Pain Management for Psoriatic Arthritis
The chronic pain of psoriatic arthritis differs from the pain experienced by the average person. The inflammation of psoriatic arthritis can cause long-term damage to joints. It also can make you more sensitive to pain, said Dr. Gil Yosipovitch, a dermatologist and researcher for Wake Forest University.
Stress also aggravates psoriatic arthritis and can make you more sensitive to pain. Because of that, there are several approaches to managing psoriatic arthritis pain.
The role of NSAIDs
Nonsteroidal anti-inflammatory drugs (NSAIDs) usually are the first step in treating psoriatic arthritis pain. Some NSAIDs are available only by prescription, while over-the-counter NSAIDS like ibuprofen, aspirin and naproxen are available without a prescription. Regardless of if you are using a prescription or over-the-counter NSAID, it’s important to talk to your doctor about them. These drugs can interact with other treatments for psoriatic arthritis, like methotrexate, and can be linked with health risks when used long term, Yosipovitch said.
There usually is a lag between the time you begin a biologic and it begins to improve your psoriatic arthritis, at least three months and sometimes longer. However, recent studies show that biologic drugs used to treat psoriatic arthritis also have some effect on mood very quickly. People with psoriatic arthritis are at greater risk of depression and depression can heighten your sensitivity to pain, Yosipovitch said.
Biologics also interfere with the process that causes the inflammation of psoriatic arthritis. Over time, you are likely to less pain.
Prescription pain medicine
When the pain of psoriatic arthritis is severe or does not go away with traditional psoriatic arthritis treatments, you may want to talk to your doctor about pain medication that helps reduce your sensitivity to pain.
Drugs like Gabapentin and Pregabalin are used to treat neurological pain. Certain anti-depressants called noradrenergic and specific serotonergics (NaSSAs) can reduce your sensitivity to pain. Capsaicin, a compound found in chili peppers, has a numbing effect on pain receptors. Applying a local anesthetic like prilocaine can help minimize the initial burning sensation of capsaicin, Yosipovitch said.
Your doctor may prescribe a pain medication when you first begin on a biologic and transition you off the pain medication once the biologic takes effect, Yosipovitch said.
Learn more about managing the symptoms of psoriatic arthritis »
Other ways to manage pain
- Exercise—When you are in pain, it can be hard to get up and move. However, exercise is important because it can keep your joints and tendons loose. Regular exercise also reduces inflammation in the body over the long term. While the link between weight loss and psoriatic arthritis has not been extensively studied, there is research linking weight loss to improved symptoms in psoriasis. Maintaining a healthy body weight can make it easier to manage the pain of psoriatic arthritis. Swimming, water aerobics and walking are good exercise choices that are easier on the joints.
- Acupuncture—Some studies show acupuncture is a valuable option for pain relief. Kelly Olbekson, of Cheney, Wash., uses acupuncture, combined with an anti-inflammatory diet and NSAIDs like sulindac, to manage her pain. “I’m never pain-free,” Olbekson said, "but I do feel a lot better and more relaxed. It seems to release muscle tension." Read more about acupuncture as pain relief »
- Meditation—Jon Kabat-Zinn, founder of the Center for Mindfulness in Medicine, Health Care and Society, studied the impact meditation had on people with psoriasis and found those undergoing PUVA while listening to guided meditation recording saw improvement in their psoriasis more quickly than those who did not listen to the tapes. While researchers have not studied the impact of meditation on people with psoriatic arthritis, some say meditation does help. Linda Cheu said meditation helped relieve stress and anxiety, which in turn, helped her psoriatic arthritis. Read more about meditation and mindfulness »