Coping with

pain

ARTHRITIS CARE Coping with pain

devised with and for people with arthritis

Pain is part of daily life for many people living with arthritis.This booklet is for anyone with arthritis who wants towork at controlling their own pain. It will help you get abetter understanding of what pain is and will explain arange of methods for dealing with pain.

Different types of pain management work for differentpeople – everyone is unique. Arming yourself withinformation is the first step along the road to pain controland living life with arthritis to the full.

Contents

Pain management 1How pain can affect people with arthritis. The pain cycle. The pain barrier. The importance of focusing away from pain.

Pain control methods 5How to use your joints to avoid stress and pain. The benefits of self-help groups and what self-management is. The importance of exercise in keeping you healthy and relieving stiffness. Specific methods of pain control such as massage, relaxation,hypnosis, counselling, complementary therapies and drugs.

Next steps 18Where you can find help, the role of your healthcare team andpain clinics. Tips for your own pain management.

Pain management resources 21

Useful organisations 22

All people pictured on the cover and quoted in this booklet have arthritis.

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PAIN MANAGEMENT

Learning to cope with chronic(long-lasting) pain may be thebiggest challenge you face as aperson with arthritis. But manypeople with arthritis havediscovered that something canbe done. You have probablynoticed that your arthritis andyour pain vary from time totime. Everyone’s arthritis andpain are different.

There are no easy answers orquick solutions to learning to livewith pain – what may be veryhelpful for some people mightnot work at all for others.

By trying some of the differentways of controlling pain listedwithin this booklet, you willprobably find a combination thatworks for you. The ideas whichfollow have all been used bypeople with arthritis, with bothpositive and negative results.

■ Pain and arthritisPain is one of the most commonsymptoms of arthritis. Around81 per cent of people witharthritis said they are in pain allor some of the time in a recentsurvey.

Pain is normally the body’s

way of signalling that somethingis wrong. Excessive irritation orinjury stimulates nerves in thearea to release chemicals thatexcite nearby nerve fibres.These nerve fibres are like tinytelephone wires that transmitconfusing sensations to yourbrain, where the signals arerecognised as pain.

‘I grew to accept painas part of my life andworked out ways inwhich I would manage it’Pain tells you that you need todo something. For example, ifyou touch a hot stove, you willreact by jerking your hand awayto prevent further injury.

Pain from arthritis can be feltfor a variety of reasons. Inflam-mation in the joint causes heat,redness, swelling and loss ofmovement, and can often causepain. Damaged joints can bepainful as well.

Both these kinds of pain canlead to a third type – frommuscles strained by tensing themand by trying to protect the

joints from painful movements.In rheumatoid arthritis, peoplemay feel all these types of pain.With osteoarthritis, most of thepain is felt from damaged jointsand aching muscles.

■ The pain cycleThe changing nature of arthritiscan sometimes leave peoplefeeling low and depressed.

Changes in bodily appearancecan often affect the way aperson feels too.

Arthritis often causes fatigue,which can make it more difficultto deal with pain.

It is possible to be caught in acycle of pain, depression andstress. This is very frustratingand can be upsetting. Learningto manage pain will help tobreak the cycle.

■ The pain barrierPain signals travel to the brainalong the spinal cord. The painbarrier is a way of describingwhether pain signals are allowedto travel to the brain orprevented from reaching it.Closing the barrier, which islocated in the spinal cord, canprevent nerve signals fromreaching the brain where theyare recognised as pain.

Many scientists think that paincontrol methods help to reducepain by directly closing orblocking the pain barrier. Inreality, these are mechanisms inthe nerve pathways leading tothe brain.

Here is another example ofhow the pain barrier works: afather, injured in a car accident,may be so concerned about hischildren’s safety that he doesn’tfeel the pain from his own

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ARTHRITIS PAIN

DISEASE FATIGUE

EMOTIONS

MUSCLE PAIN

STRESS

broken arm. His concern for thechildren somehow closes thepain barrier, preventing the painsignal from reaching his brain.Once the man knows hischildren are safe, the pain breaksthrough the pain barrier.

Some time ago, it wasdiscovered that morphine couldclose the pain barrier. Laterstudies revealed that the brainand spinal cord can release theirown morphine-like substance –endorphins – which can closethe pain barrier naturally. Nervescan be stimulated by variousmethods to release endorphinsand block pain. These methodsinclude massage, heat and cold,concentrating on other matters,physiotherapy and even yourown positive attitude. The painbarrier can also be blocked bythe activity of other nerves.

■ The pain principlesTo appreciate how youexperience pain, it is importantto understand these twoprinciples:● everyone reacts to and

manages pain differently● how you deal with your pain

can actually affect the way inwhich you feel it.

How you were brought up canmake a difference to how yourespond to pain. During yourchildhood, how did your parentsreact to pain? Were you allowedto show it, or was painconsidered bad or embarrassing?Were you able to feelcomfortable showing you werein pain, and allowed to deal withit positively?

‘I believe inacknowledging painand admitting to thefeelings thataccompany it’All these things, and a variety ofother factors such as anxiety andfatigue, determine how yourbody will react chemically topain and whether your nerveswill transmit or block apotentially painful message.

‘When I get things offmy chest, I can thenapproach the problemof pain positively’Experiencing daily persistentpain from arthritis can be a realchallenge, but it is one that manypeople have faced successfully. It

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may always be there, but theywork hard at not letting itinterfere with their lifestyle. Youtoo may be able to re-focusyourself and shift your pain into atiny corner of your life.

■ Changing gearHaving arthritis and the pain thatgoes with it can sometimes leadto a life built around pain andimmobility.

A way to reduce your pain isto change gear by emphasisingthings like optimism, humour,eating a balanced diet, dailyexercise and enjoying a goodsocial life. It can also includepractising relaxation, takingmedication and keeping pain inperspective. By doing thesethings, many people witharthritis discover that they canfeel good about themselves.

Such a change requires deter-mination and practice, but manypeople find it works. ArthritisCare’s self-management pro-grammes may help (see page 6).

You could talk to someone inyour healthcare team at yourGP’s surgery or the hospitalabout how you can make yourlife healthier. If you speak toother people with arthritis you

could find out how they leadhealthy lives.

It’s a good idea to make timeto enjoy a favourite activity suchas writing, working on a hobby,being involved in a communityorganisation or church,socialising, or making love.Shuffle activities around to keepup your interest. Always remindyourself of what you can dorather than dwelling on situationsthat are now too challenging.

■ Focusing away frompain

The amount of time you spendconsciously thinking about painwill influence how much painyou feel. If you get locked intothinking continuously about yourpain, you are probably experi-encing it more severely than youwould if you managed to turnyour thoughts away from it.

‘I keep myself busy, ithelps to keep my mindoff my arthritis’Try to distract yourself by doingsomething you really enjoy. Painis your body’s message to you totake appropriate action, and notnecessarily to cease all activity.

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PAIN CONTROL METHODS

■ Use joints well andconserve your energy

Using your joints well involvesdoing everyday tasks in waysthat reduce the stress on them.Saving energy involves listeningto your body for signals that itneeds to rest, and pacingyourself to avoid exhaustion.

Here are seven basicguidelines for using your jointswell and saving energy.Respect pain. If you haveincreased pain that lasts for twohours or more after completinga task, do a little less next time,or go about it in a way that takesless effort.Become aware of your bodypositions. Avoid being in oneposition for a long time andavoid postures that make youstiffer. Avoid activities thatinvolve a tight grip or put toomuch pressure on your fingers.Use equipment that reducesstress on joints and makesdifficult tasks easier.Control your weight as well asyou can. If you weigh more thanis healthy, this puts extra stresson weight-bearing joints and can,in some cases, lead to further

joint pain and damage.Use your largest and strongestjoints and muscles for daily taskswherever possible. For example,use a bag with a shoulder strapacross your back rather thanholding a case or bag whencarrying heavy loads. Spread theweight of an object over manyjoints to reduce the stress placedon any one joint.

‘The pain seems to beworse when I get upfrom sitting in a chair. I do my best to adaptmy movements’Try to balance rest with activity.Take breaks as and when youneed them, but be aware thattoo much rest causes musclestiffness.Simplify your work. Plan ahead,organise and create short cuts.At work, make good use oflunch and tea-breaks to changeyour position, to move aroundand to relax.Don’t be afraid to ask for help.Take responsibility for yourselfand ask for assistance when youneed it.

■ Self-help groupsMany people find that sharingand joining in with a group ofother people with arthritismakes living with the disease abit easier.

Self-help groups are user-led –that is, they are run by peoplewho experience the conditionthemselves.

Get in touch with your localArthritis Care office (see backpage for details) to find out whatlocal groups are in your area orask your doctor. You can searchfor your local group on theArthritis Care website:www.arthritiscare.org.uk

It is often easier to takecontrol of managing yourarthritis when you can share andswap your

experiences with others in asimilar situation.

■ Self-managementSelf-management is fairly self-explanatory. It is about takingcontrol of your condition, ratherthan letting it control you. Self-management is something youcan learn for yourself, and painmanagement is an integral partof it.

One way you can learn isthrough Arthritis Care’s self-management programmes,including Challenging Arthritis.This programme is used in manycountries worldwide. Researchshows that, after a six-weekprogramme, participants managetheir arthritis better, visitdoctors less and report less pain

anddepression.

ChallengingArthritis istaught in acommunitysetting bypeople witharthritis. Theleaders arepeople whowork hard atbeing in

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charge of their own arthritis andrefuse to let it control their lives.No one tells you what to do onthe programme, but you will getlots of new ideas to help youmanage your arthritis. Theprogramme is also a lot of fun. Ituses action plans (a verbalpromise to yourself and thegroup) to encourage you to dothings you otherwise wouldn’t.

Each session includesdiscussions, brainstorming andbrief lectures. There is no chargeto attend.

‘I now have my ownpain-managementprogramme. I takepainkillers, visit anosteopath, and use heat and massage forpain relief’Topics covered in theprogrammes include distractiontechniques and guided imageryto take your mind off the painand ways to relax yourmuscles.The programme alsolooks at ways to challengenegative thinking and develop apositive belief in yourself. Thisincludes practical examplesduring the sessions and

suggestions about how topractise the techniques at home.

To find out more aboutChallenging Arthritisprogrammes in your area,contact Arthritis Care. See theback page for details.

‘If I overdo things Iwill have to take thingseasier the followingday’Tips for self-managing your paincan be found on page 19.

■ ExerciseHaving arthritis does not preventyou from being active. It is agood idea to develop an exerciseprogramme with your doctor or physiotherapist that is

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appropriate to your lifestyle.Appropriate exercise helps keepmuscles strong, bones healthyand joints moving. It can alsohelp to relieve stiffness, maintainor restore flexibility, andimprove your overall sense ofwell-being.

It is important to minimise thepain exercise can cause and todo the right sort of exercise. Thetwo-hour rule is helpful. If yourjoints still hurt two hours afterexercise, you did too much.Reduce the amount next time. Itcan help to take a painkiller 40minutes before starting yourexercise.

You need to use caution whenyou start exercising. If you havea flare-up of rheumatoidarthritis, do only gentle range-of-movement (ROM) exercises.These are ones that move jointsgently as far as they can bemoved. Sometimes at thebeginning of an exerciseprogramme your muscles orjoints may feel stiff.

Start with just a few exercisesand slowly add more. Listen toyour body. If it hurts excessivelyor if you begin to have unusualpain, stop. Many people findexercising with a group

enjoyable and, for others,exercising to music helps.

There are three generic typesof exercise – if you find a form ofexercise you enjoy you will bemuch more likely to keep it up.

Range of movement exercises(ROM) keep the maximumflexibility in your joints. If you failto exercise it is your range ofmovement that is lost first.Maintaining ROM in damagedjoints is vital to stop them gettingworse.

Strengthening exercises areoften recommended to help hipsand knees – it is important tokeep muscles strong whatevertype of arthritis you have.

Aerobic exercise puts up yourheart rate and makes youbreathe faster. You need at least20 minutes of this three times aweek. (It is alright to do it in twounits of five minutes, twice aday.) Hydrotherapy or warm

water exercises can be particu-larly good for your joints.

■ Heat and coldSome people with arthritis findthat heat makes them moreuncomfortable, while othersbenefit greatly from it. You could try:● a warm bath, a hot shower or

a soak in a whirlpool bath● heated pads applied to certain

painful areas● an electric blanket or a

mattress pad to alleviatemorning stiffness

● a hot water bottle wrapped ina towel can help tokeep feet, back orhands warm.

Care is needed. Makesure you:● do not burn yourself● always put a towel

between your skinand any hot or cold pack

● never use heat or coldon any area of the body formore than about 15 to 20minutes

● do not use cold packs if youhave poor circulation orsensation

● do not use a pain relief rub at

the same time as it couldcause burning.Cold can help reduce swelling

and lessen muscle spasm, and isespecially good for the acuteinflammation felt in joints duringa flare-up (a period during which symptoms re-appear orget worse). It produces anumbing effect.

Buy a cold pack at thechemist, or you could make yourown by wrapping a damp clothor towel around a bag of icecubes or frozen vegetables.

Do not keep it on too long, oryou might get cold burns.

For some people witharthritis, a combination of heat

and cold in a singletreatment works best. Thisis called a contrast bath. Itinvolves soaking a hand orfoot in warm water, thencold, then warm again.

■ Massage andself-massage

Massage can help relax themuscles and improve theircondition by increasing bloodflow. This can providetemporary relief from localisedpain. Ask your partner or a closefriend to help out, or for a

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professional therapeuticmassage, ask for advice fromyour doctor or physiotherapist.

Self-massage involvesmassaging or gently kneading themuscles in a painful area toincrease blood flow and bringwarmth. It can be done whilesitting at your desk or whiletaking a bath. Baby or massageoil may help your hands glideover the skin.

Do’s and don’ts of massage● Unless you have broken skin,

always use a lubricant whenmassaging.

● When giving or having amassage, stop if pain develops.

● Do not massage an inflamedjoint, but you can massagearound it to promotecirculation.

■ SplintsIf a joint is very inflamed, it isprone to further damage andneeds the protection of a splint.In arthritis, a damaged joint canbe painful if it moves too much.

Splints are designed for bothrest and activity. For most typesof arthritis, you are most likelyto have one to use whencarrying out everyday activities.

■ SleepGetting a good night’s sleeprestores your energy andimproves your ability to manageyour pain. Sleep keeps yourbody healthy, letting it restoreitself and function at its best. It isthought your brain replaceschemicals, solves problems andsorts information while you areasleep. It also enables your jointsto rest.

A brief nap could be all youneed to replenish your energylevels and rest your joints.

If you have trouble sleeping,make sure you are ascomfortable as possible in bed,and that your bed and pillow aresupportive. It may help toestablish a regular routine to gothrough every night before bed,such as having a warm bath, thendoing half an hour’s readingbefore going to sleep. It is alsoimportant to avoid stimulants,such as caffeine, alcohol andcigarettes.

■ TranscutaneousElectrical NerveStimulation (Tens)

Some people have found that aTens device helps to reducearthritis pain. Tens involves

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stimulation of the nerves by low-level electrical impulses. Smallelectrodes are taped onto theskin near the painful area. Theseare connected by wire to a smallbattery-operated stimulator. Itdoesn’t hurt, but may tingle.

Tens is believed to work bystimulating nerves to releasenatural endorphins which closethe pain barrier. Tens is regularlyeffective in arthritis and can behelpful. Tens and acupunctureseem to be particularly helpfulfor back pain or pain in the neckor any specific joint that hurts.

Do not use Tens without firstconsulting an appropriate healthprofessional. It must not be used by anyone who has apacemaker or by women in theearly stages of pregnancy. Forfurther information, a factsheeton Tens is available from Arthritis Care.

■ RelaxationRelaxation is a good way tocombat pain. When we aretense, our muscles compress ourjoints. As a result they hurt andthe joints are painful. Developingthe ability to relax can help youreverse these effects. Inaddition, feeling relaxed helpsyou to have a sense of controland well-being that makes iteasier to manage pain.

Relaxation involves learningways to calm and control yourbody and mind. It must bepractised, like any new skill. Allcolleges of further educationoffer relaxation classes.

Try a number of differentmethods until you find some thatwork well for you. Here are afew basic steps.● Pick a quiet place and a quiet

time. You will need at least 10minutes to yourself, with nonoise.

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● Sit or lie in a comfortableposition with your headsupported and your eyesclosed.

● Take a deep breath thenbreathe out slowly. Feel yourstomach move in and out witheach slow, deep breath.

● Continue to breathe deeplyand slowly, focusing on yourbreathing.

● Try thinking of words such aspeace or calm.

‘People think you canrelax watching TV, but Ifind it too stimulating. Ilike to do breathingexercises’With practice, relaxationbecomes easier. If you fall asleepit doesn’t matter, but next timetry to stay awake the entire timeto consciously relax your mindand body. Relaxation exercisesafter a meal will almost certainlysend you to sleep.

Imagining pleasant scenes inyour mind is a way to helpcontrol pain. This can becomepart of a relaxation exercise,rather like meditation. Audio-tapes of relaxation exercises canalso be of help. Relaxationtechniques are also taught onArthritis Care’s ChallengingArthritis programmes.

■ HypnosisHypnosis is a form of deeprelaxation created by focusingattention internally – away fromthe usual thoughts and anxieties.If you feel hypnosis might helpyou, talk to your doctor. You willneed to work with a professionaltrained in hypnosis, to whomyou have been referred by adoctor, psychologist orcounsellor.

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■ CounsellingAny major disturbance such asserious illness or chronic painmay leave you feeling anxious,depressed or even angry.Sometimes people are afraid ofcounselling, fearing that othersmight think they are inadequate.In fact, it is widely accepted andhas become a popular way offinding confidential support.

If you have symptoms ofdepression (such as poor sleep,changes in appetite, crying, orgloomy thoughts) let someoneknow. Ask your doctor aboutcounselling or therapy.

Make sure your counsellor isregistered with an appropriatebody such as the BritishAssociation for Counselling and Psychotherapy(www.bacp.co.uk).

There are a number of waysof boosting health, both physicaland psychological.● Try to do things that make you

feel happy and fulfilled.● Look after yourself. ● Let out feelings like anger, fear

and grief.● Concentrate on positive

images and aims.● Work on having loving and

honest relationships.

● Keep a good sense of humour.

■ Complementary paincontrol

There are a number of comple-mentary or alternative therapiesavailable – homeopathy,acupuncture, herbalism,osteopathy, chiropractic andreflexology for example. Whilethere is little scientific evidenceto show any treatments areeffective, many people say theyhave benefitted from using them.

‘If I’m in pain I run abath and put four dropsof chamomile oil in thewater. I find thiscalming’It is best to inform your doctor ifyou are using any complemen-tary therapies. While mosttherapies are not dangerous,some can be harmful. There ismore information in Arthritis

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Care’s booklet on drugs andcomplementary therapies.

■ DrugsMost people who have arthritiswill be prescribed some kind ofpain relieving or diseasecontrolling drug. Pain is eased byreducing inflammation andworking on the disease process.

If you feel you want somecontrol over your ownmedication, always talk to yourdoctor about changes you feelare appropriate for you. It maybe harmful to alter yourmedication suddenly.

Information sheets on drugsused to treat arthritis areavailable from Arthritis Care.Also see Arthritis Care’s bookleton drugs and complementarytherapies for the most commondrugs used to treat arthritis.

‘Side effects of drugsare worrying, but theeffects of your arthritisare often worse’NSAIDsNon-steroidal anti-inflammatorydrugs (NSAIDs) are used mostoften in the treatment ofrheumatoid arthritis. When

NSAIDs are prescribed carefully,they can significantly reduce painand inflammation.

Inflammation is the body’sresponse to injury and isdesigned to cure. However, indamaged joints, especially inrheumatoid arthritis, the inflam-mation itself becomes damaging.NSAIDs can hold back inflamma-tion, but may affect the healthyfunction of the stomach.

NSAIDs are marketed bothunder generic names and undertheir brand names. For example,ibuprofen is marketed as Brufen,indomethacin as Indocid,naproxen as Naprosyn, anddiclofenac as Voltarol. There aremany more.

Always ask your doctor orpharmacist about side effectsand other concerns you mayhave. NSAIDs may be prescribedfor short-term use, particularlyin response to a flare-up. Pain-relieving drugs have proved tobe more effective, especiallywhen used alongside other painmanagement techniques.

Cox-2sCox-2 inhibitors are a newertype of NSAID, designed to besafer for the stomach. However,

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concerns have been raised abouttheir side effects, includingincreased risk of cardiovascularproblems, especially for peoplewith a history of heart disease orstroke. Although most Cox-2sare still available on prescription,their use is being strictlyregulated. You will need todiscuss with your doctorwhether this type of treatment issuitable for you.

Painkillers (analgesics)Painkillers come in varyingstrength – mild painkillers areavailable over the counter atchemists, but stronger ones areonly available on prescription.Paracetamol can be used for lessserious pain. It is the simplestand safest painkiller, and the bestone to try first. It is commonlyused to treat the pain andstiffness of osteoarthritis.Although it has few side effectswhen taken as prescribed, it isdangerous in overdose.

Many pain relieving drugs,including pain relief gels, can bebought over the counter withouta prescription. Never take morethan the recommended doseand, if in doubt, talk to yourpharmacist or doctor.

NarcoticsNarcotics are analgesic drugswhich imitate the body’s ownmorphine-like endorphins. Theyare generally used only duringperiods of intense pain. They canbe dangerous because theycause addiction. Narcotics haveto be prescribed by doctors.

DMARDsSecond-line, long-acting ordisease-modifying anti-rheumaticdrugs (DMARDS) are powerfuldrugs. They are used to treatcertain forms of arthritis, such asrheumatoid arthritis, lupus,juvenile idiopathic arthritis andankylosing spondylitis. They arenot prescribed for osteoarthritis.

DMARDs are drugs thatcontrol the disease itself ratherthan being specific to pain relief.Some DMARDS work specifi-cally to damp down the effectsof the immune system’s attackon the joints. These are knownas immunosuppresives.

DMARDS includemethotrexate, gold injections,D-Penicillamine andsulphasalazine. Their use iscarefully monitored (forexample, by regular blood tests)to make sure they are safe. They

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should be avoided duringpregnancy.

SteroidsSteroid is a family name for anumber of compounds includingcortisone, triamcinolone,prednisolone and methyl prednisolone.

Steroid tablets can bevery effective in reducinginflammation, but if takenlong-term they canpotentially causeunwanted side effectssuch as high bloodpressure, bonethinning, weight gainand diabetes. They areusually only used totreat flare-ups of rheumatoidarthritis, or very troublesomeinflammatory diseases.

If a low dose is prescribedover a long time, carefulmonitoring is required. Peopleon steroids should carry a bluesteroid card. If you have not gotone ask your pharmacist.

Remember to talk to yourdoctor about any anxietyconcerning your drugtreatments.

Cortisone and other steroidscan be injected directly into

joints or around tendons. Theycan relieve pain in people withrheumatoid arthritis and forsome with osteoarthritis byreducing inflammation. A triggerpoint injection (usually ananaesthetic combined with acortisone-like compound) can beused in a number of conditions

such as rheumatoid arthritis,osteoarthritis and for softtissue pains.

It can help relieve nerve,tendon, ligament andmuscle pain and maymean you can enjoy painrelief after the anaesthetichas worn off. Ananaesthetic trigger pointinjection is sometimes

called a nerve block.

Anti-depressantsSometimes a doctor willprescribe small doses of anti-depressant drugs to help breakthe cycle of stress, pain – andsometimes depression.

These drugs are often veryeffective on a person’s toleranceto pain. They are usually usedtogether with pain managementtechniques.

When taken at night, beforebedtime, they have been found

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to improve the quality of sleep. Depending on the form of

arthritis, a doctor may alsoprescribe tranquillisers to reducemuscle tension and painfulmuscle spasms.

■ SurgerySurgery to improve movement,replace joints or reduce inflam-mation is constantly beingimproved. Managing yourcondition and pain in the wayssuggested in this booklet may beenough, but when thesemethods fail to lessen pain, orwhen problems with mobilityoccur, surgery may beconsidered.

Surgery involves a degree ofrisk, so the decision to have itshould be weighed up, using allthe information you can findabout the procedure suggestedfor you.

The most common surgeryoptions are:Joint replacement – this canrelieve pain and may restorelimited movement.Arthroscopy – a surgical processthat allows the doctor to viewthe joint through a telescope anddo minor repairs.Synovectomy – a procedure in

which the lining of the joint, thesynovium is removed. This mayhelp relieve the pain andswelling.

For more information seeArthritis Care’s booklet onsurgery.

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NEXT STEPS

■ Where to find helpTo manage the problem of painfrom your arthritis, you mayneed to seek additional help.Arthritis Care’s helpline, trainingprogrammes, and the usefulorganisations listed at the backof this booklet may be suitableplaces to go. Our website andour other booklets providemore information on a range ofsubjects including exercise,medication, complementarytherapies and independent living.

You can use the resourceslisted on page 21 to develop apain management plan that isright for you.

Your healthcare teamThe first place to go to for helpis the healthcare team at yourlocal doctors’ surgery. This teamincludes your GP and thepractice nurse. It may alsoinclude a pharmacist, an occupa-tional therapist (OT), aphysiotherapist, a chiropodist, asocial worker, a counsellor or apsychologist.

Talk to the members of theteam about ways to managepain. Develop a positive

relationship with these people sothat you can share your frustra-tions and your successes. Themembers of the team shouldknow you and your medicalhistory. They should also knowwhat other helpful services areavailable to you in your area.

The secondary healthcareteam is usually based in thehospital rheumatology (ororthopaedic) department. It willhave access to other hospitaldepartments. Some departmentsinclude a nurse specialist whoruns a telephone helplinealthough the hours it is availablewill be limited.

Pain clinicsSome hospitals have pain clinicswhich specialise in the treatmentof pain, though they are verymuch in demand.

If you are having troublecoping with severe pain, talkto your doctor about going toa pain clinic. It may help you todevelop better pain manage-ment skills.

■ Tips for your own painmanagement plan

● Note down when is the mosteffective time for you to takeyour medication. Be aware ofhow your body responds topainkillers and take allmedication appropriately, inaccordance with your doctor’sadvice.

● Make a note of whether heat,cold or massage helps, andhow often you try them.

● Make space in your day forrest. Take notice of when yourbody responds well to rest,and to the resting of specificjoints in splints, and develop apositive rest routine.

● Make a note of the things thathelp you feel relaxed andcalm, and in control of yourpain. Try to practice those

techniques which you findsuit you best.

● Develop techniques forconjuring up restful, pleasantimages and memories.

● Work on having a generallyhealthy lifestyle to improveyour sense of overall well-being.

● Make a plan to do aerobic,strengthening and range ofmovement exercises.

● Make a list of questions to putto healthcare professionalsconcerning your treatmentprogramme and painmanagement. Be firm in askingthese questions and persistuntil you are happy with theanswers.

Now you have read this booklet,you will, hopefully, have pickedup various ideas and techniquesto help you to cope with pain.

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Solutions are not always quick tooccur, and there may still betimes when your pain gets youdown.

‘I handle pain byknowing my limits,making the most ofwhat I can do andavoiding stress andanxiety’It is important not to keep it allin, so if you are having a hardtime with your pain, be sure totalk to someone – a member ofyour family, a health professional,or a friend. Although they maynot be able to magically takeaway your pain, talking about itmay give you some relief.

There are plenty of organisa-tions and people who may beable to help. See pages 22-24 fordetails. If you learn how tocontrol your pain you will be oncourse to ensuring pain does notcontrol you.

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Books and booklets

Brown, Dr Harry. The Which

Guide to Managing Back

Trouble. Which? Books, 2001, Reved, ISBN: 0 8520 2848 2, £9.99(pbk).

Lorig, Kate and Fries, James F.The Arthritis Helpbook: A tested

self-management program for

coping with arthritis and

fibromyalgia.

Da Capo Press, 2000, ISBN: 0 7382 0224 X. Tested advice oncoping with and managing jointpain.

McKenzie, Robin. Treat Your

Own Back. Spinal Publications,1997, 7th ed, ISBN: 0 9598 0492 7, £10.99. Explainsself-help measures to improveback pain.

McKenzie, Robin. Treat Your

Own Neck. Spinal Publications,1983, ISBN: 0 4730 0209 4, £8.99.Explains self-help measures toimprove neck pain.

Nown, Graham and Wells, Dr Chris. The Pain Relief

Handbook: Self-help methods

for managing pain.

Vermilion, 1996. ISBN:0 0918 1371 9, £7.69 (pbk).Written by the director of the

Centre for Pain Relief in Liverpooland a journalist, this aims to helppeople with chronic pain to takecontrol. Sketches inject somehumour.

The Arthritis Research Campaignpublishes free booklets Back Pain

and Pain in the neck. Availablefrom arc Trading Ltd, JamesNicolson Link, Clifton Moor, YorkYO30 4XX.

These books can be obtained froma bookshop or library, unless aspecial supplier is listed.

Pain clinics and courses

Many hospitals have pain clinics,which run special painmanagement programmes. You can find out if there is a painclinic in your area by ringing NHSDirect (0845 4647) or visitwww.nhsdirect.nhs.uk

A directory of clinics is availablefrom: The British Pain Society, 21 Portland Place, London W1B1PY. Tel: 020 7631 8870, visitwww.britishpainsociety.org oremail info@britishpainsociety.org

Many of Arthritis Care’s trainingprogrammes include details onpain management. See back pagefor contact details of your localArthritis Care office.

PAIN MANAGEMENT RESOURCES

USEFUL ORGANISATIONS

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GENERAL● arc (Arthritis Research

Campaign)Copeman House, St Mary’s Court,St Mary’s Gate, Chesterfield,Derbyshire S41 7TD Tel: 01246 558033 www.arc.org.ukFunds medical research into arthritisand produces information.

● British Council of DisabledPeople (BCODP)

Litchurch Plaza, Litchurch Lane,Derby DE24 8AA Tel: 01332 295551www.bcodp.org.ukCampaigns for the rights of disabled people.

● DIAL UKSt Catherine’s, Tickhill Road,Doncaster DN4 8QNTel: 01302 310123www.dialuk.org.ukDetails of your nearest disabilityadvice and information service.

● RADAR12 City Forum, 250 City Road,London EC1V 8AFTel: 020 7250 3222www.radar.org.ukA national campaigning organisationwhich also holds and publishes a verywide range of information onaccessibility, holidays and generaldisability issues.

Northern Ireland: Disability ActionPortside Business Park, 189 AirportRoad West, Belfast BT3 9EDTel: 028 9029 7880www.disabilityaction.orgScotland: Update27 Beaverhall Road, Edinburgh EH7 4JE Tel: 0131 558 5200www.update.org.ukWales: Disability WalesBridge House, Caerphilly Business Park, Van Road, Caerphilly CF83 3ED Tel: 029 2088 7325www.disabilitywales.orgThese three bodies hold informationon disability organisations within thenations.

HEALTH SERVICES● National Health ServiceNHS Direct provides patientinformation, information about localNHS facilities and waiting lists andhow to complain. NHS Direct Onlinealso provides detailed information.www.nhsdirect.nhs.ukTel: 0845 4647

● Institute for ComplementaryMedicine

PO Box 194, Tavern Quay, London SE16 7QZ Tel: 020 7237 5156www.i-c-m.org.ukFor a list of qualified practitioners,send a large SAE stating the therapy.

● British ComplementaryMedicine Association

PO Box 5122, Bournemouth BH8 0WG Tel: 0845 345 5977www.bcma.co.uk

PREGNANCY AND PARENTING● Contact a Family209-211 City Road, London EC1V 1JN Tel: 020 7608 8700www.cafamily.org.ukHelpline: 0808 808 3555 10am-4pmMon-Fri. National helpline, regionaldevelopment officers and nationalnetwork of groups and contacts.Publishes the CaF Directory of RareSyndromes and specific conditions inchildren with their family supportnetworks.

● National Centre for DisabledParents

Unit F9, 89-93 Fonthill Road, London N4 3JH Tel: 020 7263 3088 Helpline: 0800 018 4730www.dppi.org.ukPromotes the networking ofinformation and experience on allaspects of disability, pregnancy andparenthood. Provides informationsheets and information to individuals.

● Jointz7 Newtown Heights, NewtownardsBT23 7YG. Tel: 028 9182 0369Arthritis Care’s Parent Group

in Northern Ireland.

CHILDREN● Children’s Chronic Arthritis

Association (CCAA)Ground Floor Office, Amber Gate, City Walls Road,Worcester WR1 2AH www.ccaa.org.ukTel: 01905 745595Support for children with arthritis and their families.

● ChoicesPO Box 58, Hove, East Sussex BN3 5WNwww.kidswitharthritis.orgSupport group for families of childrenwith arthritis.

EQUIPMENT● Assist UKRedbank House, 4 St Chad’s Street, Manchester M8 8QA Tel: 0870 770 2866www.assist-uk.org Product demonstration centresthroughout the UK.

PAIN● The British Pain Society21 Portland Place, London W1B 1PYTel: 020 7631 8870www.britishpainsociety.orgInformation about chronic pain andpain clinics.

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USEFUL ORGANISATIONS

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USEFUL ORGANISATIONS● Pain ConcernPO Box 13256, Haddington, EH41 4YD. Tel: 01620 822572www.painconcern.org.ukOffers information and a helpline.

SUPPORT FOR CARERS● Carers UKHead Office, 20-25 Glasshouse Yard,London EC1A 4JT Tel: 020 7490 8818Helpline: 0808 808 7777www.carersuk.orgWill supply contact details for officesin the whole of the UK.

● Crossroads Caring for Carers10 Regents Place, Rugby CV21 2PNTel: 0845 450 0350www.crossroads.org.ukAdvice and information for peoplewho care for a disabled person athome. Local branches in England andWales. Can sometimes assist (locally)with emergency cover.

● Crossroads (Scotland)24 George Square, Glasgow G2 1EGTel: 0141 226 3793 www.crossroads-scotland.co.uk

● Crossroads (Northern Ireland)7 Regent Street, Newtownards, Co Down BT23 4AB Tel: 028 9181 4455www.crossroadscare.co.uk

Arthritis Care is the UK’s largestorganisation working with and for allpeople who have arthritis.

Our booklets and magazine, website and professional helpline are tools to enable people to make positive choices. Our network of localgroups, self-management programmes andinternet forums bring people together to support each other in living life to the full. Our campaigning work promotes civil rights,better access to health and social care provision,and tackles issues important to people in theirlocal area.

Get in touch with us● Our helpline offers confidential information

and support. Call free on 0808 800 4050 (10am-4pm weekdays) or emailHelplines@arthritiscare.org.uk

● Our website provides information on all aspectsof arthritis and what we are doing in your area.Visit us at www.arthritiscare.org.uk

● Call us to find out more about what we do orhow to become a member.

Arthritis Care contact numbers:

UK Head Office: 020 7380 6500South England: 020 7380 6509/10Central England: 0115 952 5522North England: 01924 882150Northern Ireland: 028 9448 1380Scotland: 0141 954 7776Wales: 01239 711883

Published by Arthritis Care, 18 Stephenson Way, London NW1 2HDReprinted August 2006 ACR017 Registered Charity No. 206563 ISBN 1-903419-36-0

COPING WITH PAIN