes.              

            

MUSIC BRIDGE 

 

Rebecca Gillett: 

Thanks for joining us on this episode of the Live Yes! With Arthritis podcast. We are diving into part two of really understanding your pain. In part one, we talked about the different types of pain you might have when you have arthritis. And in this episode, we are going to take a deep dive in looking at solutions and tools to manage and relieve these different types of pain you might be experiencing. 

 

I'm excited to have our guest co-host, Sarah Cloud, rejoining me in this episode. She was in our last episode to talk about the tools to manage the different types of arthritis pain we might have. Welcome back, Sarah. 

 

Sarah Cloud: 

Great to be back. 

 

Rebecca: 

Sarah, today we have Dr. John Sturgeon, who is a licensed clinical psychologist and clinical assistant professor in the department of anesthesiology at the University of Michigan School of Medicine. He uses a combination of cognitive behavioral therapy, acceptance and commitment therapy, and emotion- and meditation-focused approaches to pain management to treat people. Welcome to the show, Dr. Sturgeon. 

 

Dr. John Sturgeon: 

Glad to be here. Thanks for having me. 

 

Rebecca: 

So, Sarah, I know you and I can relate to this. We've been on kind of a journey about the same amount of time, almost, with our various forms of arthritis. But a huge part of knowing what to access to manage our pain is understanding those types of pain. In our last episode, do you think we really kind of covered a lot of that to help people understand? And how long do you think that you, Sarah, took to really figure that out? 

 

Sarah: 

I think we covered quite a bit that would give someone the basics of where they need to start. And for our house, it took each one of us different time periods to figure out what was working, what isn't working and, “Oh, I think there's something else going on.” But it's an ever-evolving issue. 

Rebecca: 

Yeah. And I feel like part of it, too, is having somebody else to talk to, to figure out what worked for them. Right? Dr. Sturgeon, it's great to have you here, because you can tell us a little bit about your area of expertise. 

 

Dr. Sturgeon: 

I had known even going into college, for a long time actually, that I wanted to be a psychologist. One of the experiences I had as an undergraduate was that I worked for a researcher who told us that the generation of people after the baby boomers was to be the first generation of people in the history of mankind to be less healthy than their parents. 

 

And so, the idea was that even with all of the sort of technological advances and other sort of societal advances we had, our health didn't necessarily look like it was getting better the way we might want. We might be living longer, but we're not necessarily healthier in the way that we might want to be. It was kind of a way to help focus on an area that was going to be really high need. 

 

But what kept me in it is that pain itself is a phenomenon that sort of connects to everything. What's happening in your body? What's happening in your brain? What's happening in the environment around you? That complexity is sort of what attracted me to it. 

 

Because when you say that somebody has arthritis, for example, that doesn't really tell me very much about what they're feeling, or what they're doing, or what the rest of their lives look like. And if you want to know what resilience is: In a nutshell, it's that, right? That just because you have a condition, doesn't mean you're not otherwise doing well, that you haven't found ways to do well. 

 

Rebecca: 

Yeah, and that you're not your condition. It does take a little bit of time. I don't know what you think, Sarah, but it takes a little bit time for you to get to the point to say, “I might have arthritis, but it doesn't have me.” 

 

Sarah: 

It takes time to get over that grieving process of what I knew versus what is now. 

 

Rebecca: 

You have to get to the point of acceptance, right? Can you tell us what acceptance and commitment therapy is, versus cognitive behavior therapy? 

 

Dr. Sturgeon: 

I'm not sure that there's any therapy that has a bigger marketing problem than acceptance and commitment therapy. Telling people with a chronic condition that they need to accept it, really can come across wrong. Acceptance is not resignation. It's not: You have to give up and assume that this is what the rest of your life's gonna look like. Acceptance is looking at your condition and seeing where maybe your initial efforts to do something, like get rid of pain, haven't worked; how by trying to focus on just surviving in the short term, you might be losing a lot in the long term. 

 

Acceptance is not necessarily saying: “I’m going to have this pain forever.” But rather, “I have this pain right now. What's the most effective thing I can do with it to make my life worthwhile?” If we're going to go kind of chronologically, the best way to say it is that CBT, cognitive behavioral therapy, was kind of like our base treatment that we've used. It's easily the most well-validated psychological approach for pain. 

 

CBT gives you a set of things that we know, across people, across conditions, will either reduce pain, improve mood or help you function better. What that includes is things like stress management strategies: deep breathing, muscle relaxation, using guided imagery. There's a whole subset of meditation things that people now do. 

 

Knowing that, for most pain conditions, not all, but most, when you are physically active, it can be one of those things that can actually be a trigger for pain flares. But also, if you don't exercise at all, you tend to get worse. So, kind of learning how to thread the needle. 

 

Sometimes we'll talk about things like how to deal with negative thoughts about pain, about your body, about the future, what that does to your wellbeing. And then how to kind of combat those so they don't get in your way when they show up. So that's CBT, that's the base model. 

 

Acceptance commitment therapy is the idea of using some of those same CBT skills, maybe alongside something like mindfulness meditation. And then taking a broader look at what your longer-term goals are for yourself. “I may have arthritis, but what’s valuable to me is a person? And how has maybe my condition pushed me away from doing some of those things?” What this really focuses on is helping you rebuild those parts of your life that maybe were lost because of something like chronic pain or depression. 

 

Rebecca: 

We can tell people all the time that movement is the best medicine. We can tell you that you need sleep. We can tell you to set goals to manage your arthritis. But first, which one of these tools in the toolbox is going to motivate you? I mean, who doesn't have a negative thought about diet and nutrition? How do we address those goals? 

 

Dr. Sturgeon: 

Even though we say this is a set of tools that tend to help people, not every one of those tools works for every person. That means we kind of have to experiment. 

 

Rebecca: 

Talk about the role that the brain plays in pain. 

 

Dr. Sturgeon: 

The brain is the only organ that has to be involved in pain, regardless of who you are or what you're experiencing. You don't get any pain without the brain. Pain is more than a sensory signal. It is hardwired to include psychological components, emotional components, cognitive components, and, as of about three years ago, social components. Those are all considered to be a fundamental part of the pain process. And so, what we're feeling isn't just the nerves. It isn't just the discs. It isn't just the joint. It's what the brain is doing with all of that information. It's doing its job of trying to protect me. 

 

Rebecca: 

Right. So, like, for instance, in centralized, or what we now call, and we talked about on the last episode, nociplastic pain, the brain is confused by all the signals it's getting, basically, right, is an easy way to say it. It’s either hypersensitive to pain or overreacting to some of those signals it’s receiving. What is the best tool for this type of pain? 

 

Dr. Sturgeon: 

What I would start with, you know, one of the base tools that I use a lot as a clinician, is that I tell people: “Understand that when you feel pain, pain itself can't harm you.” The first thing that you want in the moment where you're feeling a pain, especially when maybe that's familiar, even if it's intense, is recognizing: “I’m not in danger right now, that the pain isn't harming me.” That may not be enough to get immediate relief, but it's a place to build from. 

 

There's a lot of different things that might help. One of the ones that we recommend, actually across pain conditions, not even necessarily just nociplastic pain, is diaphragmatic breathing, deep breathing. Because when the system is alarmed, when the system is amped up… Everybody here has heard the term fight or flight response. 

 

Your body is primed and ready to protect you from a threat, even if there's nothing happening in front of you. If you can slow down and deepen your breathing, what we're doing is engaging part of the nervous system that actually kind of… it pumps the brake. It tells the nervous system, “We're not in danger. It’s OK for us to maybe break some of these stress processes right now and slow down.” 

 

Rebecca: 

Kind of stops the brain in the process. It might be spiraling, and gives you just that pause to: “OK, wait a minute. What? I’m OK.” 

 

Dr. Sturgeon: 

The analogy I use along those lines is, chronic pain; the way we define that is anything lasting longer than six months. With any sort of a chronic pain condition, what your brain is doing is kind of like having an overprotective guard dog. You've got a dog that's not just barking when intruders are entering the house, but when the mailman shows up, right? 

 

And that dog isn't trying to make your life difficult. It's trying to protect you. So, what you want to do is be calm and show it that this is not a dangerous environment. Eventually, that fear response comes down. And that's why I sort of preach, regardless of the pain condition: If you can stop that stress response with something that feels real and feels safe, it's a very good building block to build from. 

 

PROMO: 

During Pain Awareness Month in September, the Arthritis Foundation is putting a spotlight on how serious chronic arthritis pain really is. We’re also sharing inspirational stories, as well as tips, solutions and resources to help manage your specific type of arthritis pain. Visit https://www.arthritis.org/pain

 

Sarah: 

Most chronic pain patients have anxiety-related issues. And when you mentioned fight or flight, that's your anxiety response. And I don't think people recognize that in the aspects of treating chronic pain. 

 

Dr. Sturgeon: 

I absolutely agree with you. If I'm being chased by a tiger, the anxiety I feel when it disappears into the underbrush is very adaptive. I need that, right? If I'm not anxious in that moment, who knows what might happen? Right? But if I get away, and six months later I'm still anxious about the tiger in the underbrush, how much is that really serving me anymore? 

 

Pain can produce that anxiety, and it turns out they feed one another. Anxiety, like pain, is a way for your brain to protect you. But it's responding to the wrong cues. It's telling you something that you don't actually need in the moment you're in. 

 

Rebecca: 

If we recognize that when we're having pain, we might be developing a learned response to our own pain, that might be an obstacle to managing that pain. 

 

Dr. Sturgeon: 

Big time. And now, one of the greatest misconceptions that people face before they even come in to see me, is the idea that you choose what you think about your pain. You don't. You're taught what to think about your pain. By what you're experiencing, what other people are telling you, what your doctors might be telling you, and your brain picks that up. I have to break that momentum if I want to go another direction. 

 

Rebecca: 

Yeah, very true, just stopping that process. Take a pause, like you said, take a deep breath. We know that deep breathing really does help. Even when you think about it for your emotions, when you're getting upset with a family member or loved one, a kid, like, "OK, I'm gonna take a deep breath first before I respond." We need to give ourself the grace to do the same thing when we're in pain. Right? 

 

Dr. Sturgeon: 

Practice is your best friend. Whatever it is that you want to do, commit to building that practice and doing it over and over again, and you will screw up as, as part of the process. 

 

Rebecca: 

Or you'll have setbacks. 

 

Dr. Sturgeon: 

Absolutely. 

 

Dr. Sturgeon: 

Those errors are part of how your brain figures out how important this really is. And if you want it to behave differently, you have to commit to that even through those rocky moments. 

 

Another one that I play up a lot, especially for arthritis, is exercise. But not exercise, maybe the way you did before you got your diagnosis. I encourage you to start really small with a level of exercise that is tolerable, maybe even well below what you feel able to do. Even that will involve a lot of setbacks. Whereas, you're trying to figure it out, you can go, "Oh, I did too much. That was way too much this time." That's OK. It doesn't mean all hope is lost. It just means you have to shift. You have to adjust. 

 

Sarah: 

And sometimes you have to shift how you do those exercises, because occupational therapists and physical therapists who, many have said to me, “Why don't you try doing it this way? We can modify it. You don't need to always do it the way you thought you knew how. That there's a different way to exercise that same muscle that might be safer.” 

 

Dr. Sturgeon: 

That's right. You gotta walk before you can run. 

 

Rebecca: 

Oh, definitely baby steps. Taking that time to get out of that fight or flight response is probably like the first step. Baby steps, you know, is what builds the resilience.  

 

Dr. Sturgeon: 

I think it's good to have lofty goals, but don't expect to meet them today. 

 

Sarah: 

With all the techniques you've been sharing, do any of those prevent pain? 

 

Dr. Sturgeon: 

Not every pain condition responds the same way, but ones that we do tend to see can have a preventative effect are regular diaphragmatic breathing, doing this as a routine, doing it daily. Meditation can do the same thing. 

 

The other one: physical exercise, knowing what your physical activities look like and building in enough breaks so that you're not getting to that really flared state. People's function gets better before their pain does. So, when your body gets stronger and more conditioned, because you're exercising, or you're doing these other things that help rehabilitate, the brain figures that out later. Stay calm, so the brain can update its programming. 

 

Rebecca: 

Kinda like it takes a while to know that you're full when you're eating. 

 

Dr. Sturgeon: 

That's right. 

 

PROMO: 

Whenever you need help, the Arthritis Foundation’s Helpline is here for you, now offering support in Spanish and other languages. Whether it’s about insurance coverage, a provider you need help from or something else, get in touch with us by phone, toll-free, at 800-283-7800. Or send us a message at https://www.arthritis.org/helpline

 

Rebecca: 

I wanted to take this segment to talk about what actual, tangible tools can I go reach for when I have a specific type of pain, since we've covered these different types of pain in this series on managing pain. So now, I'm joined by Dr. John Davis. He's a rheumatologist and professor of medicine with Mayo Clinic. Thanks for joining me. 

 

Dr. John Davis: 

My pleasure. Glad to be here. Thank you. 

 

Rebecca: 

I kind of wanted to go down the list of the different types of pain we've talked about and say, "OK, what's the best thing I can use?" So, let's start with nociceptive pain. When somebody has acute pain, what's the best way to treat this kind of pain? Is it heat? Is it ice? Should I rest? Should I move? 

 

Dr. Davis: 

Nociceptive pain, I think of pain that occurs when there is an injury or active inflammation. In general, anti-inflammatory therapies are probably the most effective. I'm talking about non-steroidal anti-inflammatory drugs like ibuprofen, naproxen, which are available over-the-counter. Those are oral medications and can be quite effective when taken. 

 

For some people who don't tolerate those because of gastrointestinal, that is stomach upset or discomfort, then you could use topical diclofenac gel applied to small joints like the hands. Even bigger ones, some people still get benefit, and that's maybe lower risk. Acetaminophen can be helpful to moderate nociceptive pain. It probably is less effective in general than the anti-inflammatory drugs. 

 

You can also use ice. Icing a sore, an inflamed joint, can be helpful. In general, just kinda taking it easy, and resting, and trying to offload a given joint. Braces and splints can be helpful for an acutely inflamed joint like a wrist, or a thumb, or a knee, and that could provide comfort as well. Finally, you know, for nociceptive pain caused by a flare of rheumatoid arthritis, as an example, sometimes we have to use courses of glucocorticoids. That is, prednisone, to rapidly alleviate more severe inflammation. 

 

Ideally, a patient should discuss a plan of care for flares ahead of time. They're probably not going to be able to see a doctor right away, and to be able to just kind of reach for those treatments right away. And to have it be tailored and appropriate for a given person's health problems. 

 

Rebecca: 

Definitely, as you said: Talk about it with your doctor and have a plan for when you're having this type of pain, what you should reach for based on all of your symptoms. What's the best thing to do if you're having mechanical pain in your joint? 

 

Dr. Davis: 

Mechanical pain is still a type of nociceptive pain. I think similar things, maybe we might discuss here more about activity modifications… If there's a certain activity that is reproducing the pain with each effort, then obviously modifying the activity or avoiding that activity may be important for a while. 

 

I had mentioned ideas about using assisted devices. So, to use a jar opener, that might help a sore thumb base, for example, or a brace for the knee or for the ankle or foot. These things can be helpful. Shoe inserts for mechanical pain in the forefeet can be helpful. 

 

Over-the-counter NSAIDs, the risks are low with short-term use for acute nociceptive pain. With extended or long-term use, it's important to get advice from a health care professional. There certainly are risks, including things like gastrointestinal ulcers, gastrointestinal bleeding, kidney impairment or insufficiency, elevated blood pressure, and even, rarely, cardiovascular disease events, rarely like heart attacks or strokes. I think addressing those things in an individual's personal risk is important. 

 

Rebecca: 

Yeah, that's a really good point. And there could be a prescription that would be, you know, not have as many effects. That's why, again, talk to your doctor, right? 

 

Dr. Davis: 

Yeah. 

 

Rebecca: 

Let them know how often are you taking these over-the-counter items. You mentioned rheumatoid arthritis. So, I wanted to ask: What about inflammatory types of pain? Rheumatoid arthritis, psoriatic arthritis, or if somebody has axial spondyloarthritis. If they are having a lot of pain, what would be the best course of action, aside from the medication that they're on? 

 

Dr. Davis: 

Many of the thing I've said stand. Do we use ice or heat? I think it really depends on the individual patient. In general, I think logically that if it's kind of hot with inflammation, maybe it's better to use ice to, to cool it down. Having said that, I've seen people who felt better with heat with acute flares. Experiment and see what feels best and what provides comfort. 

 

Resting both the particular joint or extremity, and also just resting the body, is important. Trying to get plenty of extra sleep. Because sleep is important for optimal immune function and kind of regulating the flare-up. 

 

And then getting a plan with regard to either using nonsteroidal anti-inflammatory drugs or potentially prednisone, orally, or sometimes a joint injection. That can alleviate the inflammation. 

 

Rebecca: 

Yeah, it is very personal if you like ice, or you like heat. I know with my RA, when I wake up in the morning, that morning stiffness: Actually, moist heat helps well. But if I've overused a joint doing laundry, let's say, ice is what I usually prefer. But moist heat seems to, I think, penetrate better than just a dry kind of heat. 

 

Dr. Davis: 

I agree. And I think when using heating pads, and ice, too, it's important to do it intermittently. Because extended exposure may cause some soft tissue injury. That's 15, 20 minutes, and then resting, for example. 

 

Rebecca: 

Neuropathic pain. What about people who are having neuropathy or nerve pain? What's the best tools? 

 

Dr. Davis: 

Neuropathy is a chronic nerve condition. Carpel tunnel syndrome, or situations where a nerve is entrapped, tends to be a sub-acute to chronic situation. I think that can be challenging. 

 

In general, simple analgesics or NSAIDs are not very effective, because inflammation isn't purely the culprit here. Medications that can be more effective are medications like gabapentin, pregabalin, duloxetine. Those have to all be prescribed by a physician or health care provider. 

 

It’s important to have a discussion with a physician or a provider about what is the best approach to managing this? And how do I deal with pain exacerbations? They're tricky to use, those medications. There can be a lot of side effects. It's important to have regular follow-up with a provider about how to get to the right dosage for a given patient. 

 

Patients who have carpel tunnel syndrome, which is a form of neuropathic pain, because the nerve is getting entrapped: That can be a steroid injection in around the nerve in the carpal tunnel. We can use braces to try to offload the entrapment of the nerve. Or to actually go to the point of having a surgical procedure to address the problem. And that goes for any type of nerve entrapment. You know, a pinched nerve in the neck or low back. 

 

Rebecca: 

And sometimes, there's referrals to physical or occupational therapy for utilizing different modalities for neuropathy, right? 

 

Dr. Davis: 

Absolutely. Physical therapy, different occupational therapy, approaches can be helpful, and really escalating to more drastic measures if those things aren't working over a realistic period of time, like six weeks, three months. 

 

Rebecca: 

And then the last one is that centralized ... Nociplastic is the new term they use, centralized pain. Like similar to what people have when they have fibromyalgia. 

 

Dr. Davis: 

Yeah. Unfortunately, this is an all too common problem still in rheumatology. I think partly it's just continued inflammation and all of that input on the central nervous system can lead to changes in how the nervous system functions, and how sensory information related to pain is transmitted. 

 

I think of it as kind of the volume is dialed up on pain signaling into the spinal cord and brain. We have to kind of continue to treat the inflammation in the ways that we have discussed before. But in addition to that, in patients with nociplastic pain, we need to try to, in a way, turn that volume down on pain overall. And there are a lot of ways that we do that. 

 

Examples of those approaches would be cognitive behavioral therapy, working with a pain psychologist. That can be very effective. Sometimes swimming therapy can be very helpful to certain patients in coping. Mindfulness meditation or different mindfulness strategies can be useful. And then there are a variety of other techniques: biofeedback, acupuncture. 

 

Oftentimes a patient may actually have concomitant fibromyalgia in addition to rheumatoid arthritis or osteoarthritis. Then, we use medications that, for example, would include things like duloxetine or gabapentin, pregabalin and sometimes even combinations of those medications. 

 

And then trying to improve sleep hygiene is important. It often isn't a cure or a total solution, but an important part of lessening nociplastic pain. So, again, it’s important to have a plan for management. It’s really looking for someone who has empathy and is willing to try to help. And is willing to partner with a person to develop effective treatment strategies for nociplastic pain long term. 

 

Rebecca: 

I know at one point I was having fibromyalgia symptoms, a flare pretty bad. And the root reason was that my rheumatoid arthritis wasn't in control at the time. I had just been off medication for a while. 

 

And so, one thing I did find that was tangibly helpful for me was a weighted blanket. You know, feeling like my nerves were just constantly firing, laying down with a weighted blanket actually helped calm my nerves down a little bit. It felt...  

 

Dr. Davis: 

That's a great tip, and I've heard that from more than one person. I'm always looking to patients. What can they teach me about how to better control pain? Because unfortunately in 2022, we still have gaps in pain management. 

 

A couple pearls: One, it is really important to control the inflammatory disease activity well in people with inflammatory conditions. The first question. If we don't put the fire out, we're probably not going to control pain sufficiently. And then: It's a trial and error process to try to use different approaches and find the ones that work for an individual patient. 

 

Rebecca: 

Yeah, definitely. So, thank you so much, Dr. Davis, for your time. We can't reiterate enough: Have a plan with your doctor, and talk about the types of pain you're having, and what's best suited for you to reach for in managing that pain. Thanks so much for joining me, Dr. Davis. 

 

Dr. Davis: 

Well, you're welcome. Thank you for having me today. 

 

PROMO: 

Do you have an idea for a topic you’d like to hear discussed on the podcast? Do you have a question about an episode or feedback you’d like to share? We’d love to hear from you. Just email us at [email protected] and we’ll get back to you as soon as we can. That’s [email protected]. Thanks for listening! 

 

Rebecca: 

We're gonna move into some comments and questions from some of our listeners. This person says they use ice when there's visible inflammation, and heat “when I feel stiffness and internal inflammation. I typically try to keep moving with slow, easy stretches to keep things moving. But sometimes I do rest if the inflammation and the pain is bad enough.” That's a hard line for people, right? I'm in pain. Should I move? Should I rest? What input do you have for people when they're battling with that question? 

 

Dr. Sturgeon: 

Once you get up and moving, you can feel better. It doesn't work all the time, but it's often worth it to try and get yourself to that point. But the only real way to assess how do I move or when do I move is to keep moving and to figure out: What does my body handle on a normal day? It's just looking for those breaks at times so that you can be more active later. That's what you're targeting. And heat and ice and meds can all be part of that toolbox. 

 

Rebecca: 

Somebody mentioned: movement, rest and prayer. Since you are a psychologist, let's talk about that. Like, the spiritual aspect of dealing with your pain. 

 

Dr. Sturgeon: 

It doesn't have to be that it's religious or that it's even spiritual. But prayer is an example, especially if there's a way that helps you feel connected to something bigger. It's a safety net for you when things are not going well. Or it can be something that enriches what you're already doing. 

 

But faith in whatever form can be a real strength. As long as you can also check in and say, “I’m otherwise doing what I think is best for me, but I'm still doing those things that are moving me forward.” 

 

Rebecca: 

Sarah, how do you answer that question? 

 

Sarah: 

That depends on which pain it hurts that day (laughs). I try to get moving and exercise. I'm still having problems getting up and getting out walking. I do rely on prayer because I do believe in a higher power. 

 

I love to do tai chi with my child. And so, I think each person is going to have to find something that works for them. But to me, the key is for the tools that you have, to find something that works for you. You can't just sit on the couch and complain that you're not getting better if you're not willing to get up and move your feet. 

 

Rebecca: 

I always have to find the silver lining to pull me back. I've had a rough year. I'm recovering from sepsis and waiting to see if I have to have another surgery. This time was really scary. I was in the hospital for many days. It just sucks. (laughs) Like, what can I do? And what can I control? 

 

And I'm finally, like, out of that… to say, OK, we have a puppy. He makes us happy. I started going on little walks with him again now, you know? I am OK. Sometimes, it can just be hard. And then you have to get back to those baby steps and all the things that you built up to get back where you were, to manage everything else. 

 

Before we go, Dr. Sturgeon, can you share what you think your top three takeaways are for our listeners? 

 

Dr. Sturgeon: 

One, remember that, especially in chronic pain, if it's a familiar pain, what your brain's looking for is safety. And that's your first job: to try and find safety. And that might mean moments where you stop and take a deep breath. It might mean telling yourself, "This is OK, I've been here. I can handle this." It might be in a conversation with your doctor. Might mean prayer. But finding a point of safety is how you start to interrupt that process. 

 

Two, pain occurs because your brain is working too hard to protect you. Not vice versa. What we're trying to do is to calm it down. Things like breathing and meditation and gentle movement. And it looks different from person to person. 

 

And three, you get better incrementally, so baby steps. You will need to keep working at it. And it might mean taking smaller steps than you want, but that's how you get there. 

 

Rebecca: 

Those are great takeaways. And I think I'm going to steal your quote from here to eternity now that “Your function gets better before your pain does.” I think that's important to remember. 

 

Sarah: 

We're gonna live with this pain for the rest of our lives, but we have to function. 

 

Dr. Sturgeon: 

Remember: Acceptance isn't assuming that you're gonna have this level of pain forever. It just means it's there right now. So, what can I do about it? 

 

Rebecca: 

Thank you so much, Sarah. Thank you, Dr. Sturgeon, for joining us in this conversation. 

 

Dr. Sturgeon: 

Thanks for having me. 

 

Rebecca: 

I just wanna remind our listeners that if you check out our show notes, for both of the two-part series episodes on our website, you'll have more resources and links in those show notes to tackle your pain. At https://www.arthritis.org/liveyes/podcast. And don't forget, we have an app that helps you manage your pain. You can also connect with others and learn other tips to managing your chronic pain called VIM, which is sponsored by our partner, Tylenol, in helping you tackle pain on a daily basis. 

 

You can download that from our website or anywhere that you get your apps in your store. And we have more pain resources available at https://www.arthritis.org/pain. Thanks everybody and be well. 

 

PODCAST CLOSE:        

As part of their support of the Arthritis Foundation, this episode was brought to you in part by Get Relief Responsibly, a scientific education and patient advocacy organization. To learn more, visit https://www.getreliefresponsibly.com. The Live Yes! With Arthritis podcast is independently produced by the Arthritis Foundation, to help people living with arthritis and chronic pain live their best life. People like you. For a transcript and show notes, go to https://www.arthritis.org/liveyes/podcast. Subscribe and rate us wherever you get your podcasts. And stay in touch!      

 

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