Chronic Pain vs. Recurrent Acute Pain in Rheumatoid Disease
An honest examination shows pain related to rheumatoid disease may frequently be better described as recurrent acute pain than classic chronic pain.
Is “chronic pain” the right way to describe Rheumatoid Disease pain?
According to the National Institutes of Health, chronic pain is “any pain lasting more than 12 weeks. Whereas acute pain is a normal sensation that alerts us to possible injury, chronic pain is very different. Chronic pain persists—often for months or even longer.”  Acute pain is considered “a warning of disease or a threat to the body” and identified as sharp or sudden, according to Cleveland Clinic. In contrast, “(c)hronic pain persists despite the fact that the injury has healed. Pain signals remain active…”
Rheumatoid arthritis pain is typically considered to be chronic pain; however, in many cases, this is a flawed assumption. As I’ve observed patients’ reports over the past several years, it has become clear where the misunderstandings may be. Let’s look at some facts.
True, rheumatoid disease (RD) is a chronic disease (lasting for many years, with no known cure). And disease activity causes various symptoms and sensations in the joints of people living with rheumatoid disease (PRD), often including varying degrees of pain. RD can cause pain in any joint and sometimes other places. However, the model of chronic pain often does not apply because concepts associated with the term “chronic pain” are not readily applicable to RD pain.
6 reasons to challenge the notion of rheumatoid pain as chronic pain
1) Most joint pain of RD is not constant. Most people experience periodic flaring of affected joints (with accompanying pain as one symptom). Even PRD who experience a persistent flaring pattern often feel relief when inflammation is reduced by medication. And pain that is a result of permanent damage is often relieved by surgery.
2) The notion of chronic pain as being “post-injury” ignores the reality of ongoing inflammatory activity in the body of people with RD. Additionally, structural damage or functional loss in PRD contradict the chronic pain paradigm that pain is not reflective of a definite physiological problem.
3) PRD tend to have a high tolerance for pain and practice various pain management strategies. Large surveys reveal that high percentages of PRD have residual pain due to disease activity, and often conceal pain instead of discuss it in ways that would bring attention to themselves. [3,4]
4) The nature of rheumatoid pain is often sharp and emerges suddenly, making it more characteristic of acute pain. RD pain is also often related to physical activity, making it similar in nature to injury (acute pain).
5) The explanation of RD pain as chronic pain ignores the effect of increased activity on inflammation and resulting pain . (See usage principle).
6) When physical pain caused by RD is alleviated, PRD tend to quickly return to activities of normal living, which contradicts notions of hypochondriasis, pain processing disorders, phantom pain, or various synonyms for chronic pain syndrome.
1 NIH Medline Plus [Internet]. 2011 Apr 28 [cited 2014 Nov 25]. Available from http://www.nlm.nih.gov/medlineplus/magazine/issues/spring11/articles/spring11pg5-6.html
2 Acute vs. chronic pain. Cleveland Clinic [Internet]. 2005 Mar 9 [cited 2014 Nov 25]. Available from https://my.clevelandclinic.org/services/anesthesiology/pain-management/diseases-conditions/hic-acute-vs-chronic-pain
3 Strand V, Emery P, Fleming S, Griffin C. The impact of rheumatoid arthritis (RA) on women: focus on pain, productivity and relationships [abstract]. Arthritis Rheum [Internet]. 2010 [cited 2014 Nov 25];62 Suppl 10:1063. Available from: http://www.blackwellpublishing.com/acrmeeting/abstract.asp?MeetingID=774&id=89712 doi: 10.1002/art.288302012
4 Young KO, Crowson CS, Symons DM. Patient survey challenges conventional notions regarding symptoms and experiences of people living with rheumatoid arthritis. [abstract]. Arthritis Rheum [Internet]. 2013 Oct 29 [cited 2014 Nov 25]; abstract #2273
5 Young KO, Symons DM, Lumpe AT, Crowson CS. Patient survey regarding utility of the health assessment questionnaire reveals an unrecognized aspect of disease activity in rheumatoid arthritis: Consequences of physical activity [abstract]. Arthritis Rheum [Internet]. 2013 Oct 29 [cited 2014 Nov 25]; abstract #2272
A little humor never hurt anyone. A sassy response to the ridiculous assertions of those who spend rheumatology research dollars trying to prove PRD are exaggerating about pain. “If they call me a drama queen for saying it hurts, then I get to have a crown…” Click to continue reading… Do Rheumatoid Arthritis Patients Have a Low Pain Threshold?
Not seeing is not believing, sometimes. “All around me, life goes on as normal. In the midst of seeming normalcy, I can’t walk properly or open a car door or whatever. It’s frustrating. Or I look down at the toes that I feel pulling and there’s no rubber bands on them. Or at the ankle that’s being stabbed. And there’s no blood. Nothing to see. When my shoulder won’t move an inch from my side for two weeks, an ER doc says it’s perfectly fine because he can’t see…” Continue reading RA Reality Versus “The Lie”
- Patient’s Rebuttal to RA Pain Catastrophizing Claims
- What Is it Like to Have Rheumatoid Arthritis? Part 1: The Usage Principle
- It’s Just Pain, Right? No, Dr. No, It’s Not
NOTE: Your comments are an important resource for future readers of this post in the months to come. Please find the comment link below each post.Kelly Young. All rights reserved.