Pain and Arthritis

Author: DAVID P JOHNSON MB ChB FRCS FRCS. MD
Consultant Orthopaedic Surgeon

Introduction
This booklet is written primarily for people who have long-term (chronic) pain due to arthritis and related conditions. Many people with arthritis live with pain for years

What is pain?
Pain is a protective mechanism and acts as a warning. If your hand touches a hot surface it triggers a series of impulses from heat-sensitive nerve fibres. The result is a rapid reflex response. Your muscles react and pull your hand away. Although everyone understands what we mean by the word ‘pain’, it is difficult to define. Pain isn’t just physical; it has emotional effects too – making us feel upset or distressed. Pain may result from a physical injury – for example, a cut, a broken bone or a burn. In other situations the ‘injury’ is internal and is caused by chemicals produced as the result of a process called inflammation – for example in many forms of arthritis. Our bodies have specialized nerve endings which detect temperature and chemical changes or mechanical stresses. The chemicals produced as a result of inflammation activate these nerve endings which send ‘pain’ signals via the spinal cord to the brain.

Pain can also be caused when these nerve endings or nerves are permanently damaged and begin to send signals to the spinal cord spontaneously, without needing a specific stimulus. This causes the nerves to signal pain for no reason, or in response to something that would not normally hurt, such as gentle stroking of the skin. Some people with arthritis, as well as some people with other diseases (such as shingles or diabetes), suffer this sort of pain. This type of pain often requires different treatments from the pain caused by stimulation of normal nerve endings.

In some instances it is difficult to explain the exact cause of chronic pain and impossible to make it go away completely, and this can add to the distress or anxiety. This type of chronic pain can be either confined to one part of the body or felt all over the body (chronic widespread pain). Fibromyalgia is one condition that causes chronic widespread pain which is difficult to explain or treat. Such conditions are a challenge to both the patient and the doctor. The fact that is hard to explain where the pain is coming from does not mean the pain is imaginary or ‘psychological’. However, psychological factors can affect the way in which the brain senses physical pain.

Pain control
Some people learn to cope with pain with the help of drugs, physical treatments and other techniques. Others find their pain more difficult to deal with. Understandably, it may become a dominating and negative force in their lives. The good news is that there are new approaches available to help manage pain better. These approaches can still be helpful even if the person is already coping well. One of the keys to handling pain is to understand what is happening. It is important to understand what treatments are available, what they entail, and why they are helpful. Understanding more about the pain itself, including its causes and its different characteristics, can also help people to cope better, even though it does not cure the pain.
Link: http://www.arc.org.uk/arthinfo/patpubs/6030/6030.asp

Editor: David P Johnson MD.
St Mary’s Hospital. Clifton Bristol. BS8 1JU.
Web site: www.orthopaedics.co.uk
boc@orthopaedics.co.uk
© OrthopaedicsOpinionOnline 2011 www.OrthopaedicOpinionOnline.co.uk
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