PAIN

Understanding Your Pain

Pain can be the hardest part of having arthritis, but it is possible to 
manage it. Before learning different management techniques, however, 
it's important to understand some important concepts about pain.

Not All Pain Is Alike

Just as there are different types of arthritis, there also are different 
types of pain. Someone with the same kind of arthritis as you may feel a 
different kind of pain. Even your own pain may vary.

Each person with arthritis requires his or her own pain management plan. 
What works for some people may not work for others. You may need to try 
several different treatments before you find one that suits you.

What Is the Purpose of Pain?

Pain is an alarm signal that goes off when you've been injured or part 
of your body has been hurt. Types of pain can vary from person to 
person.

Pain is your body's alarm system. It tells you that something is wrong. 
When part of your body is injured or hurt, nerves in that area release 
chemical signals. Other nerves send these signals to your brain, where 
they are recognized as pain. Pain often tells you that you need to do 
something. 

For example, if you touch a hot stove, pain signals from your brain make 
you pull your hand away. This type of pain helps protect you.

Long-lasting pain, such as arthritis pain, is different. While it tells 
you that something is wrong, it often isn't as easy to relieve. Managing 
this type of pain is important, because it can disrupt your life.

What Causes Pain?

Arthritis pain is caused by:

Inflammation (in-flah-MAY- shun), the process that causes the redness 
and swelling in your joints;

Damage to joint tissues, resulting from the disease process or from 
stress or pressure on the joints;

Muscle strain caused by overworked muscles attempting to protect your 
joints from painful movements; and/or

Fatigue, resulting from the disease process, which can make your pain 
seem worse and harder to handle.

The Pain Cycle

Along with physical changes, such as movement limitations, the emotional 
ups and downs of arthritis also can add to your pain. If you feel 
depressed or stressed due to limited or lost abilities, your pain may 
seem worse. You can get caught in a cycle of pain, limited/lost 
abilities, stress, and depression that makes everything seem harder to 
handle.

Limited/lost abilities, stress, and depression
can make it harder to deal with pain.

Why Do People React Differently to Pain? 

People react differently to pain for several reasons: 

Physical reasons: The sensitivity of your own nervous system and the 
severity of your arthritis determine how your body reacts to pain. These 
factors determine whether your nerves will send or block pain signals.

Emotional and social reasons: Other factors that affect how you react to 
pain and how much pain you feel include your fears and anxieties about 
pain, previous experiences with pain, energy level, and attitude about 
your condition. The way people around you react to pain also may affect 
how you personally react to pain.

Whatever the reason, many people with arthritis have discovered that by 
learning and practicing pain management skills, it is possible to reduce 
pain.

How Does the Body Control Pain?

People react differently to pain because of various physical, emotional, 
and social influences Your body controls pain by blocking pain signals 
from the brain

Pain signals are sent through a complex system of nerves in your brain 
and spinal cord. Your body tries to stop these signals from reaching 
their destination by creating chemicals that help block pain signals. 
These chemicals, called endorphins (en-DOOR-fins), are morphine-like 
painkilling substances that decrease the pain sensation. 

The body produces endorphins in response to different kinds of 
"controls." These include "natural" controls, such as your own thoughts 
and emotions. For example, imagine that a father who is driving with his 
children is hurt in a car accident. The father is so worried about his 
children that he doesn't feel the pain from his own broken arm. The 
concern for his children has blocked the pain signal and kept the pain 
from affecting him.

The body also produces endorphins in response to "outside" controls, 
such as medicine. Morphine is one example of a powerful pain-blocking 
medicine. Other outside pain control methods, such as exercise, 
relaxation, massage, and heat and cold treatment, can stimulate the body 
to either release endorphins or block pain signals in other ways.

What can make your pain feel worse?

Increased disease activity Stress Excessive physical activity
Dwelling on pain Fatigue Anxiety Depression

What can block pain signals?

Positive attitude and pleasant thoughts Carefully monitored exercise
Relaxation Medication Massage Distraction Pleasing sights Topical
lotions Humor Heat or cold treatments

Pain can be controlled by blocking pain signals.

Managing Your Pain

Thinking of pain as a signal to take positive action rather than an 
ordeal to be endured can help you manage pain. This section describes 
some positive actions for you to consider.

Take Control

Your mind plays an important role in how you feel pain and how you 
respond to illness. People with arthritis often feel helpless and 
depressed. With these feelings come decreased activity, poor 
self-esteem, and increased pain. So building a sense of personal control 
by adjusting your thoughts and actions is an important part of pain 
management. Here are some ways you can manage pain better:

Keep a positive attitude: Arthritis can limit you, but it doesn't have 
to control your life. One way to reduce your pain is to build your life 
around wellness, not pain or sickness. This means thinking positive 
thoughts, keeping a sense of humor, eating a balanced diet, exercising 
every day, and enjoying activities with others. It also means following 
your treatment plan, taking your medication properly, and practicing 
relaxation.

Talk to your doctor, nurse, or physical or occupational therapist about 
how you can make your life more healthy. Get involved in a favorite 
activity or hobby. Remind yourself of what you can do rather than what 
you can't do.

Don't dwell on your pain: How often do you think about your pain? The 
amount of time you spend focusing on it has a great deal to do with how 
much discomfort you feel. People who dwell on their pain usually say 
their pain is worse than those people who don't dwell on it. One way to 
take your mind off of pain is to focus on someone or something else.

Everyone has the ability to be distracted. The more you focus your 
attention on something outside of your body, the less you will be aware 
of physical discomfort. For example, get involved in an activity or 
hobby you enjoy, develop a new interest, or get involved with helping 
others. If you can't avoid thinking about the pain, try to think about 
it differently. Think of the pain as your body's message to do something 
different.

Practice positive self-talk: What we say to ourselves often determines 
what we do and how we look at life. For example, you may come home from 
work and think, "I don't want to exercise today It's cloudy outside, 
there's no one to walk with, and besides, I've already exercised twice 
this week." Or perhaps you approach the situation from a different 
perspective and think, "I don't feel like exercising today, but I know 
I'll feel better afterward and have an easier time falling asleep."

Both of these are examples of self-talk. However, each can have a 
different effect on the way you feel pain. Negative self-talk can lead 
to increased pain. Positive self-talk can help distract you from pain.

Changing negative self-talk to positive self-talk is a challenge, but it 
can be done. To make the change, follow these three steps:

1.Make a list of your negative self-talk statements. 
2.Then change each negative statement to a positive one. For example, 
"I'm tired and don't feel like attending my support group tonight, but 
if I don't go, I might miss out on some helpful hints, like the ones I 
learned about last month. I can always leave the meeting a little early, 
if necessary. I'll bet someone in the group has some good suggestions 
about how to cope with the kind of fatigue I'm experiencing." 
3. Practice positive self-talk. At first it may seem awkward. However, 
you'll soon discover what a difference it can make.

Change your pain habits: It's easy to slip into the habit of taking more 
medicines or relying on other unhealthy practices, such as drinking 
alcohol, to escape your pain. If you answer yes to any of the questions 
below, you may need to find new ways to handle your pain.
Do you finish a bottle of pain medication faster than you used to? Do
you spend a lot of time in bed aside from your regular sleep time? Do
you drink alcohol to decrease your pain? Do you talk about pain or
arthritis much of the time? 

One way to start managing your pain is by building your life around 
wellness and positive thinking.

Changing your pain habits will help you feel better. One way to make a 
change is to do something positive in place of the old habit. You can 
reinforce this change by rewarding yourself each time you do something 
positive-perhaps by spending some extra time in a soothing whirlpool or 
taking an additional 10 minutes to read the morning newspaper. Discuss 
these habits with your doctor, nurse, or other health-care professional 
who specializes in pain management. Ask about new ways to manage pain.

Create a pain management plan: Make a chart of your own pain control 
methods to help you keep track of which methods you have used and which 
ones work best for you. Use the chart located at the back of this 
booklet. Post it on your refrigerator so you can refer to it often.

Take Medicines Wisely

The type of medication your doctor prescribes for you will depend on 
your individual condition. It is important that you follow dosage 
instructions carefully.

Many different types of medicines can help control the pain and swelling 
of arthritis. Your doctor may recommend some of these depending on your 
physical condition, how much pain you have, and other factors.

Nonsteroidal anti-inflammatory drugs 
(NSAIDs) are a group of drugs that help reduce joint pain, stiffness, 
and swelling. NSAIDs cut down on the production of prostaglandins 
(PROS-tahGLAN-dins), which are chemicals that the body makes. 
Prostaglandins intensify pain by making nerve endings more sensitive.

By cutting down on the production of prostaglandins, NSAIDs help block 
pain signals that are trying to reach the brain. Examples of NSAIDs 
include aspirin, ibuprofen, and naproxen sodium. Other NSAIDs are 
available by prescription only, including nabumetone (Relafen), etodolac 
(Lodine), and diclofenac(Voltaren).

One of the most common side effects of NSAIDs is stomach upset or 
irritation. Your doctor may recommend that you take a "coated" aspirin 
or take your medication with meals (not before meals) to help avoid 
irritating the stomach. Your doctor may have you try several kinds of 
NSAIDs before you find the one that works best and has the fewest side 
effects. 

Acetaminophen (ah-SEAT-ah-MEAN-oh-fen) is a pain reliever that does not 
contain aspirin. Acetaminophen is helpful if you just need pain relief, 
are allergic to aspirin, or have had an ulcer. This drug gives temporary 
relief of common arthritis pain, but it does not reduce swelling. It is 
available without a prescription.

Historically, narcotics and other strong painkillers have been 
prescribed mainly for short-term and intense (acute) pain. However, some 
physicians believe that these types of drugs, when closely monitored, 
can be quite effective in the treatment of chronic, or long-term, 
disease.

Narcotics reduce pain by blocking pain signals that are traveling to the 
brain. These drugs imitate the body's own endorphins, which block pain 
signals naturally. Morphine and codeine are two examples of narcotics.

Antidepressants can help relieve chronic pain in people who are not 
necessarily depressed. These drugs work by blocking pain messengers in 
the brain. Antidepressants also are sometimes used to help people with 
arthritis break out of the pain-limited/lost abilities-stress-depression 
cycle (see p. 3). Doctors prescribe these medicines in doses smaller 
than those prescribed for depression. Antidepressants also can result in 
more restful sleep, which in turn may result in more effective pain 
management.

Tranquilizers can help reduce painful muscle tension and spasms in some 
types of arthritis. However, these drugs can be addicting if they are 
used for a long period of time.

Nerve blocks are injections of anesthetic drugs (similar to what a 
dentist uses) directly into the nerves of the painful area. Nerve blocks 
can help relieve nerve, tendon, ligament, and muscle pain. Yet nerve 
blocks are not as effective for long-lasting pain because they work only 
for a limited period of time. They also can cause temporary muscle 
weakness and numbness near the painful area.

Cortisone is a hormone produced in the body Scientists have developed a 
synthetic form of cortisone that can be injected directly into joints or 
other tissues. These injections can relieve pain by reducing swelling 
and inflammation in the area. If you have severe pain and swelling in a 
certain joint, cortisone or another cortisone-like drug may help you 
feel better. However, these injections must be monitored carefully, 
because side effects can occur if you receive injections too frequently.

Muscle relaxants, such as cyclobenzaprine or carisoprodol, also may 
relieve pain by decreasing muscle spasms that often trigger pain 
signals. Like tranquilizers, however, they should only be used for brief 
periods of time.

Second-line drugs are yet another class of drugs that doctors sometimes 
prescribe. While their main function is to reduce inflammation, slow 
down the process of the underlying disease, and/or suppress the immune 
system, they also can help relieve pain. These drugs take several weeks 
or months to work. Examples of second-line drugs include methotrexate, 
gold, hydroxychloroquine, penicillamine, and azathioprine.

Topical pain relievers can temporarily relieve the pain of arthritis. 
They include creams, rubs, or sprays that are applied on the skin over a 
painful muscle or joint. Some topical pain relievers may contain 
combinations of salicylates (sa-LIS-ill-ates), skin irritants, local 
anesthetics that relieve pain in one area, and ingredients that relieve 
itching.

Salicylates decrease the ability of the nerve endings in the skin to 
sense pain. Irritants stimulate nerve endings in the skin to cause 
feelings of cold, warmth, or itching, which distract attention from the 
actual pain.

Topical nonprescription creams containing capsaicin (cap-SA-shun) may be 
used alone or with other medications to temporarily relieve the pain 
associated with osteoarthritis and rheumatoid arthritis. When applied as 
directed to joints affected by arthritis, the medication usually begins 
to work within one to two weeks. It works by decreasing a substance in 
the nerve called "substance P; which sends pain signals to the brain. 
Some people may at first feel a burning or stinging sensation at the 
place where capsaicin is applied, but this usually goes away with 
repeated applications.

TIPS FOR SAFE MEDICATION

* TAKE your medicines exactly as your doctor instructs.

* Do not skip a dose unless your doctor recommends it. This can increase 
your pain to a large degree.

* Don't stop taking a medicine unless your doctor recommends it. You may 
need a dose change, another medication, or a combination of medications. 

* Keep in mind that it takes some medications longer to work than 
others.

UNPROVEN REMEDIES

Unproven remedies are treatments that have not yet been shown to both 
work and be safe. They include certain products, diets, devices, and 
procedures.

Unproven remedies may appear to work simply because of the up and down 
nature of arthritis. That is, you might feel better one day, but worse 
the next So you might think an unproven remedy caused your arthritis to 
improve, when in fact you would have felt just as well without it.

Because no cure presently exists for arthritis, you may be tempted by 
promises of quick cures and treatments. Some of these may not be 
dangerous. Others can be very harmful. The best guide to remember is to 
stay with the treatment plan your health care provider gives you, which 
has been tested and proven safe. 

Exercise Regularly

People with arthritis can improve their health and fitness through 
exercise. Exercise is beneficial because it can help:
keep joints moving; keep the muscles around joints strong; keep bone
and cartilage tissue strong and healthy; improve the ability to do
daily activities; improve overall health and fitness, including:
- increased energy;
- sleep improvement;
- weight control; 
- a stronger heart; 
- stronger bones and muscles; 
- decreased depression; 
- improved self-esteem and sense of well-being. 

Regular, appropriate exercise also can help you effectively manage pain. 
A physical therapist, occupational therapist, exercise physiologist, or 
doctor can recommend an exercise program for you.

Your program should include special range-of-motion exercises to help 
keep your joints movable. It also should include general fitness 
exercise, such as water exercise or walking. These exercises help keep 
your heart, lungs, bones, and muscles strong. Exercise also helps 
relieve stiffness and gives you an improved sense of well-being.

EXERCISE TIPS

* Start with just a few exercises, and slowly add more. 

* "Listen" to your body. If it is telling you that your exercise hurts 
too much or is causing too much pain, stop. Ask your doctor to help you 
distinguish the difference between normal exercise discomfort and the 
pain associated with too much exercise.

* If you have a flare (a period during which disease symptoms return or 
become worse), do only gentle range-of-motion exercises.

* Ask your local Arthritis Foundation office about joining a supervised 
warm-water or land-exercise program. Many people find that exercising 
with a group is fun as well as healthy.

* For more information about exercise, read Exercise and Your Arthritis, 
available from your local Arthritis Foundation office.

Use Your Joints Wisely and Save Your Energy

You can relieve pain by reducing stress on painful joints, saving your 
energy, and using assistive devices

Using your joints wisely means doing everyday tasks in ways that reduce 
the stress on painful joints. Saving your energy means "listening" to 
your body for signals that it needs to rest. It also means learning to 
pace yourself. Following are guidelines for using your joints wisely and 
for saving your energy:

* Use proper movement techniques for bending, lifting, reaching, 
sitting, and standing.

* Be aware of your body position. Avoid activities that involve a tight 
grip or that put too much pressure on your fingers. Use self-help 
devices, such as jar openers, reach extenders, zipper pulls, and 
buttoning aids. These aids put less stress on your joints and make 
difficult tasks easier. 

* Use your largest and strongest joints and muscles. For example, if 
arthritis doesn't affect your shoulder or neck, try using a shoulder 
bag, backpack, or fanny pack to carry items instead of a tote bag, 
briefcase, or purse, all of which must be handheld. This protects 
painful elbow, wrist, and finger joints. When you lift or carry objects, 
use both arms. This prevents you from placing too much stress on one 
joint or one area of your body.

* Avoid holding one position for a long time. Move or change positions 
often. Keeping joints in the same position may cause joint stiffness and 
pain.

* Balance activity with rest. Learn to understand your body's signals 
that you're getting tired. Take breaks when you need them. Don't wait 
for the physical signals of pain before you rest. Plan your schedule to 
alternate activity with rest even when you are feeling well. 

* Respect pain. If you have pain that lasts for two hours or more after 
completing an activity or exercise, then you've done too much. Next time 
do a little less or try exerting less effort.

* Simplify your work. Plan ahead, organize, and create shortcuts. Use 
labor-saving devices, such as an electric can opener or electric garage 
door opener, that require less energy on your part and place less stress 
on your joints.

* Ask for help when you need it. Family and friends would rather help 
you than have you become too tired or ill from doing too much. You may 
wish to consult a physical or occupational therapist who may be able to 
suggest useful assistive aids.

* Contact your local Arthritis Foundation office for more specific tips 
on wise joint use.

Use Assistive Devices When Necessary

An assistive device is any type of product or aid that protects injured 
joints from further damage. Assistive devices can be further categorized 
into three subgroups:

* Products that allow you to carry out routine activities, such as 
bathing, cleaning, and dressing. Examples include grab bars for bathroom 
use, large-handled utensils for eating, and aids for fastening and 
unfastening clothing.

* Aids that improve mobility, keep joints from becoming too stiff, and 
distribute weight over a number of joints, such as canes and walkers.

* Devices that help stabilize joints, provide strength, and reduce pain 
and inflammation. Examples include braces and splints.

Splints help reduce joint swelling and pain

Use Heat or Cold Treatments

Using heat or cold treatments can reduce the pair and stiffness of 
arthritis. Cold packs numb the sore area and reduce inflammation and 
swelling. They are especially good for severe joint pain caused by flare 
Heat treatments relax your muscles and stimulate circulation. You can 
use dry heat methods, such as a heating pad or heat lamp, or moist heat 
methods, such as a bath or hydrocollator pack.

Before using either treatment, be sure your skin dry and healthy. Check 
your skin for cuts and sores. Don't use cold or heat - especially 
paraffin baths - if either type of skin damage is evident. Also, protect 
the skin over any bone that is close to the surface of your skin. Place 
extra padding over the area to prevent burning or freezing your skin. 

Following are ways to use heat or cold treatments:

HOT TIPS
Soak in a warm bath, shower, Jacuzzi, or whirlpool. Place a heating
pad on the painful area. Don't sleep with the heating pad on, because 
you might burn yourself. Use an electric blanket or mattress pad. Turn
it up before you get out of bed to combat morning stiffness. Use
flannel sheets. They feel warmer against your skin. Use a hot water
bottle wrapped in a towel to keep your feet, back, or hands warm.
Before getting dressed, warm your clothes by placing them in the dryer 
for a few minutes. Place hot packs on the painful area. One type of hot 
pack is designed to be heated in water and covered with a towel. Another 
type is a gel-filled mitt or pack that can be microwaved and wrapped 
around painful joints. Don't let the pack get too hot, and always 
provide towel layering between the hot pack and your skin. Dip your
hands in a paraffin bath. This is a mixture of melted paraffin and 
mineral oil. The warm coating soothes stiff, painful fingers. Ask your 
doctor about this method. 

COOL TIPS
Place a cold pack or ice bag on the painful area. You can buy these at
the drugstore, or you can make one by wrapping a towel around a bag of 
frozen vegetables. 

After using either treatment, carefully dry the area. Check your skin 
for purplish-red skin or hives. These signs indicate that the treatment 
is too strong. Also check the area for any swelling or discoloration. 
Gently move your joint to reduce stiffness. Finally, allow your skin to 
return to normal temperature before using another treatment.

TIPS FOR USING HEAT OR COLD SAFELY

DO:
Use either heat or cold for only 15-20 minutes at a time Always put a
towel between your skin and any type of pack. Always carefully follow
the advice of your physical therapist, occupational therapist, or doctor 
when using these methods, especially heat. Use milder temperatures for
a child's skin, which is more sensitive than an adult's skin. 

DON'T:
Do not use cold packs without first consulting your physical therapist
if you have poor circulation, vasculitis, or Raynaud's phenomenon. Do
not use cold that is too cold or heat that is too hot. It is normal for 
your skin to appear pink after using a cold or hot pack. However, if an 
area appears dark red or spotty red and white, there may be some skin 
damage. Blisters also appear if the pack was too cold or hot Do not use
creams, heat rubs, or lotions on your skin while using a cold or hot 
treatment. Do not make your bath or shower water too hot. This may
cause dizziness or fatigue. Do not use an electrical device unless it is 
UL approved. 

Get Enough Sleep

Getting a good night's sleep restores your energy so that you can better 
manage pain. A good night's sleep also rests your joints to reduce pain 
and swelling. Only you know how much sleep your body needs, so get into 
the habit of listening to your body. If you feel tired and achy after 
lunch every day take a brief nap. This can help restore your energy and 
spirits. If you have trouble sleeping at night, however, try relaxing 
quietly in the afternoon rather than taking a nap.

TIPS TO HELP YOU SLEEP BETTER
Perform mild exercises For more information, see pages 13-14. Avoid
alcohol and caffeine, especially late in the day. Establish a regular
sleep schedule. Take a warm bath before going to bed. Listen to
soothing music or a relaxation tape. Spend some quiet time by yourself
before you go to bed. Read for pleasure. Avoid technical information,
business-related material, or other pieces that can preoccupy your 
thoughts and result in a poor night's sleep. Do not take sleeping pills
unless your doctor recommends them. If you are sleeping poorly, talk to
your health-care provider. 

Consider Massage

Massage brings warmth to the sore area and is soothing. You can massage 
your own muscles or you can ask your doctor to recommend a professional 
who is trained to give massages.

When giving yourself a massage, use lotion or oil to help your hands 
glide over your skin. Menthol gels provide a comforting tingle that can 
further ease the pain.

TIPS FOR SAFE MASSAGE
When doing self-massage, stop if you feel any pain. Don't massage a
joint that is very swollen or painful. If you use a menthol gel for
massage, always remove it before using a heat treatment otherwise you 
might burn yourself. If you have a professional massage, make sure the
massage therapist is knowledgeable and has had experience working with 
people who have arthritis. 

Practice Relaxation Techniques

People who are in pain experience both physical and emotional stress. 
Pain and stress both have similar effects on the body. Muscles become 
tight, and breathing becomes fast and shallow Heart rate and blood 
pressure go up. Relaxation can help you reverse these effects. It gives 
you a sense of control and well-being and makes it easier to manage 
pain. Relaxation is more than just sitting back, reading, or watching TV 
It involves learning ways to calm and control your body and mind.

You can achieve mental relaxation through deep breathing, meditation, or 
distraction. Distraction, or taking your mind off your pain by focusing 
your attention on something else, is extremely helpful. Listening to 
music, getting involved with a hobby, and participating in conversation 
are examples of distraction.

TIPS FOR RELAXING
Pick a quiet place and time. Take at least 10 minutes for yourself with
no noise from the TV or radio or from other people. Use soft music to 
muffle other noises. Sit or lie in a comfortable position with your
head supported and your eyes closed. Take a deep breath. Feel your
stomach move in and out with each slow, deep breath. Continue to
breathe deeply and slowly, focusing on just your breathing. Try
thinking about words such as "peace" or "calm." Don't worry about
whether you reach a deep level of relaxation. Allow the relaxation to go 
at its own pace. Don't try to chase away other thoughts that come into
your mind. Just quietly go back to your breathing Concentrate on 
relaxing and staying calm. Do not practice relaxation right after a
meal. If you fall asleep, don't worry. Next time, try to stay awake the 
entire time. Set aside time regularly to practice. Then relaxation will
become easier. 

There is no best way to learn how to relax. Everyone responds 
differently to different techniques. The important thing to remember is 
to relax both your body and mind. Try some of the following methods 
until you find some that work for you.

Guided imagery uses your mind to focus on pleasant images. First, begin 
by breathing slowly and deeply. Think of yourself in a place where you 
feel comfortable, safe, and relaxed. Create all the details - the 
colors, sounds, smells, and how it feels. These images take your mind 
away from pain and focus it on something more pleasant.

Prayer is very relaxing and comforting for some people. You may want to 
make a tape recording of a soothing inspirational message or practice 
your own type of personal prayer.

Hypnosis is a form of deep relaxation and guided imagery in which your 
attention is focused internally - away from the usual thoughts and 
anxieties. Most people who find hypnosis helpful in relieving pain 
report it to be both soothing and enjoyable. You'll need to work with a 
professional psychologist, counselor, or social worker who is trained in 
hypnosis. Those health-care professionals who are trained in hypnosis 
also may be able to teach you how to safely hypnotize yourself.

Relaxation audio tapes and videotapes can help guide you through the 
relaxation process. These tapes provide directions for relaxation so you 
don't have to concentrate on remembering the instructions. Many 
professional tapes are available for purchase. You also might want to 
make your own tape of your favorite relaxation routine.

Evaluate the Need for Surgery

Most people with arthritis will never need joint surgery Most people are 
able to manage the disease and pain by following the guidelines in this 
booklet and advice from their doctor. When these methods don't lessen 
the pain, or when there are problems with joint mobility or function, 
surgery may be considered. Some types of surgery include:

Arthroscopy: This is a surgical process that allows the surgeon to view 
and repair the inside of your joint through small openings in the skin 
It often can help relieve joint pain.

Synovectomy (sih-no-VECK-toe-me): This is ; procedure in which the 
diseased lining of the joint - the synovium - is removed. This may help 
relieve pain and swelling in some cases.

Joint replacement: In this procedure, damaged joints are replaced with 
artificial joints. This procedure can relieve pain and may restore some 
joint motion and function.

Consider Other Treatments

Biofeedback uses sensitive electrical equipment to help you be more 
aware of your body's reaction to stress and pain and to learn how to 
control your body's physical reactions. The equipment monitors your 
heart rate, blood pressure, skin temperature, and muscle tension. These 
body signals are shown on a screen or gauge so you can see how your body 
is reacting.

Biofeedback helps you learn how you feel when your muscles are tense or 
relaxed. If you practice a relaxation technique while using the 
equipment, you can learn to control some of your body's responses to 
pain. One advantage of biofeedback that it shows you that you have the 
ability to relax.

TENS treatment involves a small device that directs mild electric pulses 
to nerves in the painful area Theoretically, some types of TENS work on 
principle of blocking pain impulses through large nerve fiber 
stimulation. Other types of TENS work by causing the release of 
endorphins. The amount of pain relief varies widely from person to 
person.

To use a TENS machine, electrodes are taped on the skin in areas related 
to your pain. These electrodes are connected by wire to a small, 
batteryoperated stimulator. TENS doesn't hurt, but it may cause some 
tingling. Usually it feels like a vibrating or tapping sensation. TENS 
works for some people, but not for others. Talk to your doctor or 
physical therapist about whether TENS might help you.

Ultrasound helps some people. Ultrasound uses high-energy sound waves to 
bring comfort to painful joints and muscles. A physical or occupational 
therapist must perform this technique.

Who Can Help?

Your Health-Care Team

This is your first place to turn for help. The healthcare team is 
coordinated by your doctor and may include a nurse, an occupational 
therapist or a physical therapist, an exercise physiologist, a social 
worker, a counselor, a psychologist, and a pharmacist.

Talk to the members of your health-care team about ways to manage pain. 
They may be able to help you find services in your area. Don't be afraid 
to suggest a pain management idea of your own or one from this booklet.

Pain Clinics

Pain clinics specialize in treating pain. These clinics are staffed by 
several different health-care professionals, including physicians, 
psychologists, physical and occupational therapists, exercise 
physiologists, and nurses. They may be located in a hospital or may 
operate independently. Some clinics treat all types of pain. Others 
specialize in treating certain types of pain.

Professional Counselors

Any major disturbance in your life - such as illness, chronic pain, 
family problems, or increased dependence on others - may make you feel 
anxious, depressed, angry, or even hopeless. Many people become 
depressed when they have severe pain. Some people feel so bad that they 
cannot sleep or eat In these cases, therapy, counseling, or medication 
may help.

Some people are afraid to admit that they need help They believe that 
others will think they are crazy if they talk to a psychiatrist, 
psychologist, or counselor about their problems. However, some health 
professionals are specially trained to work with the emotional side of 
chronic health problems like arthritis These trained health 
professionals also can teach you how to manage stress. If you have 
increased stress, you may feel more pain.

It's smart to get help when you need it. If you have the symptoms of 
depression - poor sleep, changes in appetite, crying, sad thoughts - get 
help from a health-care professional.

Support Groups

Sharing your feelings and experiences with a group can make living with 
arthritis easier. The basic goal of a support group is to give you a way 
to share and learn about arthritis. A support group helps you to feel 
understood and can give you new ideas to help cope with problems. It 
also can help you feel good about yourself because you'll be. helping 
others in the group.

Contact your local Arthritis Foundation office or ask your health-care 
providers about local groups for people with arthritis or people with 
pain. Sometime you can help yourself with the help of others like you.

Researchers

Researchers are constantly looking into ways to manage pain. They are 
finding ways to block pain at the site of the injury They also are 
finding new ways to harness the body's natural pain relief system. There 
is help and hope when it comes to pain management.

For More Information

Contact your local Arthritis Foundation office for a list of free 
brochures and detailed information about treatments for arthritis. Their 
services also may help you.

SERVICES

* Arthritis Self-Help Course - Learn how to take control of your own 
care in this six-week (15-hour) class for people with arthritis.

*Warm-water exercise program - Join in the fun of a six- to 10-week 
exercise program in a heated pool.

* Land-exercise programs - Move easier in several levels of exercise 
classes, or exercise at home by purchasing an Arthritis Foundation 
exercise videotape.

* Support groups and clubs - Share your successes and problems with 
others, and get tips on how to overcome problems caused by arthritis.

The Arthritis Foundation

The Arthritis Foundation is the source of help and hope for 40 million 
Americans who have arthritis. The Foundation supports research to find 
ways to cure and prevent arthritis and seeks to improve the quality of 
life for those affected by arthritis.

As a not-for-profit organization, the Arthritis Foundation relies on 
public contributions to fund research and provide service programs. You 
can become a member of the Arthritis Foundation and help support the 
fight against arthritis. Please contact your local chapter or complete 
and mail the membership form in the back of this brochure. You will 
receive materials about the benefits of Arthritis Foundation membership, 
including the bimonthly magazine Arthritis Today.

My Pain Management Plan

Work with your doctor and other health-care professionals to create your 
own pain management plan. Create a larger version based on the 
information provided in this section. Include plenty of space to write 
down information. Use it to remind you of what you can do to manage your
arthritis pain Post your plan where you will see it often.
MEDICATIONS:
Types of medications I take and when to take them 
EXERCISE:
Type of exercise I will do, when I'll do it, how often I'll do it 

REST: 
When I'll completely rest when I'll rest specific joints, and when I'll 
wear my splint

HEAT, COLD, and/or MASSAGE TREATMENT: 
What I'll do and when I'll do it 

RELAXATION: 
Forms of relaxation I'll practice and how often I'll practice them.