Chronic Pain and Arthritis Treatment

I was recently asked: “do NeuroMind techniques (and other MindBody treatments we teach for chronic pain) work if you have an existing condition like arthritis?”

In other words, how do chronic pain and arthritis treatment work together?

People who have arthritis psoriasis have a strange rash on their skin. The rash is a manifestation of the autoimmune disease. Psoriasis is a disease where your immune system attacks you. There’s a group of these autoimmune diseases, and each of them nasty in its own way.

Psoriasis affects joints and skin. Rheumatoid arthritis affects little joints primarily, but it can affect any joint and it has other manifestations in your body. It may affect your organs as does systemic lupus. And there’s a whole series of other autoimmune diseases with unpronounceable names describing different ways your immune system can attack you and cause inflammation and damage to an area of your body.

If we move aside from autoimmune diseases, then you have degenerative diseases like osteoarthritis.

Osteoarthritis & Chronic Pain

This is when there’s damage to joints and cartilage. Your body tries to heal this, but the healing response is inadequate.

The healing response ends up behaving like the autoimmune response – it creates inflammation. It’s the inflammation which releases cytokines – damage cells which start to attack your own body.

With these conditions, just like with Ehlers Danlos, (where there’s recurrent damage of joints and other soft tissues) you end up with a very powerful chronic ongoing peripheral source of pain.

What’s important to understand is how this peripheral pain can turn into a central pain problem. Or rather, how peripheral pain from a condition like arthritis can turn on central sensitisation.

People have studied rheumatoid arthritis a lot over the last 20 years. There’ve been studies where they’ve noticed a proportion of people start off with a peripheral cause of pain which is obvious. For example rheumatoid arthritis, where you have a series of joints which are swollen, hot, inflamed and are being damaged. You do your blood tests and the blood tests show high inflammatory markers and high antibodies against rheumatoid antibodies.

Medical science has become better at treating these chronic inflammatory conditions. A rheumatologist can prescribe heavy duty medication which causes the inflammation decreases.

But in a proportion of people (between 18% to 45 %,) instead of getting better, get worse. This was a mystery to the researchers. People didn’t understand what was going on. The disease was looking better and the person was saying “I feel worse.”

Here’s an example to show what’s really happening. Suppose some has osteoarthritis in a knee. The knee inflammation settles, but the pain starts to spread. That’s the first sign.

The pain starts to spread and now the knee starts to become sensitised. What’s happened is the pain messages which came from that peripheral source have bombarded the pain system and spinal cord. Central sensitisation has turned on. This means the pain messages which were overloading the dorsal horn have turned on amplifiers, and now interneurons are spreading the message.

As the interneurons start to spread the pain message, what you feel is that the pain is no longer just in your knee . It has spread into your thigh as well, and possible down into your calf.

As sensitisation progress, people will get hyperalgesia, which means they feel more pain than is normal. Then they get allodynia, which is when just a soft touch or temperature variation is perceived as pain.The only other thing that gives the same reaction is sunburn, so this is the cardinal sign someone is sensitised.

If someone with arthritis has sensitisation, the joint is quieter, all the blood tests are good, but the whole area becomes more and more painful.

Chronic Pain and Neuroplastic Changes

Studies have looked at neuroplasticity and chronic pain. With chronic pain, areas of your brain get taken over by the chronic pain process. The chronic pain process invades areas that should be doing other things like logic, memory etc.

This is how chronic pain affects people’s ability to think clearly. I’ve had many people in my clinic tell me: “Look I just can’t think clearly. It’s like my brain is in a fog.” And lastly, people often become increasingly anxious and become depressed.

Another key problem is people become sleep deprived. A lack of quality sleep causes pain to become more widespread. There are autonomic symptoms that may start to occur: irritable bowel, irritable bladder, hot and cold palpitations.

When you compare the disability of people who have pain from rheumatoid arthritis with somebody who also has significant central sensitisation, studies show the people who are sensitised are much worse off.

For inflamed joints, there’s a pretty good treatment (though it is heavy duty.) But for the people who are sensitised, there’s very few drugs and they are at best helpful, and at worst harmful.

If you can get 30%  pain reduction from chronic pain medication, you’re doing well. That’s why in my course, the focus is on reprogramming your mind and your pain system. This is to teach people how to change and turn down pain amplification using the same neuroplastic process that turned it on.

So that’s the relationship between chronic pain and arthritis treatment. While they don’t always together, arthritis can set off chronic pain sensitisation, and this makes the pain worse, more widespread, and harder to treat.

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