Following on from my trysts with the sofa , cat and pill box the other morning….
The replies on the blog threw up (like me after a night out on the tiles) some very interesting observations and thoughts.
However, firstly, I would like to say the book “The Arthritis Help Book” gets my general approval and was loaned to me by my OT department, to run alongside my “classes” on a Wednesday afternoon, all about Arthritisii ! But this here pain mularky has got me in a tangle….
Right, firstly you have to distinguish between Acute and Chronic – not easy, because you can have recurring acute, and spasmodic chronic which are slight oxymorons, inasmuch as acute you expect to go away on treatment, whereas chronic is associated with long term conditions (which I am sure you are aware of.
Although I have my rheumy nurse and cons telling me that it is no good just using pain killers when you feel the pain because then you never get on top of it, on the other hand the pain management team are trying to tell me it is no use using pain killers with chronic pain because you will never get rid of it, and, more importantly, will only run the risk of the side effects, addiction, dependence or whatever, meaning that you will require ever more stronger painkillers etcetra !!!
SOOO through gentle exercise, relaxation, pacing and only using painkillers on acute pain (like in a flare) one should be able to manage one’s pain. I tend to believe in that to a certain degree.
He explained that if you are experiencing chronic pain, the best thing, aside from all those things above, is to carry on as if you don’t have any pain, but in a more leisurely manner! (he didn’t quite put it like that but that’s what he meant). Sensitised nerves (ones which have been involved in the initial pain signals) react far more easily than non sensitised nerves so that pain can be completely out of proportion to the stimulus, and more pain is felt than is actually necessary.
(You following this)
Right then next bit –
The brain turns messages from sensitised nerves (from the damage/stimulus) into the pain we feel. Nerves from the brain can increase and decrease sensitivity of areas in the spinal cord. This means processes in the brain (for example, thoughts, feelings, past experience, attitude) can influence pain.
The brain is therefore capable of increasing or decreasing pain by regulating the sensitivity.
The above is not fantasy it is a medical and proven fact.
Soooo managing pain means not only regulating your activity, but also your thoughts and emotional reactions to it.
So you need a baseline (which will be different for different activities). This will be the level at which you won’t flare up your pain but will be enough to feel some discomfort. I.e. PACING! – Yep that old chestnut.
My problem is – if you think about it, everything is going to take so much time to “set up” because, you are limited in your daily tasks and completely occupied with yourself. It’s going to take forever.
Soooo when my consultant came last week and spoke us about drugs, painkillers etc. He was talking about how they can treat thousands of people with RA with the front line DMARDS quite successfully, who then lead “normal” lives. I thought - aye up how normal is all that pacing and pain management. Because it will be a constant in our lives. All that has to be fitted in between the set backs we have from the days when we have flares (even months). Who the heck is normal with RA – Who is normal, what is normal. For instance are we eskimo normal or united kingdom normal?!!!
Anyways the upshot is. When I get woken up in the middle of the night with a pain, the only thing I want to do is swallow a pill and get back to sleep.
All this is a bit long winded and I am sorry if most of you know all this but sometimes it seems I take one step forward and two back.
I am nursing a frozen shoulder this morning – don’t ask me why – I am not aware of not pacing myself over the last few days, haven’t done anything to upset it. So there. Or perhaps I have overrested myself!
Parting thought from my Pain Management man – Rome wasn’t built in a day – No S””t !
He also said “having a flare up may be painful but does not usually mean there is any further damage”.
I am sure I will get there in the end – wherever that is! Be happy!!!