Chronic Pain: It’s Not Just About Your Joints | Arthritis Information

Chronic pain from arthritis can feel as if it has a life of its own, however altering your attitudes and beliefs can help. Johns Hopkins offers advice to help you break the cycle of pain.

The origin of arthritis pain is undeniably physical, arising from pressure on nerve endings due to joint damage, muscle strain, or inflammatory substances in the joint fluid. The nerve endings send warning signals to the brain, and the brain must interpret the signals. At this point, what we know as "pain" takes on a psychological as well as a physical component.

The interplay of mental and physical factors is what makes it possible for two people to experience pain differently. The same stimulus can provoke definite pain in one person but only mild discomfort in another. These differences involve variations in nerve sensitivity at the site where the pain originates, but they also result from how the brain interprets the pain signals.

Interpretation is where a person's thoughts, feelings, and mood exert their effects. Depression, anxiety, and even social or cultural influences can alter the experience of pain. Research conducted over many years suggests that altering attitudes and beliefs about pain can make it more tolerable.

Research published in the Proceedings of the National Academy of Sciences demonstrates the mind's power to alter pain perception. In the study, researchers gave volunteers brief exposures to three levels of heat on their legs at temperatures that produced mild, moderate, or severe pain. The study participants were exposed to the heat three times and were asked to rate their level of pain. In some of the exposures, the researchers told the volunteers to expect one level of pain, but they actually delivered heat that was higher or lower.

When people were told to expect moderate pain but actually received the highest temperature, they rated their pain 28% lower than when they were told they received the highest heat. Magnetic resonance imaging (MRI) scans taken during the testing showed corresponding alterations in brain activity when the volunteers were given the false expectation of a less painful exposure.

Chronic pain takes the greatest mental toll and is the most likely to respond to your psychological state. Fatigue, anxiety, depression, and stress can intensify your experience of pain. Dwelling on the pain, too, can make it feel worse and allow it to overshadow the rest of your life. When pain gets such a firm grip, a vicious cycle may ensue: You become fixated on the pain and perceive it as more intense. That leads to anxiety and depression, which can cause you to withdraw from normal activities. As you become less active, strength wanes, joints get stiffer and more painful, and debilitating fatigue can set in. This leads to more anxiety and depression, and the destructive cycle continues.

Breaking the Cycle of Pain -- Fortunately, it is possible to pull out of this downward spiral. Strategies to help ease chronic pain include:

• Distraction. The less you think about the pain, the better you will feel. Distract yourself with enjoyable activities that allow you to focus on something else.
• Be positive. Look for what’s good in your life. Try to flip negative thoughts into positive ones.
• Optimize your health. Focus on improving your overall health. Eat well, exercise, get adequate sleep, and manage your stress. Try to think of yourself as a healthy person who has arthritis, not as a person who is sick.
• Laugh. Find the humor in life. Seek the company of positive, upbeat people.
• Find ways to relax. Pain causes muscles to tighten and can increase your heart rate, breathing, and blood pressure. Massage, prayer or meditation, visualization techniques, deep breathing, relaxation tapes, and quiet music are good relaxation methods. Experiment until you find a relaxation technique that works for you.