At SSPC, arthritic pain is possibly the most common condition we encounter, and without doubt the most common question is “How can I reduce my pain”? Whilst traditionally the main management of joint arthritic pain has been rest and medication, we now know that’s probably not the best advice for your pain. However it’s still not an easy question to answer, but here’s the choices you have:
Take your medication as instructed. Many different types of medicines can help control the pain of arthritis. There are three general categories of people when it comes to medication: 1. Those that take it exactly as instructed; 2. The “high pain threshold” category that try as hard as they can to just cope and not take any medication; and 3. Those that take the medication as they see fit – this can be either overmedicating (which can be quite dangerous on the stronger drugs) or under-medicating (only taking a single or short dose when the pain is really bad). Whilst the Category 1 people are the ideal, over time many people naturally morph into category 2 or 3. Whilst pain is a warning sign for our body to avoid further damage, sometimes (and particularly in chronic conditions like OA) the body goes into a pain “over drive” – sending more and more warning pain signals despite the opportunity of damage being minimal as a result of the particular task you are doing. What ends up happening is the task that you could do last week becomes more difficult and painful this week – not because your OA has progressed, or not because the task presents any more danger than last week, but because your brain has become even more protective of your joint. Unfortunately it is this pain protection “over drive” that leads to more disability, more stiffness, more weakness, and more pain.
It is for this reason that “being brave” or not taking your medication because you have a “good pain threshold” is actually not helpful. The pain medication is not just a band aid, it helps control the brain’s overprotective tendencies, and enables you to keep moving and doing your exercises.
Your GP or specialist will advise on appropriate pain medication, and this can be as simple as taking an analgesic like paracetamol (Panadol osteo for most people). Even if there is no obvious and immediate effect, these medications are often keeping you moving and helping reduce your requirement for strong painkillers in the future. If you have been instructed to take them, and you are in pain, there is no sense in deciding to not medicate!
Weight Reduction: we have been through this in detail in recent seminars and newsletters. Losing even a kilo of weight will have a dramatic effect on lower limb arthritic conditions. One kilo might not seem a lot, but if you take 6000 steps a day, then 6000kg less force being transmitted through our body tissues certainly is. So you can appreciate how much less force is on our joints if you lose 5 or 6 kgs, or more! Weight reduction isn’t always easy, but even slight changes to your diet can have a dramatic effect. Chris, our SSPC Dietitian, has some great strategies for those seeking an individualised approach to weight management.
Lifestyle Modifications: In reality, certain activities hurt certain joints – squatting and kneeling can really hurt knee OA. Crossing legs in sitting can really hurt hip OA. Gardening can aggravate hand OA. If you know what hurts and aggravates, it may not be necessary to stop that activity – there is often a way to compromise. If stairs are not so good, don’t be afraid to take a lift every now and then; if squats and lunges aggravate, there are many other quads exercises that you can do that won’t hurt you. If your hip OA hurts when sitting, then organising a higher chair, or cushion to raise your seat can be really helpful. If gardening hurts your knees, get a kneeling aid from Bunnings. Nearly always there’s a way to continue activities that would normally hurt, as long as you know how to modify them. What we don’t always want you to do is necessarily completely avoid an activity – if you never do stairs because it hurts, you are sending your brain a consistent message that stairs are bad. When you next have to go up or down stairs, your pain can be extreme – not because the stairs present any more danger, but because your brain has gone into pain protection “over drive”! Find a way – ask your physio!
• Heat and cold. There’s not a lot of evidence we can provide for the use of heat and cold, but… we know it works well for some. Heat can be very soothing and relaxes your muscles and stimulates blood circulation. Cold therapy, whilst not exactly soothing at the time, numbs the painful area and reduces swelling. At the end of the day, it’s whatever works best for you. Ice isn’t necessarily better than heat in the management of OA, or vice versa – give them both a try and see which helps you the most. Whatever you can do to reduce pain will help keep you moving, and that’s the critical thing!
• Tape/Braces/Walking Aids/Orthotics etc: There is often a common thought that braces and supports should be avoided if possible. We often hear people say “I don’t want to become reliant on it” or “it’s just a band aid” or “the brace will make my knee weak”. That’s actually not all true. If you do use a walking stick every single time you walk, then you may become overly reliant on it; if you put a brace on every single waking hour of the day it may become a security blanket; if all you do is take medication and not increase your activity, then it may be a band aid. But with good education, none of the above should happen. Anything that helps ease your pain will help you to be more active – the more activity, the more strength and the less pain. So if it helps, don’t be afraid to use it – there’s no prizes for the bravest person!
• The Brain is the Boss! Pain is controlled by the brain, so whatever you can do to take over control of the brain, the better! Remember point 1 above – the brain can go into “overdrive” so techniques like meditation, yoga, relaxation strategies, and breathing techniques can help enormously!
• Exercise. No matter which way you turn, exercise needs to be at the forefront of your pain management strategy. These two concepts used to be inversely proportional – the greater the arthritic pain, the less exercise one did (or was told to do). Well, exercise and OA now need to be proportional – the more someone has OA, the more they need to exercise that arthritic joint – you just need to find the right type of exercise for your joint! The research is clear – appropriate and regular exercise does help reduce pain. Exercise also has the additional benefits of improving muscular strength, lubricating and moving joints, reducing stress and anxiety, and also helps improve sleep, which is important for healing. That’s where you probably need your Physiotherapist!
And keep in mind, the GLA:D Exercise for OA group classes are held at SSPC!
The take home message from all of this is it doesn’t matter what works to ease your pain – whatever it takes, do it, and utilise this window of opportunity with reduced pain to get active with the right sort of exercise!
Anthony Lance
SSPC Physiotherapist
