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Pain can be experienced for many different reasons, such as an injury or traumatic event, health condition, surgery or other complicated situations. Pain can also be the disease itself. When dealing with pain, it is important to understand:
- What type of pain is it?
- How can you prevent and manage the pain at home?
- When should you see a health care provider about treatment options?
You can learn more about these topics below. This will help you understand the link between psoriatic arthritis and chronic pain. Knowing what triggers your flares, symptoms and self-management strategies can help you manage your pain at home.
Speak with your health care provider about your symptoms and work together to set goals and create a pain management plan that works best for you. You can also speak with one of our Patient Navigators if you have questions.
What are the different types of pain?
People with psoriatic arthritis can have both acute and chronic pain:
- Acute (short-term) pain can last for a few moments, like when you bump into something. Or it could last a few days or weeks, like a toothache. Arthritis flares can be acute pain because they come and go.
- Chronic (long-term) pain lasts for at least 3 months but can last longer. Some examples of chronic pain include arthritis pain, migraine headaches and pain from nerve damage. This type of pain can often be described as aching, dull, burning or throbbing – but any pain can be chronic pain.
Causes of pain
We experience pain when nerves of the body send a message up the spinal cord and to the brain. The brain processes the pain message and tells you how to react. Together, the brain, spinal cord and nerves in the body make up the nervous system.
The causes of pain are categorized by how it is processed by the nervous system:
- Nociceptive [noh-si-SEP-tiv] pain can be thought of as an injury with an immediate effect of pain. An example of this would be a paper cut or a broken bone. This type of pain can also be called visceral or somatic pain.
- Neuropathic [nur-oh-PA-thik] pain happens when nerves or the nervous system is injured or damaged. This type of pain can also be called peripheral or central neuropathic pain, depending on where the injury or damage has been done. An example of this would be a pinched nerve from a spinal injury or herniated disc.
It is important to understand what causes the type of pain you are experiencing. Your health care provider may perform a physical exam. You may have X-rays, an MRI, blood tests or other tests. Different treatment options are more effective depending on what is causing the pain. Nociceptive pain may be effectively treated with anti-inflammatory medicines and opiates.
Most acute pain is considered nociceptive pain. However, there may be situations in which acute pain can be both nociceptive and neuropathic.
Different people experience pain differently. Each person has a different tolerance for pain. Factors influencing how you experience pain can include your age, gender, mental and physical health and even genetics.
Chronic pain can involve:
- Anxiety or depression
- Fatigue (extreme tiredness or exhaustion)
- Pain that spreads to different areas of the body
- Pain throughout the body
- Sharp or stabbing pain
- Weight gain
- Worsened pain when you think about it
- Worsened pain when you feel anxious, depressed or stressed
- Worsening of other health conditions
If you are experiencing these symptoms, speak with your health care provider.
Psoriatic arthritis and pain
When you have psoriatic arthritis, there is inflammation in the joints and entheses (places where tendons and ligaments connect to bone).
Symptoms of psoriatic arthritis that may cause pain include:
- Stiffness, pain, swelling and tenderness in joints
- Stiffness of joints, tendons or ligaments when waking up or after being at rest
- Reduced range of motion in joints
- Tendon tenderness, pain or swelling in areas such as the bottoms of the feet, heels, hips or spine
- Swollen fingers and toes
- Nail separates from nail bed, becomes pitted or looks like a fungal infection
- Uveitis (inflammation of the eye that causes swelling, pain and redness)
Pain from psoriatic arthritis can be acute or chronic. Acute pain can occur when you have a flare in certain joints or entheses. However, you may experience chronic pain if your psoriatic arthritis is not effectively treated and inflammation not controlled. You may also experience chronic pain if uncontrolled psoriatic arthritis has caused permanent joint damage.
Chronic pain can have an effect on your overall health and quality of life. It can lead to mental health problems such as anxiety and depression, sleep problems and others in addition to ongoing pain. In turn, these can worsen the severity of your pain.
Triggers of psoriatic disease flares and pain
Psoriasis triggers may also affect psoriatic arthritis. Stress, injury or trauma, especially to the joints, can make psoriatic arthritis worse. For some people, tobacco or alcohol use, infections or starting or stopping some medicines may cause flares. Allergies, diet and changes in weather may cause flares for some, but this is not scientifically proven.
Certain medicines may also be triggers for psoriatic arthritis flares. These include anti-malarials, lithium, beta blockers and some heart medicines.
Understanding what triggers your psoriatic arthritis flares can help you and your health care provider to develop a plan to avoid or reduce your exposure to those triggers. Your flare management plan can also include tips on what to do when you experience a flare. This may include using medicines, resting from chores at home or work, using hot or cold packs to relax muscle or reduce inflammation.
How can I prevent and manage chronic pain?
Diet and nutrition
The potential link between psoriatic disease and diet is not fully understood. However, scientists are still researching this possible connection.
A healthy diet is important to your overall health, even though dietary changes alone are not a replacement for an effective treatment plan.
We recommend that you speak with your health care provider before making any changes to your diet or adding vitamins or minerals to your diet. You may also want to speak with a registered dietician, certified nutrition specialist or a medical professional with experience in diet and nutrition.
Since there is no universal diet that helps people who have psoriasis or psoriatic arthritis, you may want to pay close attention to what helps or agitates your psoriatic disease.
Hot and cold therapy
The use of hot or cold therapy can help relieve pain. A heating pad or warm bath can reduce pain and stiffness. Warmth can also soothe sore muscles. Cold from an ice pack can be used to reduce inflammation in joints, pain and stiffness.
Follow safety instructions from your health care provider about using hot or cold therapy.
Psoriatic arthritis symptoms and pain can benefit from physical activity. Movement helps to keep your joints and tendons flexible and healthy. Physical activity can also help to reduce the inflammation, pain and fatigue from psoriatic arthritis. Building muscle also helps to reduce the workload on your joints. It can also help improve your sleep, although you should avoid physical activity close to bedtime.
Consider trying some of the following physical activities:
- Swimming or warm-water exercise
- Tai chi
Tips for physical activity with psoriatic arthritis:
- Start at a low physical activity level and slowly work up to moderate activities. On days that you are experiencing more pain, consider doing physical activity at a lighter level or for less time.
- Trying a class at a gym or your local community recreational center can help if you are just starting and wondering if you are doing certain exercises correctly.
- Listen to your body. If you have not been active, start small. If you feel sore after physical activity and worse the next day, your body is telling you to slow down. This may mean less intensity or shorter duration of physical activity.
- Stay hydrated. Be sure that you are drinking enough water during the day and especially when you are exercising.
Speak with your health care provider before starting any fitness regimen. You may also consider speaking with a physical therapist or qualified fitness or health professional to help you create a physical activity plan that is most appropriate for you.
Not getting enough sleep and poor sleep hygiene (practices or habits related to sleeping) can make chronic pain worse. Having good sleep hygiene may help with managing your pain and improve both your mental and physical health. The following are some things you may consider to improve your sleep hygiene.
Be mindful of what you eat or drink before bedtime.
- Avoid caffeine and nicotine before bedtime.
- Avoid foods or drinks that may cause stomach upset before bedtime, such as caffeinated or carbonated drinks or foods that are heavy, rich, fatty or fried.
- Limit or avoid alcohol before bedtime.
Have a regular bedtime routine that helps you relax.
- Avoid stimulating activities before bedtime, such as action movies or emotionally upsetting or exciting conversations or activities.
- Follow a regular sleep schedule every day.
- Create a comfortable sleep environment that may include using blackout curtains or a sleep mask, ear plugs or white noise machines, or making other changes so that your bedroom is more relaxing.
- Limit or avoid screen time (use of smartphones, tablets, computers and TV) before bedtime.
Other things that you can do to help improve the quality of your sleep include:
- Increase your exposure to natural light during the day (and to darkness at night).
- Keep a sleep diary to track what time you go to bed and wake up, naps during the day, any food or drinks that might affect your sleep and how tired you felt during the day.
- Limit daytime naps to 30 minutes if you do nap.
- Increase physical activity during the day.
You may also want to speak with your health care provider if you are still having trouble sleeping. This may be a sleep doctor or sleep specialist. Share your sleep diary with your health care provider, if you keep one to help your provider better understand what may be affecting your sleep. Your health care provider may consider medicines to help you sleep and reset your natural sleep rhythm. Be sure to tell your health care provider about all of the medicines that you use, including over-the-counter (OTC) medicines, vitamins and supplements.
There is a connection between how you experience pain and your emotional and mental health. Pain can feel worse the more anxious, depressed or stressed you feel. It makes sense that there is a mind-body connection with severity of pain because the brain processes pain messages.
One of the ways that you can prevent and manage your pain is by managing your stress in one of the following ways:
- Acupuncture involves the use of extremely thin needles to target strategic points of the body to relieve pain and help heal the body.
- Deep-breathing exercises involves taking a deep breath in and letting it out slowly. Slowing down and controlling your breath can help calm the body and reduce stress.
- Guided imagery (also called visual imagery) involves picturing a calm and relaxing place or situation in your mind to relax your body. Images that use at least 3 of your 5 senses (sight, sound, taste, smell and touch) can be more effective. An example could be a calming image of a beach with a cool breeze and warmth of the sun, smell of the ocean air and sound of the waves.
- Meditation or other mindfulness practices involve focusing or quieting your mind and body to manage stress.
- Progressive muscle relaxation involves tightening and relaxing different muscle groups, one after the other. This helps to release tension and relax your muscles.
- Tai chi is a type of exercise that involves slow and controlled movements with deep breathing.
- Yoga can help strengthen muscles, increase flexibility and reduce pain and stress.
You may also want to speak with a mental health professional, such as a counselor, social worker, therapist, psychologist or psychiatrist.
Use assistive devices
Assistive devices (also called self-help devices) can help make daily activities easier on your joints. This reduces the workload on your joints and may help reduce pain. There are a variety of assistive devices for different activities and tasks.
At home, there are certain products that can help with chores or other tasks.
- Bathroom hand rails to provide support
- Kitchen appliances with helpful grips and jar openers
- Products to help with zippers or buttons on clothes
- Shoe inserts or more supportive footwear can ease foot pain
- Walking devices such as a cane or walker may also be helpful
At work, you may want to speak with an occupational therapist about devices that may be appropriate in your workplace.
- Chairs, tables and other work surfaces can also have modifications
- Technology assistive devices can include specialized computer mice, keyboards, voice recognition programs, hands-free headsets for phones and others
How do I talk about chronic pain with my health care provider?
Pain is not something that you should have to live with or learn to live with. There are many things that you can do to help prevent or manage your pain at home. But it is important to know when to see your health care provider about your chronic pain.
If you experience pain every day, speak with your health care provider about a pain management plan that would be most appropriate for you.
Both you and your health care provider are experts when it comes to managing your health. Your health care provider will know about diseases or conditions and how to diagnose and treat them. You are the expert about your body, your health goals and your treatment preferences. This means that only you can know how much your chronic pain is hurting and affecting your quality of life.
Explain your symptoms
It is important to explain your symptoms clearly and be as specific as possible to help your health care provider understand the pain that you experience.
This should include:
- How does it feel?
- How much does it hurt?
- Where is it? Is it in one area or does it travel to different areas?
- How long does it last? Does it come and go or is it always there?
- When does it hurt? In the morning? At night?
- What makes it better or worse, such as physical activity, resting or other things you have tried to manage the pain at home?
It is important to understand there is a difference between how pain feels and how much it hurts. When describing how much pain hurts, you can use a scale from 0 to 10, where 0 is no pain and 10 is extremely painful. This helps your health care provider understand how intense the pain is. Describing the feeling of pain can help your health care provider understand what may be causing the pain.
The following are some ways of describing how pain feels:
- Dull aching
- Pins and needles
- Sharp, shooting or electric-feeling
- Sharp and stabbing
Explain how your pain affects your quality of life
Speaking with your health care provider about how your pain affects your daily activities and quality of life can help them better understand what may be the best treatment plan for you. This would include any effect it has on you emotionally or mentally.
Some things that you may want to explain include pain or difficulty when:
- Getting out of bed
- Getting ready for your day, such as putting on your clothes or shoes without help
- Carrying out your responsibilities at work or having to miss work
- Doing daily tasks at home
- Not being able to do activities that you used to
Explain the emotional impact
It is important to explain how your chronic pain is affecting your mental and emotional health. This is because chronic pain can be worsened by anxiety or depression. And mental and emotional health can be worsened by chronic pain.
Talking about your emotions can help to better understand what you are experiencing and develop a treatment plan that will work best for you.
How do I talk about chronic pain with others?
Managing psoriatic disease and chronic pain can be difficult. And it may be frustrating when family members, friends and those in your life do not understand what you are going through. Chronic pain may often be referred to as an “invisible illness” because the symptoms are not visible to those around you. You may also have heard the comment that, “You don’t look sick.”
As with your health care provider, there are ways to effectively communicate with others about your chronic conditions:
- Be patient and understanding with others. It may be just as difficult for others to understand how your psoriatic arthritis and chronic pain affect your daily life as it is for you to explain them.
- Educate others about your conditions. Others may not understand what you are going through because they do not understand your chronic conditions. Explain what psoriatic arthritis and chronic pain are. You may also want to share educational resources from your health care provider or the National Psoriasis Foundation.
- Describe your day-to-day life. Explain the types of symptoms you experience and how your conditions impact your quality of life. This will help others to understand difficulties you experience and adjustments that may be considered for daily activities. Also, share your symptoms of chronic pain, how it feels and how it affects your emotional and mental health.
- Explain the unpredictable. You may also want to discuss how your symptoms may change from day to day. Some days may be “good” days, while others may be more difficult. This may be helpful for others to understand when you are unable to attend events or when you cancel plans that were made in advance.
- Know when to ask for help. Be honest with yourself and with others about how your chronic pain may be affecting your daily and physical activities. This may mean describing how difficult household chores or work responsibilities are for you to do. Letting others know will allow for the opportunity to help or find ways to adjust or assist you with these activities.
- Show thanks. Let your family members, friends and other people in your life know that you appreciate their support. Their support could come in various ways from helping with tasks, listening to you and learning about your conditions or just validating that your pain is real.
It may not always be easy for people around you to understand what you are experiencing. But you can do your part to help them see what you are going through and how they can best support you.
What are my treatment options?
Treating your pain means treating your psoriatic arthritis first and then developing a pain management plan. Keep in mind that pain management does not have an effect on psoriatic arthritis and the progression of the disease. Treatment for psoriatic arthritis is important to slow disease progression, prevent permanent joint damage and reduce inflammation and pain.
Treatment for pain management often requires seeing a pain specialist or a pain management center (also referred to as a pain clinic). Pain management centers may use a variety of methods to help manage your pain, including medicines, physical and behavioral therapy and other complementary and alternative treatment options.
Prescription medicine treatment options for pain depend on the type of pain (acute or chronic) and the cause of the pain (nociceptive or neuropathic).
Medicines for pain management
Depending on what type of pain you are experiencing, your health care provider may recommend different treatment options for your pain management plan. The recommended dosage for each treatment option will depend on your level of pain and how you respond to treatment. However, general guidelines for treating chronic pain aim to reduce and manage pain with the lowest dosage necessary to achieve effectiveness.
Every OTC and prescription medicine may have side effects or risks. We recommend that you speak with your health care provider about your concerns with your treatments or pain management plan.
It is important to understand that opioid medicines that are often used for reducing pain do not treat inflammation. Opioids may also be addictive and can interact with other medicines.
Treatments for nociceptive pain
These work by inhibiting (blocking or lessening) the message pathway either from the nerves to the brain or the brain to the part of the body that experienced the injury. Remember that most acute pain is considered nociceptive pain.
- Nonopioid analgesics [non-OH-pee-oid a-nuhl-JEE-ziks] are generally used for mild to moderate pain. Medicines in this category can be given orally, although some are available as topicals. Topical analgesics can come in various forms, such as creams, gels, lotions, ointments, patches or sprays. It is important to follow instructions on how to use topical analgesics and what areas of the body they can be applied.
- Acetaminophen [uh-see-tuh-MI-noh-fuhn] is a pain reliever that is sold OTC. An example of an OTC option is Tylenol. Acetaminophen is generally used for headaches, minor aches and pains and can help with reducing fevers. There are also OTC and prescription medicines that are considered acetaminophen combinations that contain acetaminophen. Acetaminophen may cause liver damage. For more information about safety and use of acetaminophen, visit KnowYourDose.
- Nonsteroidal anti-inflammatory drugs (NSAIDs) include OTC and prescription medicines. Some OTC options include Advil®, Aleve®, Motrin® and generics, such as aspirin, ibuprofen or naproxen. NSAIDs help to decrease inflammation, joint pain and stiffness. They can be taken as pills or applied topically as creams, gels, patches or sprays. NSAIDs may cause stomach ulcers or pain, kidney problems or liver problems. For more information about safety and use of NSAIDS, visit the Alliance for Rational Use of NSAIDs.
- Opioid analgesics [OH-pee-oid a-nuhl-JEE-ziks] (also called narcotic analgesics) are available by prescription and are used to treat acute and chronic pain. They can be short-acting opioids (released quickly into the body to relieve pain in a short amount of time). Or they can be long-acting opioids (released slowly into the body to control pain for longer periods of time). Some examples of opioids include morphine and oxycodone. Opioids can be taken orally, as an injection (shot) or as an intravenous (IV) infusion (slow drip of medicine into your vein).
Side effects of opioids include drowsiness, constipation, nausea, vomiting and mood swings. Opioids may also cause dependence or addiction. Your health care provider or a pain management center must carefully monitor the use of opioids. For more information about safety and use of opioids, visit the Centers for Disease Control and Prevention (CDC) Guideline Information for Patients.
- Coanalgesics [coh-a-nuhl-JEE-ziks] include many different types of medicines that are able to reduce pain.
- Anticonvulsants are generally used for treating neuropathic pain. But they may be helpful with acute pain as well. Side effects of some anticonvulsants include nausea, vomiting, drowsiness, hyperactivity and sleep disturbance.
- Local anesthetics [a-nuhs-THEH-tiks] are prescription medicines that can be used to relieve chronic pain. They are available as injections or topicals that you apply directly on skin to numb the skin or area.
- Muscle relaxants are not generally used to relieve pain. But they may be effective to reduce pain that is linked with muscle spasm.
Treatments for neuropathic pain
These work by targeting the nerves or area of the nervous system that was injured or damaged.
- Tricyclic antidepressants (TCAs) are prescription medicines generally used to treat depression. They have also been found to be effective in treating chronic pain, migraines, sleep disorders and other conditions. Some examples of TCAs include Pamelor (nortriptyline) and Norpramin (desipramine). A common side effect of TCAs is nausea. Other side effects include blurry vision, constipation, dry mouth and eyes, excess sedation, low blood pressure when standing and urinary retention.
- Selective serotonin-norepinephrine reuptake inhibitors (SSNRIs) are often used to treat fibromyalgia (a chronic pain disorder) and other neuropathic pain. Some examples of SSNRIs include Cymbalta (duloxetine) and Effexor (venlafaxine). A common side effect of SSNRIs is nausea. Other side effects include liver damage and increased blood pressure and heart rate.
- Calcium Channel Alpha-2-delta ligands have been found to be effective in treating neuropathic pain conditions. Some examples of calcium channel alpha-2 delta ligands include Neurontin (gabapentin) and Lyrica (pregabalin). These medicines require careful monitoring by a health care provider or a pain management center. Side effects of calcium channel alpha-2-delta ligands include sedation, dizziness and drowsiness.
Some medicines generally used for nociceptive pain may also be used for neuropathic pain. These include local anesthetics and opioid analgesics.
Other treatment options
There are also other treatment options that can be used as part of your pain management plan that have been studied less than the ones previously mentioned:
- Antiepileptic medicines that are used for treating seizures and bipolar disorder has been studied for its possible effect in treating acute and chronic pain. There is limited evidence of their effectiveness, though.
- Injections of hyaluronic acid, corticosteroid or local anesthetic may be considered to relieve pain.
- Medical marijuana may be used to reduce chronic pain symptoms. As of June 2017, there are currently 29 states, the District of Columbia, Guam and Puerto Rico that allow the use of medical marijuana for an approved medical condition or medical purpose. However, the U.S. Food and Drug Administration does not approve whole or crude marijuana (including marijuana oil or hemp oil) for any medical use. Possible side effects of marijuana include impaired driving ability, psychological changes or lung damage.
- Serotonin reuptake inhibitors (SSRIs) are a type of medicine generally used to treat major depressive disorder and other mood disorders. Similar to TCAs, they can also be used to treat neuropathic pain.