January 1998
Healthwise

Staying on Top of Pain
by Charlotte Armstrong

For some it might begin with an aching in their thumbs when opening jars. Or maybe stiffness in the morning getting out of bed, or a pain here and a crick there after sitting at a desk for an hour.

We put a lot of mileage on our bodies over a lifetime. But our moving parts aren't guaranteed for smooth and painless function for life. More than 37 million Americans--about one in seven--have some form of arthritis (see box). All of them must deal with some degree of pain from a chronic disease--one that has ups and downs, but never completely goes away.

Arthritis--Many Different Diseases

Arthritis is a general term that refers to more than 100 different diseases that affect the joints, including muscles, tendons, and ligaments, and sometimes other parts of the body. Osteoarthritis, the most common form, primarily affects cartilage--which normally cushions joints--causing it to fray and wear away. Osteoarthritis is associated with aging and can cause joint pain, stiffness, reduced joint motion, and deformity.

Rheumatoid arthritis causes inflammatory changes in the joint lining that result in pain, stiffness, swelling, and loss of function in the joints. The disease can also affect other parts of the body and is often chronic.

How is it that some people with severe disease are still able to live active, involved lives? Their lives reflect how they manage the disease, according to Dr. Kate Lorig, Director of the Stanford Patient Education Research Center in Palo Alto, California. At a talk at the National Institutes of Health, Dr. Lorig explained that in arthritis, pain is the biggest problem. But it is not true that each small increase in pain means a matching loss in mobility. Instead, up to a point, pain can increase quite a bit, causing only a little more disability.

However, after a certain point, even a small increase in pain can greatly reduce an affected person's ability to get around. The good news is that a small decrease in pain can sometimes help someone improve mobility a great deal. The other good news is that not all the pain in arthritis is from the disease itself. Some of the pain comes from muscles that have lost their strength (become deconditioned) because the original arthritis pain made it tougher to exercise. Deconditioned muscles don't work as well and become tense, causing more pain.

With this in mind, one way to reduce pain is to exercise. Exercise, done carefully, is much more likely to help than to hurt. It can make you stiff or sore for a short time, but it is unlikely to cause lasting problems. The key is to start slowly, build up gradually, and do it regularly.

Emotions such as depression, worry, and fatigue can also increase pain. By the same token, your mind can also be a tool to reduce pain. The mind, Dr. Lorig said, is like a radio--you can get a lot of stations but you only get one clearly at a time. You can distract yourself from pain or anxiety for a short time by focusing on an unrelated idea--like counting when climbing stairs or going to sleep.

Dr. Lorig also recommends "self-talk," another technique that makes use of the mind. Self-talk means to take the mental messages we give ourselves every day--"I'm too discouraged to do this" or "I will only fail if I try to exercise"--and change them from negative to positive. Try "I will start the day with something pleasant," like drinking a cup of coffee, stroking a pet, or talking with a friend. These messages help rule our emotions, and "up" messages can lift our moods.

By trying measures like these, people with arthritis can break a cycle in which pain, inactivity, and emotions like depression and anxiety all feed into each other. Everyone with arthritis, says Dr. Lorig, has to do three things:

1) do what the disease demands, like taking drugs or watching your diet;

2) get on with life, like being a parent, making a living, keeping a house;

3) deal with the emotions that come with a life changed by illness.

Confidence is key to doing all three.--an NIH HEALTHWise report, January 1998

Be HEALTHWise: Exercise!

Some pointers for people with arthritis:

appleChoose the exercise program you enjoy most and make it a habit.

appleProgress slowly.

appleStart strengthening exercises slowly with small weights (a 1- or 2-pound weight can make a big difference).

appleAdd endurance exercise such as walking or biking for 5 minutes 2 or 3 times a day.

appleEase off if joints become painful, inflamed, or red and work with your doctor to find the cause and eliminate it.

More tips are available in a brochure by the National Institute of Arthritis and Musculoskeletal and Skin Diseases (NIAMS) on arthritis and exercise. It is available on-line at http://www.nih.gov/niams/healthinfo/arthexfs.htm. For a printed copy of it or other materials on arthritis contact:

National Arthritis and Musculoskeletal and Skin Diseases
Information Clearinghouse
National Institutes of Health
1 AMS Circle
Bethesda, MD 20892-3675
Phone: 301-495-4484
TTY: 301-565-2966
Fax: 301-587-4352

The Arthritis Foundation is the major voluntary organization devoted to arthritis. The Foundation publishes a free pamphlet on exercise and arthritis and a monthly magazine for members that provides up-to-date information on all forms of arthritis. Contact:

Arthritis Foundation
1330 West Peachtree Street
Atlanta, GA 30309
Phone: 404-872-7100 or 800-283-7800
or call your local chapter (listed in the telephone directory)
World Wide Web address: http://www.arthritis.org

For more information, contact:

Charlotte Armstrong
Writer/editor, NIH
Phone: 301-496-8855
Fax: 301-496-0019
E-mail: Charlotte_Armstrong@nih.gov

Apple

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