Managing Pain |
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Arthritis is a word used to describe pain in your joints. The pain can be felt in a number of ways. If you have inflammation in or around the joint this is likely to cause swelling, redness, and heat but sometimes just a damaged or worn joint may also cause pain. These problems may also make you reluctant to move you joint or give you difficulty on movement. Pain caused by damage or inflammation can cause a strain and discomfort to the muscles surrounding the joint. Sometimes you can experience pain as a result of sports injuries and it might be difficult to understand what is causing your pain.
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There are many reasons for pain in joints and the most common one that most of us are aware of is the damage and discomfort that is experienced with osteoarthritis. Although osteoarthritis is very common it is important that you know what type of arthritis you have as this will help you understand the best way of managing your pain and the difficulties you experience as a result of the joint discomfort. For instance, if you have joint problems that have been diagnosed as Rheumatoid Arthritis you may need different treatment than for Osteoarthritis or Ankylosing Spondylitis. Once your doctor has seen you and given you a name (diagnosis) for the type of arthritis you have then you can plan to get further information to help you manage your conditions. |
One of the hardest things to learn to manage is how to control pain. The health professionals should try and offer you some advice on how to manage your pain and in some cases offer you treatment for pain. However, if you have an opportunity to take part in educational or specialist self management programmes it is likely that these will help you to reinforce your own pain management strategies and improve your knowledge of how to manage your disease. How you feel, how tired you are, how fearful you are and how other things in your life are working all have the potential to make you feel more weighted down by your pain. So, learning to understand how to manage your pain is important. |
Pain control
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Pain can be disabling and lead to chronic fatigue and a sense of hopelessness. Pain control needs to be tailored to the individuals’ lifestyles, the level of pain experienced and in some cases, how well controlled the disease is. |
In some parts of the United Kingdom there are expert patient programmes that have been introduced to help people learn about coping with a chronic illness. Although these programmes do not focus on the specific issues related to arthritis they can be helpful. If you have rheumatoid arthritis The National Rheumatoid Arthritis Society
(NRAS) have very useful information for you
www.nras.org.uk |
If you have a condition that is referred to as an inflammatory form of arthritis – such as Rheumatoid, Psoriatic Arthritis, Ankylosing Spondylitis you might find this link also helpful.
If you have Osteoarthritis http://www.nhs.uk/
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In the meantime here are some important facts that may help you in managing your pain: |
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Medications for pain back to top |
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All pain relief medication should be taken at regular time intervals when you are trying to get effective pain control. Many people make the mistake of only taking their tablets to relieve pain when the pain is very bad and then wonder why the tablets have not worked. The brain is sensitive to pain messages from the body and if you only take medication occasionally the brain will not be able to 'turn off' the 'help I have pain' messages sent from the painful areas (such as a knee or hip) to the brain. Regular pain relief helps to break the cycle of pain messages going from the painful joints to the brain. If pain relief is used regularly this breaks the cycle. Remember that pain relief does not only mean medicines but also means finding techniques that help you to feel comfortable, for example relaxation, a hot bath or shower. For an easy to follow detailed explanation on the pain and the pain cycle see the leaflet on the arthritis research UK website. |
Achieving good pain control is about using a group of pain control methods as an overall long-term plan. So if you are unable to control your pain it may be right for you to consider taking regular pain control medications with pacing strategies, rest and the use of an aid or device such as a walking aid if you have knee or hip problems. When you have good pain control and you feel the problem has settled - then you should gradually reduce the pain medications. You should think of it as: And
2. Step down - when the pain is well-controlled review how to gradually reduce your pain control medications and additional strategies (e.g. reduce resting time) and gradually continue to reduce them as long as the pain remains controlled. |
Note: When discussing medications it is important that the advice outlined below is only a guide. Medications you take should be used according to the advice provided by the manufacturer and your doctor, nurse or pharmacist who prescribed the medications. Always check with them before making any changes to your medications. You should not exceed the prescribed dose and check that you are safe to take the medications (information is provided in the packaging of your medication).
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1.Pain Relief
Creams and packs that you can use to apply to the painful joints, sprains and strains. Some of these are anti-inflammatory creams (e.g. ibuprofen). It is important to know that when creams that are applied to the skin if applied to frequently or liberally they can be absorbed by the body and have effects throughout the body. This is especially important if you are worried about taking a non-steroidal anti-inflammatory tablet by mouth but decide to use a cream instead. Some of the anti-inflammatory creams can be bought over the counter at the chemist. They have been shown to be effective for pain relief in the short term (up to two weeks) particularly for smaller joints. There are also creams that work by producing a sensation or 'counter irritant effect' (or burning effect). The fine nerve endings recognise the mild irritant and this effect reduces other pain message that the brain receives from the painful joints. One of these creams is a capsaicin cream. These creams can sometimes take several weeks before the pain relief is felt and when first used can cause an initial burning sensation. |
Compound Pain relief tablets (analgesics) These tablets are sometimes called ‘compounds’ because the medication is made up of a mixture of two types of pain relief. Some drugs are mixed with paracetamol or aspirin and a stronger form of pain control called an
opiod. There are a number of different mixtures and these tend to have slightly more side effects than the simple analgesics. For many of the compound or pure opiod tablets the one of the most common side effect is constipation, drowsiness and difficulty with tasks, so risks of falls might be an issue if you are older and less agile. It is worth being aware of these issues and taken account of them with your doctor or nurse, family and friends, and if you are taking regular compound pain relief make ensure you take regular bulking forming laxatives such as Ispaghula Husks (e.g.
Fybogel) to avoid constipation.These can be purchased from your pharmacist. Always check with your doctor that this is safe for you to take. Other side effects can include nausea, vomiting and drowsiness.
Paracetamol 500mg with 8mg Codeine Phosphate (500mg/8mg =
Co-Codamol 8/500) Examples include: Codeine Phosphate 30-60mg every four hours (according to doctor’s prescription but usually to a maximum of 240mg per day).
Tramadol - 50-100mg 4 hourly (according to doctor’s prescription).
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Non-Steroidal Anti-Inflammatory Drugs (often called
NSAIDs) There are lots of different types of these drugs and they are effective in reducing pain but they do come with some side effects that you need to be aware of (see Note below) Your doctor has to prescribe the majority of the NSAIDS although one or two can be purchased at lower dosages over the counter (for example, ibuprofen). In some cases you may also be prescribed another tablet to be taken whilst you are taking an
NSAID. The tablet is one to provide additional protection for your stomach – for example they are called Proton Pump Inhibitors (e.g.
Omeprazole). The Arthritis Research Campaign (arc) produce an information leaflet on NSAIDs and this can be accessed at
www.arthritisresearchuk.org/
A group of NSAIDS called COX IIs provide some benefits for people who are at an increased risk of having a stomach ulcer. You can read more about these type of medications at:
www.nice.org.uk/ REMEMBER: The general advice is that you should discuss your pain with you doctor or nurse and that together with them you must consider your personal and individual risks related to take any medication. If you are prescribed an NSAID or COX II the recommendation is that you should have the lowest dose that will help your pain for the shortest length of time. Please discuss this information in more detail with your doctor or nurse as they will want to make sure you are safe on medication but importantly get the right level of pain relief.
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See also the Medication page |
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In addition your rheumatologist or family doctor may prescribe other medications depending up the type of arthritis you have. Some of the treatments will be to improve control of the disease and this should reduce the pain. Some treatment options depending upon the disease and problems experienced may include: |
Injections of steroid (for inflamed joints) or hyaluronans (a viscosupplementation for Osteoarthritis which may in rare cases be used for treatment of Knee OA). These are usually injected directly into the painful joint. Although some evidence suggests hyaluronans may be helpful for some people with knee OA they are quite expensive and need to be considered in discussion with your doctor or nurse. |
Steroid treatments - these include tablets, injections (into a muscle) or infusions (a needle is inserted into a vein and a bag of fluid mixed with the steroid are given to you over a period of a few hours). The use of disease modifying drugs or biologic therapies for some types of arthritis (see the section on medications)
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2. Hot and cold packs.
Hot packs may be useful especially for stiff or aching joints and muscles. Again you must be careful that you do not damage your skin. Skin that is painful may not be able to properly recognise when the heat is burning or damaging the skin. Make sure that you don’t let the pack get too hot and test the temperature before applying to a painful joint. As with cold packs it would be advisable to wrap a fine piece of cloth around the pack. These packs are made from a range of products and can be heated in the microwave - but do make sure that you use the packs as advised by the manufacturers.
Resting can sound difficult, especially if you are being asked to rest when you are experiencing pain, or have plenty of tasks that you want to do today and don’t like resting anyway! But…learning relaxation techniques can relieve the tension and ultimately constant pain messages to the brain. Fatigue will affect how you perceive pain and how you cope with it. Learning ways to relax completely can be a real trial for some people others, are gifted at it! You need to find the best way to help you relax. Some people find certain types of music help others like absolute quiet. It is useful to try resting on a bed for a short time each day when the pain is bad, lying in a dark room, without any additional noises or distractions that remind you of things to be done. A short sleep may even be worthwhile. Set an alarm to ensure that you only sleep for a certain period of time so that over time you don’t lose your normal night sleep patterns.
5. Managing Fatigue
www.arthritisresearchuk.org/
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Fatigue is often not mentioned or fails to be recognised and sometimes you may feel that you are the only one who is exhausted and failing to cope - interestingly when I see new patients who come along having recently been diagnosed and 'I say are you feeling exhausted ?' they look relieved and surprised to have their fatigue
recognised. Many say they felt they must be 'weak' or a 'being pathetic' because they were feeling so fatigued. It comes, in a way as a relief to many to realise that it can be part of a disease like
RA.
www.nras.org.uk/
Passive exercise
If you have any doubts about the safety or your ability to undertake any exercise regime you should discuss this with your own doctor before starting an exercise
programme. www.arthritisresearchuk.org/ |
9. The use of aids (walking sticks, joint protection, footwear). |
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Anyone with a chronic illness whatever that illness will be enticed by the vast array of products that promises a cure when traditional medicine has failed to provide the same promise. It is natural to seek other solutions and find a way to resolve some of the difficulties that arthritis might put in your way.
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It is not possible to cover the complete range of complimentary therapies available and I would recommend looking at the most up to date evidence on websites such as Arthritis Research UK. |
Further information can be accessed from the patient information websites or an excellent report on complementary and alternative therapies can be accessed at www.arthritisresearchuk.org
Last updated October 2020 |
Susan
Oliver Associates
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