Understanding Types of Pain

Not all pain is the same. In fact, there are several different types of pain that can affect us differently — physically, emotionally, mentally. Knowing your type of pain is the key to effectively treating it. This episode is the first of a two-part series for Pain Awareness Month in which you’ll learn to identify your type of pain and potential causes. Listen now and stay tuned for part two in which we explore solutions to pain.

About This Episode

Not all pain is the same. In fact, there are several different types of pain that can affect us differently — physically, emotionally, mentally. Knowing which type of pain you’re experiencing is the key to effectively treating the pain. However, identifying the type of pain is not always easy — it’s often the hardest part of understanding the pain.  

For Pain Awareness Month this September, we’re featuring a two-part series podcast on pain in which we’ll first explore — in this episode — the unique and different types of pain people with arthritis may experience. We’ll answer key questions, including: What are the different types of pain? How do you identify the type of pain you’re having? What are its causes? And more. In the second part of the series — in an upcoming episode — we’ll review different solutions and tools to both prevent and treat these different types of pain. 

Our guest experts are Sarah Cloud, arthritis patient, advocate, ambassador and health care administrator and Daniel Clauw, MD, Professor of Anesthesiology, Medicine (Rheumatology) and Psychiatry at the University of Michigan

 

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 Guest

Dr. Daniel Clauw

Dr. Clauw is a Professor of Anesthesiology, Medicine (Rheumatology) and Psychiatry at the University of Michigan. He attended undergraduate and medical school at the University of Michigan, following which he did an internal medicine residency and rheumatology fellowship at Georgetown University. He stayed at Georgetown as a faculty member from 1990 to 2002, serving as Chief of the Division of Rheumatology and Vice Chair of Medicine. While at Georgetown he founded the Chronic Pain and Fatigue Research Center (CPFRC), and in 2002 was recruited to bring this group to the University of Michigan, where the group has become one of the most successful pain research groups in the world. He also served as the first PI of the University of Michigan Clinical and Translational Sciences Award (CTSA), as well as the first Associate Dean for Clinical and Translational Research, and founded the institute that houses the UM CTSA, the Michigan Institute for Clinical and Health Research. He has over 450 peer-reviewed publications, over $100M in federal funding, and is currently co-PI of four NIH center grants and two R01s, studying various aspects of chronic pain. He also has been a very active mentor, serving as the primary mentor for 35 NIH K awardees, nearly all of whom have gone on to obtain R series funding or the equivalent.   


Additional Resources

Sources of Arthritis Pain 

Mechanisms of Arthritis Pain

Causes of Inflammatory Joint Pain

Musculoskeletal Pain and Arthritis

Podcasts on Pain and Pain Management

Understanding the Anatomy of Arthritis Pain

Read More About the Cloud Family

 

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This episode was released Tuesday, September 13, 2022.

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. Today, we're talking about a topic that affects all of us with arthritis, and that's pain. We all know that the struggle is real when it comes to pain and that not all pain is the same. In fact, there are several different types of pain that can affect us differently — physically, emotionally, mentally. Truly knowing which type of pain you are experiencing is the key to effectively treating that pain. 

 

For Pain Awareness Month in September, we're going to have a two-part series. In this episode, we're going to dive into the unique and different types of pain that people with arthritis may experience. And in the second part of this series, we're going to be talking about the different solutions and tools that you can access to treat these different types of pain, or perhaps even prevent and treat these different types of pain. 

 

Joining me in this conversation is one of the Arthritis Foundation’s volunteers on our Patient Leadership Council. She’s a patient, a mom, a wife. And the entire family lives with a form of arthritis. So, joining me is Sarah Cloud. Welcome to the show, Sarah. 

 

Sarah Cloud: 

Thank you for having me. 

 

Rebecca: 

Share a little bit with our audience about your arthritis journey. 

 

Sarah: 

Well, I was diagnosed at 19 with osteoarthritis after several injuries. I had injured my hip and my knees. I was in the military. And that led to a very fast discharge from the military because I could not run. I could barely walk some days. 

 

I kind of ignored it for a long time. Well, you know, it's going to rain, my knee hurts. (laughs) But it was always constant in certain areas. Fast forward. So, about four years ago, I was diagnosed with rheumatoid arthritis and with Ehlers–Danlos syndrome. And so that makes it a different type of perspective when you combine those two with the osteo. I also have degenerative disc disease from my previous career of driving school buses for 22 years. 

 

In all of this, we didn’t really pay attention to arthritis until our son was diagnosed at the age of 12. He is now 24. Chris has enthesitis-related JIA (juvenile idiopathic arthritis), and they have now since added on ankylosing spondylitis. And in that journey, my husband was diagnosed, after 25 years of misdiagnosis to his back issues, with ankylosing spondylitis. And we laugh and joke in our house that everyone in the house has arthritis, including the dogs… 

 

Rebecca: (laughs) 

 

Sarah: 

... because yes, even our puppy has osteoarthritis. So, it's been an interesting journey. But we kind of pretty much cover every category. 

 

Rebecca: 

Yeah, definitely. I mean, all age spans in every category, right? Like dogs get arthritis, too. A lot of people are surprised to hear that. Sarah, you’ve been pretty involved in the Arthritis Foundation. 

 

Sarah: 

We didn't know any other children who had this. The only person we knew with autoimmune or autoinflammatory arthritis was a dear co-worker of mine who'd had RA for 20 years, and her experience was invaluable. But it's not the same when dealing with an 11-year-old. 

 

Finally, we saw an ad in the newspaper for the Arthritis Foundation and they were looking for kids with arthritis in our area. And that is how we got involved. And it gave us a voice because, when you live in a rural area, you do feel absolutely alone. And it became a mission that no other family was going to spend two years not knowing anyone else whose child had this diagnosis. And it kind of went from there. 

 

Rebecca: 

Sarah's heavily entrenched in the Foundation. So, I'm so glad to have your personal experience to talk about pain. Joining us to dive into understanding the mechanisms of pain is our guest speaker today, Dr. Daniel Clauw. He's a professor of anesthesiology, medicine (rheumatology) and psychiatry at the University of Michigan. Dr. Clauw is one of the leading experts when it comes to chronic pain. He has a very lengthy resume, and you'll be able to read more about that in our show notes if you click on his bio. Tell us a little bit about yourself. Welcome to the show. 

 

Dr. Daniel Clauw: 

Thanks so much for having me. Well, you already told them a lot about me. I'm clinically trained as a rheumatologist, but I became more of a pain researcher, and I lead a large pain research group at the University of Michigan. When I was being trained as a rheumatologist, I thought then, and I still think now, that too much of the focus or emphasis in rheumatology training is to just treat the inflammation that is associated with autoimmune diseases. And that's noble. The hallmark of autoimmune diseases is that there's inflammatory pain, but often there's a lot more than that. 

 

Rebecca: 

There are different types of pain that we can experience, and people with arthritis, of course, are no stranger to pain. But there's different types of pain. So, let's just start talking about that. The first one we're going to hit is nociceptive pain. What is nociceptive pain? What does that mean? And what are the signs of that type of pain? 

 

Dr. Clauw: 

Nociceptive pain essentially means that the pain is occurring because there's some kind of damage or inflammation in that area of the body. And the term nociceptive means that it's activating nociceptors, which are the ends of the nerves basically that are picking up different sorts of signals from different areas of the body. And so, the classic nociceptive pain would be, you hit your thumb with a hammer or you have a surgical procedure performed. 

 

We know that nociceptive pain has certain characteristics and that people can localize nociceptive pain fairly well. If you burn yourself or you break your leg, you can almost always sort of point to, with one finger, where the pains are coming from, or even draw sort of the distribution of the pain. 

 

That's not the case with nerve pain, or the kind of pain that we see with fibromyalgia, where often it will be a little bit more difficult for people to localize the pain. Or in nerve pain, it'll be a region of the body where the nerve actually travels through that particular region of the body. 

 

We use things clinically now, like body maps. We will very often give that to someone and say, “Check all the different areas of the body where you're experiencing pain.” And we can just tell by looking at a body map, if someone is putting Xs in specific locations — for example, over the joints — that probably is nociceptive pain. But if people are starting to check boxes at the tops of their arms and the tops of their legs, in different areas of the body, we know that those are not areas that are typically involved by inflammation in any autoimmune disease. And we start thinking, oh, maybe this person has more central sensitization — nociplastic pain is the new term for that — but pain that is coming more so from the brain rather than a problem in that area of the body. 

 

Rebecca: 

What is mechanical pain? And what are the signs of that? And that would be something I think is more related to like osteoarthritis, right? 

 

Dr. Clauw: 

Correct. Mechanical pain would be one of the subsets of nociceptive pain. There often isn't a lot of inflammation in osteoarthritis, but there's damage to the cartilage and to the bone and to the joint structures. People typically will notice pain when they use that joint. If they have osteoarthritis in their knee, that knee is likely to hurt a lot more after they’ve been up and walking on the knee, weight-bearing on the knee, than if they haven't been using that area of the body. 

 

When we use the term mechanical pain, it often actually means that the pain in some way can be reproduced by having someone put weight on their knee. If they have back pain, we might move them through different ranges of motion of their back. But we can reproduce that pain in many cases by moving that region of the body or touching that region of the body where they're experiencing pain. 

 

Rebecca: 

I almost think of that as like… I've dislocated my shoulder before, so that was definitely pain right in that joint, because it was dislocated, right? So, that would be more of a mechanical pain. 

 

Dr. Clauw: 

Correct. 

 

Sarah: 

And what would be the difference then with inflammatory pain? 

 

Dr. Clauw: 

Inflammatory pain is also nociceptive pain in that it is coming from the periphery. It's just that that pain is due to ongoing inflammation. We don't see a lot of inflammation in the synovial fluid in people with osteoarthritis compared to rheumatoid arthritis or psoriatic arthritis, where there's a lot of inflammation. That joint is actually visibly swollen, red, warm, tender. Those are the cardinal signs of inflammation. 

 

The other thing that we see in inflammatory pain, when people have a lot of pain due to inflammation, they'll often have a lot of morning stiffness. If someone has warmth and redness over a joint, and that joint is stiff when they wake up in the morning, and the pain gets better after 30 to 60 minutes, then I'm thinking that's inflammatory pain in that joint, that there's some kind of inflammatory process that's driving that person's pain. 

 

Rebecca: 

Yeah. That's usually a telltale sign for people when they're trying to figure out what type of arthritis. Like how long is that pain and stiffness lasting? Is it lasting throughout the day, or is it mostly in the morning? 

 

Dr. Clauw: 

If a joint is inflamed over a long period of time, the synovium in the joint — the lining of the joint — becomes inflamed and larger. Sometimes you can't see that the joint is swollen. But if you put your finger and push over that, the person will jump, you know, 'cause you can tell that there's, if you will, subclinical swelling there. 

 

Rebecca: 

Yeah. It's usually like swollen and spongy. 

 

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

 

Rebecca: 

Can you go ahead and explain what synovitis is and the synovial fluid’s role in the joint? 

 

Dr. Clauw: 

The purpose for the synovial fluid is to lubricate the joint and provide sort of an easy gliding of the joint while it's going through its range of motion. When a joint is inflamed, as occurs in most of the autoimmune diseases, that synovial lining will increase dramatically in size, from being just a single cell layer to something that is actually palpable. 

 

It's not just a single cell layer; it might be several millimeters thick or even up to a centimeter thick, because the person has chronic inflammation. And we look carefully for that as rheumatologists 'cause that's one of the hallmarks that someone actually has an autoimmune disease causing their pain, rather than some other reason that they might have ongoing pain in that area of the body. 

 

Sarah: 

That's how they figured out my son's knee, because the synovial lining was very thick, and it had been going on for a long time. And when the rheumatologist saw the scans and the X-rays and the MRI, they knew exactly what they were looking at. 

 

Dr. Clauw: 

That ongoing inflammation caused that synovial lining to get bigger and bigger and bigger. And a lot of non-rheumatologists are not really taught specifically how to do that examination. So, it's unfortunate, but not surprising, that other people that, you know, may have seen your son before the rheumatologist didn't pick up on that. 

 

Rebecca: 

Yeah. I think that's why it's important as patients to start learning the different types of pain you're having. Let's move into neuropathic pain. What does that mean? And what are the signs of possibly having neuropathic pain? 

 

Dr. Clauw: 

Neuropathic pain means that one of the sensory nerves, or several of the sensory nerves, are either pinched or damaged. And when I say pinched, I think people are familiar with having a pinched nerve in your back, or sciatica, where the nerves come out of your spine and your back. But another common, if you will, pinched nerve that most people are familiar with is carpal tunnel syndrome, where the median nerve that goes through your wrist can be inflamed or pinched as a result of overusing your wrist, for example. 

 

Those would be two types of neuropathic pain that most people would be familiar with. But there's also nerve damage that can occur from like chemotherapy drugs or heavy alcohol use. Some autoimmune diseases cause nerve damage because the small blood vessels that feed the nerve become inflamed, and then that subsequently causes damage to the nerve itself. And neuropathic pain simply means that the pain seems to be originating because of some damage, dysfunction or, if you will, pinching of one of the sensory nerves. 

 

Rebecca: 

Even something like diabetes, right? There’s neuropathy involved. I think rheumatoid arthritis, right? Some of the other autoimmune inflammatory types of arthritis have that neuropathy type of pain. So, we know then, that is generated by nerves. That would be treated in a totally different way as well. 

 

Dr. Clauw: 

Right. And then the other thing that we know about that kind of pain is it often follows what we call a stocking glove distribution — that the smallest nerve fibers are the ones that are the furthest away. People will present with numbness and tingling  'cause the nerves are damaged. It starts in their toes and their fingers first, and then may involve other areas of the body. But again, we're looking for patterns. 

 

It's both the location of the pain, i.e., being in the feet, the hands, as well as the numbness, tingling, lancing type of pain that you see with nerve pain, almost electrical sensations. 

 

Sarah: 

It feels like a different type of pain. I have a pinched disc or a pinched nerve in my C-spine. And yeah, when your fingers go numb and it's an electric shock to your hand, it's the first clue: Oh, I might need to go have my neck looked at. 

 

Dr. Clauw: 

Or people sometimes… It's like a hot poker or something. There'll often even be some sensation of temperature change in that area of the body. 

 

Rebecca: 

How can somebody differentiate whether it's carpal tunnel versus actual inflammatory arthritis? 

 

Dr. Clauw: 

If it was inflammatory arthritis alone, what you would expect to see is pain and tenderness in specific joints. Certain types of arthritis involve certain joints, and so we again look at the pattern. But at the end of the day, it's going to be more discreet pain in the joints, with synovitis in the joints. Whereas neuropathic pain, like carpal tunnel syndrome, people may have some discomfort in the wrist, but they're going to have a shooting sensation, usually going all the way down into their fingers, all the way up past their elbow. 

 

Rebecca: 

That makes sense. Yeah, for sure. 

 

Sarah: 

The next one we have is centralized pain. What would be the difference with centralized pain to the other categories? 

 

Dr. Clauw: 

Well, this is the condition that our group has historically studied the most. The condition that most people would be most familiar with, as sort of the poster child for centralized pain, is fibromyalgia. Individuals with rheumatoid arthritis, lupus, with any autoimmune disease, will also have this kind of pain. And often we don't necessarily call that fibromyalgia anymore. If someone with rheumatoid arthritis has this other kind of pain, we'll say, it's rheumatoid arthritis with nociplastic pain, or rheumatoid arthritis with central sensitization. 

 

There's a lot of terms that are used synonymously to indicate that this person has more than one mechanism of pain. When people develop central sensitization or nociplastic pain, in addition to them having widespread pain in multiple body areas, they'll have sleep problems, fatigue and memory problems. And that whole constellation of symptoms is really referred to as nociplastic pain. The brain is causing the fatigue, causing the sleep and memory problems, the mood problems that individuals with this kind of pain will typically experience. 

 

Sarah: 

Would this category, then, include complex regional pain syndrome? 

 

Dr. Clauw: 

Well, there's two types of complex regional pain syndrome. And one type is the more diffused type that is more fibromyalgia, nociplastic pain-like. But this would also include a high proportion, for example, of individuals that have any kind of hypermobility syndrome, like Ehlers–Danlos, will have fibromyalgia or nociplastic pain. The same kind of nociplastic pain is the primary pain behind things like irritable bowel syndrome or tension or migraine headaches. 

 

Gastroenterologists, for example, saw someone that had pain in their abdomen. But when they scoped them, they didn't find anything wrong in their abdomen. And just like fibromyalgia patients a long time ago, weren't believed that their pain was real and were dismissed, you know: “You’re just a neurotic, middle-aged woman. There’s nothing really wrong with you.” 

 

These conditions now have another name in and of themselves. They're called chronic overlapping pain conditions. And these would be conditions like fibromyalgia, low-back pain and endometriosis … are thought to be chronic overlapping pain conditions. Because even though we say low-back pain, most people with low-back pain don't have a problem in their back; they're more likely to have low-back pain either as a result of nociplastic pain, this fibromyalgia-like pain, or neuropathic pain. But most low-back pain is not nociceptive pain; it's some damage or inflammation in their back. Most people that carry the label endometriosis probably have more nociplastic, fibromyalgia-like pain than have something wrong in their pelvis that needs to be surgically removed. 

 

Rebecca: 

Yeah. That's a lot to wrap your head around. How did the term nociplastic come to be? Like, why are we now moving toward calling it nociplastic versus centralized pain? 

 

Dr. Clauw: 

We have no idea. 

 

Rebecca: (laughs) 

 

Dr. Clauw: 

It's here to stay. We have to live with it. Until five years ago, we only thought there were two main kinds of pain — nociceptive pain and neuropathic pain. And now we acknowledge there is this third type of pain. So, that was really good for conditions like fibromyalgia and irritable bowel, where people had struggled for credibility. 

 

Rebecca: 

The central nervous system is not functioning the way, in processing pain, the way that it should, and that could be the reason for your pain. It's important for people to really understand that, I think. It takes away that stigma that so many people struggled with over the years: that people don't believe I'm having pain, right? Because they can't see it on an image, on an MRI or an X-ray. 

 

All of the science and research that's happening, and changes in technology, are better able to help us identify pain, right? So, one other topic is psychogenic pain. We hear that term sometimes, or psychosomatic. What is that type of pain? 

 

Dr. Clauw: 

There's no such thing. That term should be abandoned. Terms like psychogenic pain, terms like somatization are just pejorative terms that should be abandoned. They don't have any useful purpose. 

 

Rebecca: 

OK. 

 

Dr. Clauw: 

It's not OK to say that anymore. It's just stigmatizing. You’re going to have psychological impact from the pain. And if you don't, then that's probably more of a malady, if you have severe pain and it doesn't in any way psychologically affect you. There were all sorts of terms that are almost like code words invented by clinicians to say: “This person has pain that I don't really have to take care of 'cause it's not really real pain.” 

 

Sarah: 

Or “It's not my area. It's in your head.” 

 

Dr. Clauw: 

What we've learned is that a lot of pain is in the head, and that it was surprisingly difficult to convince a lot of pain researchers that a lot of pain actually comes from the central nervous system in the brain. But we've known forever that things like phantom limb pain is, that has to be coming from the brain. The person doesn't have that limb anymore and they still have… they feel pain in that area of the body. Or post-stroke pain. We know that after stroke, some people will develop severe pain. So, we've known that the brain is capable of causing pain, and in fact, I would go one step further: The only organ you need to have to have pain is the brain, 

 

Rebecca: 

Is there a type of pain that we might have missed that we haven't talked about? 

 

Dr. Clauw: 

People will often talk about, well, what's the difference between emotional pain and physical pain and things like that. And it is true on things like functional neuroimaging, there are certain brain regions that are activated when someone feels emotional pain versus when they feel physical pain. But there are also clearly brain regions that are only activated when someone has physical pain. 

 

TYLENOL COMMERCIAL 

 

Rebecca: 

Why is it important to have this conversation, to understand the types of pain, Dr. Clauw? 

 

Dr. Clauw: 

I've always said to my patients, “You're going to be better than anyone at telling me which of your pain is flaring now, because that will help me direct treatment.” If the pain that has gotten worse in you between your last visit and this next visit is inflammatory pain, I'm going to increase the dose of some of your drugs that are going to reduce ongoing inflammation. 

 

But if I instead think that your pain is due to more fibromyalgia, more nociplastic pain, I'm going to do much different things. I'm going to ask you to try to work on getting better, deeper sleep, to work on getting more physically active and even doing a little bit of exercise. I'm going to suggest different types of drugs that work on pain that's coming from the brain. 

 

If you can feed that information back to your health care providers, it'll just make the treatment a lot more successful. Because they are quite different treatments based on which type of pain seems to be flaring you right now. 

 

Rebecca: 

Sarah, I wonder if you have any tips to share. We often talk about how important it is to track your pain, to share that information with your doctors. Any tips that you have? And how you've done that? And how you differentiate, you know, the pain you're having? 

 

Sarah: 

For me it was always, well, that hurts, so don't do it. For Chris, the rheumatologist had always stressed that, if it hurts, stop, and we're going to figure out why it hurts. Especially when he was in high school, and he was very active and doing running and different sports. We had to teach him how to differentiate between, this is my arthritis that is flaring, versus, I have a mechanical issue, or you just ran three miles, your legs are going to hurt. (laughs) 

 

Rebecca: 

Yeah. 

 

Sarah: 

When he is hurting, I can ask, is this my arthritis that is hurting, or is this I overdid it today? Or do we have something else going on? I think about when my hand is hurting: Is it numb? Does it feel electrical? And if it is, I'll write down that day in my journal: This is neuropathic pain. I think this is either, you know, my C-spine, or this is coming from the shoulder issue, versus, I can't bend my fingers a certain direction. They're turning... OK, that's an inflammatory issue, versus, I really shouldn't have walked three miles yesterday because my feet just hurt. 

 

Rebecca: 

Right. 

 

Sarah: 

You have to sit and think about what you did versus how and where it's hurting. But you have to explain that to the doctor, that this is the issue I have when… not just, well, I hurt more. 

 

Rebecca: 

It's not just the type of pain; it's what activities surrounded the results of having the pain. And then for Dr. Clauw, right, when a patient comes to you with this tracking journal of their symptoms and their pain, there's a lot of things for you to be able to dive into, right? 

 

Dr. Clauw: 

Right. And these are also all therapeutic targets, you know? Because if you focus too much as a clinician on the pain, you miss things that you can often do more about. So, more and more research is suggesting that a lot of pain occurs because people are sleeping poor. 

 

A lot of the studies are suggesting, for example, in new onset fibromyalgia in children, that the sleep problems come before the pain. Sleep problems or memory problems that were called fibro fog initially, and fibromyalgia, are really common in people with chronic pain. If a rheumatologist is just myopically focusing on treating the inflammation, sometimes they just ask about the pain, and they don't even ask how people are sleeping or some of these other things. 

 

Rebecca: 

Yeah. How much are you moving? How much are you sleeping? 

 

I do want to ask, if we can go down the list for the different, main types of arthritis that are known, is there a specific type of pain that we can associate typically with it? We know starting off, fibromyalgia is that centralized pain-processing disorder, or that nociplastic pain. That's common with fibromyalgia, correct? 

 

Dr. Clauw: 

Yes. But again, people with fibromyalgia can have some osteoarthritis or carpal tunnel syndrome superimposed. 

 

Rebecca: 

Yeah. It's common for all of us with autoimmune to also have fibromyalgia pain as well, right? So, but osteoarthritis, what is the typical type of pain that people see? 

 

Dr. Clauw: 

It's typically nociceptive, but again, a little bit inflammatory, but not nearly as inflammatory as rheumatoid arthritis, lupus, psoriatic arthritis. 

 

Rebecca: 

And then rheumatoid arthritis. 

 

Dr. Clauw: 

Again, inflammatory mainly with, you know, secondarily, but again, in a rheumatoid that's had rheumatoid arthritis for 15 years, they might not have a lot of ongoing inflammation, but those joints are all damaged. And they almost have the equivalent of osteoarthritis, because the cartilage is lost, the bone is damaged, just as occurs in osteoarthritis. Late in RA, people will typically have more sort of mechanical pain, and even fibromyalgia-like pain, rather than just inflammatory pain. 

 

Rebecca: 

Psoriatic arthritis is part of the spinal arthritis family, like axial spondyloarthritis arthritis. Are there specific hallmarks? Of course, they’re autoimmune, autoinflammatory diseases. 

 

Dr. Clauw: 

They typically start out as inflammatory. And then as people have those conditions longer and longer, often then that's when they transition to having more and more fibromyalgia-like pain and mechanical pain and less inflammatory pain as the disease goes on. And we see that with other conditions, sickle cell disease, other conditions, that are very inflammatory, very nociceptive, early in someone's life, but become much less inflammatory and much more so central nervous system driven as the person gets on in life. 

 

Rebecca: 

And then the last one I'll ask about is gout. 

 

Dr. Clauw: 

Gout is classic nociceptive pain. Can't even put the bedsheets on top of that angry, hot, warm toe that's incredibly inflamed. And you don't really usually see a lot of the other kind of pain with gout. It's really when, during an acute gout attack that — other than infectious arthritis — that's the most inflammatory type of arthritis we see. 

 

PROMO: 

Whenever you need help, the Arthritis Foundation’s Helpline is here for you. 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: 

In this segment, Dr. Clauw, we take some comments and questions that have been posed through social media in our listener segment. One person says it feels like “I have someone hammering my joints with an ice pick from inside out.” To me that sounds pretty painful, but probably very descriptive. If you hear somebody saying that to you, what would your response be? 

 

Dr. Clauw: 

There's probably an inflammatory component to it, in that they localize it so well to the joints, but it doesn't mean that they couldn't have these other pain mechanisms. Is it just in the joint, or is it radiating? If someone has pain in six, eight different locations in different arms, legs, different areas of the body, that almost certainly has a central nervous system component to it. 

 

Rebecca: 

Some people talk about the pain feels like “I’m swimming in ice.” Somebody mentioned that, and a couple of people are talking about, like cold. 

 

Dr. Clauw: 

It's either nerve pain or it's central nervous system pain. But it's not usually peripheral pain, when you start to feel like heat and cold sensations, things like that. 

 

Rebecca: 

OK. Another topic: Let's say when the weather is changing, their pain increases, they get more headaches, and then pain appears anywhere along the body, along with some fatigue. Why is it that that is a thing? That when the weather is changing, people are feeling more pain? 

 

Dr. Clauw: 

We think it's because of changes in the barometric pressure, not changes in the temperature, 'cause most people are not sitting outside all the time. 

 

Rebecca: 

What, Dr. Clauw, would you say are your top three takeaways for our listeners and really trying to understand the different types of pain they may be experiencing? 

 

Dr. Clauw: 

The first takeaway would be: The better you understand your pain and the different underlying causes of the pain, the better care you're going to get. Because you can then feed that information to the people that are taking care of you. And they'll be able to provide more precise care, 'cause these different types of pain have markedly, different types of treatments. 

 

The second thing I would say is: Make sure that you have sort of thoroughly thought through: Do you have some fibromyalgia-like pain, or some central sensitization? Because there's a lot of simple things we can do for that kind of pain, a lot of non-drug treatments that can be quite helpful for that type of pain. 

 

And then I guess the third thing would be, just in general, advice for chronic pain patients: Just keep moving forward. People get discouraged when they have chronic pain, and they get in ruts. And they are reluctant to try new things. But the best thing that you can do as a patient is just have an open mind to trying new therapies that you haven't tried, especially some non-drug therapies. The evidence base is increasing for things like acupuncture, yoga, tai chi, mindfulness. You might be surprised that one or more of those things can be really helpful for you. 

 

Rebecca: 

Thank you. Is there anything you want to add, Sarah? 

 

Sarah: 

I think we need to remind ourselves that we are our best advocate. And so, if you are having different types of pain, one, educating yourself on what they are, but also being able to speak clearly to your doctors about what the type of pain is and looking at those alternatives. 

 

Rebecca: 

That's some really great advice. Thank you for helping us get to the root of the pain, all puns intended. Dr. Clauw, it was great to have you, and we look forward to hearing more from you in the future. Thanks so much for your time. 

 

Dr. Clauw: 

Thanks for having me. 

 

Rebecca: 

And thank you, Sarah, so much for joining us as well in this conversation. 

 

Sarah: 

Thank you for having me. 

 

Rebecca: 

I want to remind you that we do have that pain management app tool, Vim, which is sponsored by our partner, Tylenol, in helping you tackle pain on a daily basis. The app is great. You can get tips and strategies for managing your nutrition, managing your physical activity and setting some goals to managing your pain, but also to connect with other people. That’s the fun part of Vim. 

 

We have more pain resources available to you if you visit our website at https://www.arthritis.org/pain. Thanks everybody.  

  

PODCAST CLOSE:        

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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