RA - A Real PAIN in the Rear

It’s difficult to describe the various types of pain experienced with RA. As I sit in a cozy chair writing this article, all of the middle finger joints are swollen and tender to the touch making typing difficult.

The pain I am currently experiencing

The right hip hurts to the point of needing to pull it up into a contorted position up on the armrest of the chair. Both wrists hurt when flexed. The right elbow displays a sharp pain right above the joint where surgery was done just eight short months ago. Both knees ache and crunch when moved. Calf muscles feel stretchy and stiff. Both Achilles tendons sting…the right one is bad enough that it burns even while lying down to sleep.

What is pain?

Upon rising from the chair, the Frankenstein walk becomes a hallmark gait. Sharp, dull, achy, diffuse, localized – all types of pain are present all at the same time and this experience is a daily one with RA.

Pain is the body’s way of telling you something is wrong. According to the American Pain Society,

“[Pain is] an unpleasant sensory and emotional experience associated with actual or potential tissue damage, or described in terms of such damage. While it is unquestionably a sensation in part or parts of the body, it is always unpleasant and, therefore, an emotional experience.”1

Understanding different types of pain

RA is usually nociceptive pain

The Cleveland Clinic classifies pain as either acute – short term, or chronic – long term.2 While some RA-induced pain may be acute, it can come and go depending on what joint is being affected, much pain associated with RA is chronic. Pain sources can be nociceptive – caused from the stimulation of local nerve receptors, or non-nociceptive – caused by problems with the central nervous system.3 RA pain is typically nociceptive since it tends to be localized to various inflamed or damaged tissues.

Types of nociceptive pain

Nociceptive pain can be further divided into somatic – localized to an area resulting from damage to the musculoskeletal system, and visceral – non localized pain.4 According to Northwestern University, in somatic pain,“Patients may describe this as sharp, aching, and/or throbbing pain that is easily localized.”5

What type of pain is rheumatoid arthritis?

Pain associated with RA is typically chronic, nociceptive, and somatic. Management for this type of pain is facilitated through the use of analgesics like acetaminophen (Tylenol), non-steroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen, or narcotics.

Neuropathic pain in rheumatoid arthritis

Another type of pain caused when the nervous system is damaged, called neuropathic pain, may also be associated with RA. For example, the tingling sensation associated with carpal tunnel syndrome is caused by pressure on, or damage to, the median nerve that enters the hand.

RA-induced damage to vertebrae could adversely affect the spinal cord causing neuropathic pain down nerves into extremities. This explains the long term pain, numbness and tingling in my fingers after having neck surgery.

Treating RA pain at the source - inflammation

With RA, the first and foremost goal is to treat the cause of the pain – inflammation. In this regard, my thought is, “RA drugs, do your thing so inflammation and pain is reduced.” If not, I’ll be forced to take more drastic actions such as treating the pain symptoms directly. That’s where my treatment options become less available since my stomach can’t handle NSAIDs.

Treating pain symptoms directly

I’m left with Tramadol, Tylenol, the hot tub, topical Voltaren gel (an NSAID), and rest. If that doesn’t work, perhaps I’ll pull out the prednisone steroid pills or get a steroid injection into a joint as a last-ditch effort. And then there’s surgery as a more drastic measure to repair damaged tissues.

I’d prefer to directly treat the underlying inflammatory processes of RA that cause tissue joint damage directly and not just mask the pain symptoms.

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