When you have rheumatoid arthritis (RA), you likely experience times of remission when the disease’s pain doesn’t bother you as much. But with flares, the pain can be debilitating. There’s the pain radiating directly from your inflamed joints, and then the secondary pain in your muscles caused by how you hold your body as a result. It’s a lot to manage. That’s why we’ve put together some ideas for you on how you can better manage your pain during a flare-up.
Medications for treating short- and long-term pain
It probably comes as little surprise that your first step in dealing with pain is through medication. Nonsteroidal anti-inflammatory drugs (NSAIDs) are the most frequently used pain relievers for RA. You may have been prescribed them when you were originally received your diagnosis. You could also be using over-the-counter versions of NSAIDs. NSAIDs can alleviate pain and take down inflammation in many cases, but you might need to augment them during a flare.
“If the patient is taking prescription NSAIDs, over-the-counter NSAIDs such as Aleve or Advil should be avoided, as the combination may increase the risk of ulcers and bleeding,” says Alan Schenk, MD, rheumatologist at Saddleback Memorial Medical Center, Laguna Hills, California. “However, acetaminophen like Tylenol can safely be used along with NSAIDs, and the combination often provides superior pain relief compared to either alone.” Tell your doctor if you experience side effects like stomach upset when you take NSAIDs.
Your rheumatologist may also have prescribed corticosteroids. These medications work to diminish inflammation and pain quickly. Side effects may include bone thinning, unwanted weight gain and diabetes. It isn’t considered safe to take steroids for long periods of time. Doctors often prescribe a corticosteroid for relief of more acute symptoms, with a plan to taper off the medication gradually.
Some people with RA have found pain relief with opiate painkillers. However, these are highly addictive and have a host of side effects including severe, ongoing constipation. The Drug Enforcement Administration has ordered a limit to the number of opiates that can be manufactured beginning in 2017.
Disease-modifying antirheumatic drugs (DMARDs) and biologics aren’t pain relievers. They’re RA drugs that block the cellular process that leads to joint inflammation. But over time, DMARDs and biologics can reduce pain and make RA flares less debilitating. They also have the important effect of slowing the progression of destruction to joints.
Physical therapy and adaptive devices
As someone with RA, you possibly have a physical therapist on your care team. They can help you with specifically designed physical or occupational therapies that help keep joints flexible. Therapists may also suggest new techniques for accomplishing daily tasks, methods that will be less impactful on joints during a flare.
To avoid stressing vulnerable joints, assistive devices are another means of making daily functioning easier and less painful. For example, kitchen knives with saw handles help protect finger and wrist joints so you can keep cooking even when you’re flaring.
A number of alternative and home treatments may calm RA pain. These aren’t meant to replace medications, but they might help relieve some of your symptoms.
A hot shower or bath, heated clothing, heat packs, or warming lotions can all provide temporary relief to localized areas as well as your body in general.
The Arthritis Foundation says that fish oil could be helpful in decreasing joint tenderness, and it may help with depression. Fish oil might not be safe to take with certain medicines, so ask your doctor before you add it to your diet.
Pain and morning stiffness from RA may be helped by a type of fatty acid contained in the oil from seeds of evening primrose, borage, and black currant plants, taken as a supplement. Plant oils can interact with your prescription medicines, so talk to your doctor before you take them.
Tai chi is an exercise that combines a series of low-impact moves and stretches with deep breathing. At least one study found that tai chi may relieve RA pain. Tai chi is a safe practice as long as you’re guided by an experienced instructor and you don’t push yourself outside your physical limits.
Carla Gervasio practices acupuncture at Urban Wellness Acupuncture in New York City. She regularly works with people who have RA. “I’ve seen acupuncture help relieve pain and reduce inflammation for most people within approximately 24 to 48 hours,” says Gervasio. One study showed a reduction of pain in people with RA who underwent acupuncture. Acupuncture can be worth trying, but not everyone may benefit.
Having RA may be manageable when your disease isn’t flaring. But flares can knock you out. When that pain arrives, you want relief, and fast. Contact your doctor when your disease flares so you can track your triggers and prevent further damage to your joints. Then seek out prompt pain relief with NSAIDs, over-the-counter pain relievers such as acetaminophen, and home care.