Managing arthritis pain

Put simply, pain is the body's way of telling you something is wrong. Nerve fibres from the affected area transmit warning signals to the brain – which is when you first feel the pain.

There are two main types. Acute pain is the short-term pain that comes from stubbing your toe, for example. Chronic pain persists or recurs over a longer period. Both can lead to a third type: muscular pain caused by the constant tension of protecting the joints from painful movements.

People with rheumatoid arthritis may experience all three pain types. Those with osteoarthritis tend to suffer joint pain and muscular aches. Arthritic pain can occur due to the effects of inflammation – such as heat, redness, swelling and restricted movement – or because the joints are damaged and not working properly.

Pain levels fluctuate, and we all experience and react to it in different ways. But at its worst, unaddressed chronic pain leads to a cycle of discomfort, depression and stress.

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How do you get rid of arthritis pain?

Get to know your joints

Rule number one? Listen to your body. Learn to recognise the triggers that cause joint pain, then find new or different ways of doing things. It’s often advisable to avoid activities that require a tight grip or putting too much pressure on your fingers.

Aim to use your largest and strongest joints and muscles for everyday tasks. Try a bag with a shoulder strap to spread the weight, instead of holding a case in one hand, for instance.

Finally, try to avoid being in the same position for a long time as this can cause muscles and joints to stiffen. The trick is to strike the right balance between rest and activity.

Make exercise work for you

Exercise helps you maintain a healthy weight, which reduces stress on the joints and so eases pain. It also reduces stiffness, improves muscle tone and lifts your mood.

Three main types of exercise can help reduce arthritis pain – and it's important to find the one that works for you. Always warm up properly, build up gradually – and if you feel any excessive or unusual pain, stop immediately. If your joints still hurt two hours after exercise, you’ve probably done too much.

Stretching Also known as range-of-movement exercise, this helps ease joint pain and maintain maximum flexibility. It involves easing joints through their comfortable range of movement then gently pushing them a little further.

Strengthening Great for hip and knee pain, this helps strengthen the muscles to keep joints stable.

Aerobic This type of exercise raises the heart rate and makes you breathe faster to burn calories and boost overall fitness. Try the likes of walking, swimming or cycling for 30 minutes a day, five times a week – but build up to this slowly and don’t push yourself too much.

Apply hot and cold treatments

Both heat and cold can alleviate arthritis pain. So what's the difference?

Heat is good for soothing joint pain. It works by opening the blood vessels and boosting blood flow. Try a hot water bottle, electric blanket or warm bath.

Cold is particularly effective for acute inflammation. It works by slowing blood flow to the affected area, reducing swelling and relaxing the muscles. Try applying a pack of frozen peas wrapped in a towel for 10 to 15 minutes.

Wear a splint

Very inflamed joints are prone to more pain and damage, particularly when carrying out everyday tasks. Using a splint can help address this – so do consult your GP or occupational therapist if you think you could benefit from one.

Try a TENS device

TENS devices are battery-operated stimulators that appear particularly effective for easing neck and back pain.

Small electrodes are taped to the skin near the painful area. They are thought to ease pain by stimulating nerves with low-level electrical impulses to release natural pain-relieving brain chemicals called endorphins.

Always check with an appropriate healthcare professional before using a TENS device.

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Don't let the pain control you

Distraction really works! If you're constantly thinking – and worrying – about your arthritis pain, you're likely to experience it more severely than you would if you focused on something else.

So make an effort to keep things in perspective and find ways to do the things you really enjoy – whether that's a favourite hobby, socialising or simply relaxing.

Relaxation exercises, such as mindfulness meditation or deep-breathing techniques, can promote positive thinking and an overall sense of calm. It's a good idea to try a few different methods until you find the one that works best for you.

Sleep well

Chronic pain can make it seem impossible to get a good night's sleep. But adequate slumber is vital to replenish energy levels, calm the mind and rest the joints.

A few tips? Keep your bedroom calm and comfortable: clear the clutter, fit blackout blinds and keep electrical devices elsewhere. Invest in a supportive mattress and pillows, particularly if you suffer from neck or back pain. And avoid stimulants such as alcohol and caffeine in the evenings.

Your GP can advise you on ways to manage long-term fatigue.

Investigate complementary therapies

These work alongside conventional drugs to ease pain and side effects. Always check with your doctor before trying new therapies.

Acupuncture Very fine needles are inserted into the body to stimulate nerves and encourage the release of pain-relieving endorphins.

Homeopathy Based on the principle that 'like cures like', homeopathic remedies are drawn from a highly diluted form of the ailment being treated. Exactly how homeopathy works in unclear and controversial, but some people report pain relief.

Herbal medicines Remedies drawn from plants and plant extracts are used to ease chronic pain and reduce inflammation.

Reflexology Pressure is applied to parts of the hands or feet, which are believed to map other areas of the body. The pressure is said to cause physical changes in these areas, though again its efficacy is open to question.

Osteopathy and chiropractic Both are forms of physical manipulation to improve joint, posture and muscular problems, and alleviate stiffness and pain.

Massage Muscles and joints are rubbed and kneaded to relieve tension or pain.

Hydrotherapy This involves exercising your joints and muscles in a soothing warm water pool.

What’s the best drug for arthritis pain?

Many types of medication are available to specifically target arthritis pain, so do talk through your options with your doctor.

Painkillers (analgesics)

These relieve arthritis pain and stiffness. They include paracetamol and codeine, and vary from low-dose over-the-counter to prescription-only medication.

Non-steroidal anti-inflammatory drugs (NSAIDs)

These reduce inflammation and the associated pain. They include ibuprofen, diclofenac and naproxen. Side effects may include digestive problems and increased risk of stroke and heart conditions.

Disease-modifying and immunosuppressive drugs

These are used to treat types of arthritis that involve autoimmunity, such as rheumatoid arthritis. They include methotrexate, sulfasalazine and antimalarial drugs. They require careful monitoring to prevent side effects.

Biologic drugs

These include anti-TNFs – such as etanercept and infliximab – which suppress the inflammation- and pain-causing action of a protein called TNF. They are prescribed to control severe inflammatory arthritis.

Other biologic drugs – administered in hospital via a drip – are available for people who haven't responded to anti-TNF treatment.

Steroids

These powerful drugs are taken orally or by injection to reduce inflammation. They carry potentially serious side effects, so your doctor will prescribe a low dose initially.

Painkilling patches

If you suffer from chronic arthritis pain that isn't responding to regular medication, your GP may prescribe a painkilling patch containing opioid drugs.

There are two types. A gel patch contains a reservoir of the drug and has an uneven release pattern. A matrix patch has the drug evenly spread throughout so the amount released can be controlled. Most patches last between 72 and 96 hours and offer steady background pain relief although, initially, it may take several hours before the effects are felt.

Constipation can be among the side effects of taking opioids. Consult your doctor immediately if you have any concerns.

Antidepressants

These are sometimes prescribed to break the cycle of pain, stress and poor sleep caused by arthritis. They work by boosting levels of the feel-good brain chemical serotonin.

Could surgery work?

Surgery is normally the last resort after other treatments have been explored. It varies from minor procedures – to repair cartilage, for example – to more intrusive operations, such as full joint replacement.

Your consultant will explain the various surgery options, and associated risks, for your condition.

Getting further help for arthritis pain

Nobody should have to cope with the pain of arthritis alone. Never be afraid to ask questions, share your worries and seek out help from others.

Your first point of contact? The healthcare team at your doctor's surgery, who will be able to advise you on how best to manage the pain and what other services are available in your area.

If you suffer from depression or anxiety as a result of your arthritis, ask your GP whether counselling may be beneficial. And if you're having trouble coping with chronic pain, your doctor may refer you to a pain clinic, where you can access a variety of therapies and treatments.

Arthritis Care runs free self-management programmes, offering ideas on how to take control of your condition. These sessions – which involve discussions and practical suggestions for everyday life – also help boost confidence and reduce stress levels. Other self-help groups can be of benefit, too.

For more information, go to www.arthritiscare.org.uk and download your free copy of Arthritis Care’s booklet Managing Pain.

For facts, support and guidance on all aspects of arthritis, call Arthritis Care's free helpline on 0808 800 4050. They're open Monday to Friday, 09.30-17.00.

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