Reviewed by Brunilda Nazario, MD, July 10, 2008

Being in pain can be the hardest part of living with rheumatoid arthritis. While medicines help, they don't always make the pain go away completely.

Coping with your pain means acknowledging that the problem is not just the pain itself. Constant pain has an effect on your whole life.

Most people with rheumatoid arthritis are faced with frequent or ongoing pain. While you may not be able to avoid pain, you can take control of the situation. Is the pain of rheumatoid arthritis starting to affect your life? There are specific positive steps you can take to live with it -- but keep it in its place:

Get Educated About Arthritis Pain

Understanding your pain will better help you deal with it. There are a number of types of pain caused by rheumatoid arthritis.

• Acute pain from inflammation. Anyone with rheumatoid arthritis knows the pain that comes with a flare.
• Pain from joint damage. Joints may become damaged over time by rheumatoid arthritis and cause pain even though your arthritis itself is inactive.
• Exacerbation of pain. After living a long time with pain and the other struggles of rheumatoid arthritis, you can get stressed and worn out. The real pain you feel is made worse by your emotional state.

Most people with rheumatoid arthritis will experience all of these types of pain. This can become a complicated and overwhelming situation and requires an overall approach.

There are educational programs available to help people who have to live with pain. The benefits they provide can make a big difference.

• Learn how pain works, why it happens, and what it means.
• Gain coping and life-management skills for when you are in pain.
• Get trained in cognitive-behavioral therapy or biofeedback. These are methods of reducing the pain you feel by using your mind.

Contact the Arthritis Foundation (www.arthritis.org) to find your local chapter and sign up.

Come Up With a Pain Management Plan

When pain strikes, consider it a signal to take positive action, not to give in and suffer. Even if you are not able to eliminate pain completely, you are doing what you can to help yourself. There are a number of tools at your disposal to manage pain. Experiment until you find what works for you.

• Pain-relieving medicines. Consider taking your pain medicines on a schedule, rather than waiting until you are in more pain and have to play "catch-up." Severe rheumatoid arthritis pain usually requires maximum doses of NSAIDs, although side effects must be considered at higher doses.
• Meditation and relaxation. Escape from stressful situations and relax your mind. Meditation can help relieve pain, and it is a skill that can be learned.
• Distraction. Focusing on pain makes it worse, not better. Do something you enjoy instead - or any activity that keeps you busy and has you thinking about something else.
• Heat, cold, and massage. These tried-and-true treatments are easy and can provide some quick relief for mild symptoms.

Nurture a Healthy Attitude

No one should have to live with pain. It doesn't seem fair, and it's not. It is natural to sometimes feel like a victim, or experience any number of other emotions.

• Frustration
• Despair
• Anger
• Anxiety
• Depression

While these emotions are normal human responses to chronic pain, they don't help you feel any better. In fact, just the opposite -- they can bog you down in negative thoughts, making the situation worse.

There is nothing positive about pain, but you can take a positive approach to living with it. Know the strategies and commit to giving them a chance.

• Cognitive-behavioral training. This is a kind of psychotherapy you can do yourself. A psychologist or other mental health professional can teach you the methods. Cognitive-behavioral training can help you avoid negative thoughts that make pain worse.
• Join a support group. Being with people who understand what you're dealing with makes you feel less alone.
• Exercise. Believe it or not, exercise will make your joints feel better, not worse. Even if you're in pain, there are some exercises you can do. Talk to your doctor or a physical therapist. Build an exercise schedule into your treatment plan and stick to it. Over time, the results can be dramatic.
• Eat a healthy balanced diet. Drink alcohol only in moderation. Don't smoke! Cigarettes, alcohol or unhealthy foods can seem comforting when you are in pain, but in the long-term they won't help. You deserve better -- you deserve the benefits of a healthy lifestyle.
• Get additional support from a mental health professional. The vast majority of people with rheumatoid arthritis are not mentally ill, but being in chronic pain can cause feelings of depression. Asking for help can be a sign of strength, not weakness.

Visit the Arthritis Foundation Pain Center for more information. Link to
http://www.arthritis.org/conditions/pain_center/default.asp.

SOURCES: American College of Rheumatology: "Position statement on 'complementary' and 'alternative' therapies for rheumatic diseases," 1998. American College of Rheumatology Ad Hoc Committee on Clinical Guidelines, Arthritis and Rheumatism, 2002; vol 46: p 328. Arthritis Foundation web site: "Pain Center." Horstman, J. The Arthritis Foundation Guide to Alternative Therapies, Arthritis Foundation, 1999. Lee, D., The Lancet, Sept. 15 2001; vol 358(9285): pp 903-911. Lorig, K. British Journal of Rheumatology, 1995; vol 34: p 703. Miller, R. Miller's Anesthesia, 6th ed., Elsevier/Churchill Livingstone, 2004.