Pain Sensations from RA

It’s complicated to describe the various types of pain experienced from RA. As this article was being written, all of the proximal interphalangeal or PIP finger joints (middle joint) are swollen, painful, and tender to the touch. The metacarpophalangeal or MCP joints at the base of each finger are painful upon grabbing the computer mouse. Both wrists hurt when flexed. The right elbow displays a sharp pain in the joint and a burning sensation down the forearm from a torn tendon that is getting surgery next month. Both knees ache and crunch when stirred. After three ankle surgeries, each calf muscle displays a dull ache at all times and the associated Achilles tendons sting with a sharp pain whether moving or not. Sleeping on the left hip is near impossible. Sometimes it’s hard to pinpoint the source or cause of the pain. While this day may not typical, one thing is certain; some sort of pain is always present with RA.

Pain is the body’s way to telling you something is wrong. According to one source,

“[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.” (American Pain Society, 2003)1

Pain is difficult to describe and measure. It is extremely complex biologically and psychologically (Dubin & Patapoutian, 2010).2Pain scales were developed for caregivers to better understand how pain is impacting a person (Merck Manuals).3 But these scales possess limitations.

Pain can be classified as either acute – short term, or chronic – long term (Cleveland Clinic).4 While some RA induced pain may be acute, it can come and go depending on what joint is being affected, much RA pain is chronic. Pain sources can either be nociceptive or neuropathic. Nociceptive pain is caused from the stimulation of local nerve receptors and tends to be sharp or aching. Nociceptive pain can be further divided into somatic – localized to an area resulting from damage to the musculoskeletal system, or visceral – non-localized pain. With somatic pain,

“Patients may describe this as sharp, aching, and/or throbbing pain that is easily localized.”5

Pain sensations associated with RA are 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. 6

Neuropathic is caused by problems with the central nervous system and oftentimes results in dull pain, numbness, and tingling sensations (Merck Manual).7] 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. Numbness and tingling caused by pinched nerves in the spinal region is also neuropathic. While arthritic pain tends to be nociceptive since it is localized to various inflamed or damaged tissues, inflammatory pain from RA is sometimes viewed as a blend between nociceptive and neuropathic since changes in the spinal cord mimics neuropathic pain (Nicholson, 2004).8

There are many ways healthcare providers attempt to treat pain including NSAIDs, narcotics, nerve blocks, electrical stimulation, and behavior modification (Cleveland Clinic).9 With RA, the first and foremost goal is to treat the cause of the pain – inflammation. In this regard, the typical treatment plan is for biologics and disease modifiers (DMARDs) to control inflammation so pain is reduced. The idea is if the disease processes are under control, pain will be summarily reduced. If this doesn’t work, patients are often forced to take more drastic actions such as treating the painsymptoms directly with NSAIDs, steroids, or narcotics. But these traditional pain treatments present snags for many RA patients. Oral NSAIDs can cause gastric inflammation, ulcers, and an increase in cardiovascular risk. Inflammation-reducing prednisone possesses many long-term side effects. And narcotic pain relievers can be addictive. Some RA patients seek help from a doctor who specializes in pain treatment.

Pain is a constant reminder of the raving effects of RA. Learning to treat and cope with pain is a critical part of living with RA.

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