The Pain Brain Drain
I was recently talking to a friend, who mentioned her daughter’s golf lessons. “She’s taking golf?” I asked. She replied, “Yes, I told you that when her lessons started.”
A few days ago I was laid up with hip pain, looking for some distraction on my iPad until the muscle relaxer and painkiller kicked in. Remembering a tv show recommended by a friend, I began streaming it. It was exactly the distraction I needed, so I texted my friend to thank her. She replied, “I didn’t recommend that show to you, but I’m glad it’s helping.”
What is happening to my brain?
The unsettling feeling of not being able to trust my memory or cognition began flooding my body, and then I realized that it’s a familiar feeling. Suddenly, I knew exactly what was happening to my brain: I had been in too much physical pain during those conversations to remember them accurately.
Often when it comes to rheumatoid arthritis/rheumatoid disease [RA/RD] brain fog, it stems from my fatigue. While I haven’t been energetic for these past couple months of increased disease activity, I haven’t felt that heavy, debilitating fatigue that sometimes accompanies my flares. When I’m wearing that heavy coat of fatigue, everything feels slow from my feet all the way up to the thoughts in my head. I have a hard time finding the word I’m looking for, and feel like my brain isn’t “clicking.”
I’ve come to realize that I also have cognitive lapses when it comes to pain. This phenomena isn’t as pronounced as the brain fog that comes with fatigue, but I’m realizing that my brain muddles information it takes in when I’m in a lot of pain. My brain splices two conversations with different people into a memory of one conversation, or it jumbles the chronology of the details, or leaves some out altogether.
Our brains are always deciding what information should go into long-term storage and what should be deleted. We take in so much information every day that we couldn’t function effectively if our brains didn’t prioritize it. However, when I’m in pain it seems like the file clerk in my brain came to work high and is putting information in the wrong folders and destroying what should be preserved.
Understanding that pain impacts my cognition
While feeling that I can’t trust my brain after a flare is not a comfortable feeling, understanding that pain impacts my cognition is less unsettling than the exasperated “What is wrong with my brain?” query. It’s frustrating that RA/RD impacts me literally from my head to my swollen toes, but at least there’s not an additional neurological diagnosis waiting in the wings. I would rather have a mind like a steel trap, but understanding that my memory is less reliable after a flare can help me develop strategies. When I’m in pain, I can make an effort to take more notes during work meetings than I typically would or take a moment to back at emails I sent while hurting before following up with people to make sure I haven’t mixed up anything in my memory.
It’s amazing how profound the impacts of RA/RD are, as this disease can impact joints, tissue, muscles, organs, and even cognition, not to mention the impact of medication side effects. While I would give anything to get rid of this disease, understanding just how pervasive the symptoms are helps me better understand the challenges I’m contending with, and allows me to give myself a little grace when I misremember.