A Beginners Guide to RA: Pain Management

Patient Expert

Rheumatoid arthritis is a pain in the... well, it can pretty much be a pain anywhere and everywhere. Whether you're dealing with the intense pain of a flare or the cranky muttering in the background when your RA is mostly controlled, you'll probably need to find a way to manage pain. Unlike the "minor arthritis pain" of commercials that magically disappears when you take Drug X, real RA pain needs more - it needs a toolbox.


The proper medication is the foundation of it all. It starts with one (or more) of the DMARDs (disease modifying antirheumatic drugs like methotrexate, Arava or one of the Biologics) to suppress the disease and anti-inflammatories or narcotics to deal with the pain. It's important to find a doctor who will understand this and prescribe the meds you need. If your rheumatologist "doesn't believe in" painkillers, try finding another one or talk to your family doctor about your medication needs. You may also ask for a referral to a pain clinic where they use a multidisciplinary approach to teach you how to live well with pain, e.g., pain meds, biofeedback, exercise and counseling.

When you have the prescriptions, take the pills. You are in a race with the pain and if you wait to take painkillers until you can't bear it anymore, you will never catch up. Taking your painkillers on a regular basis will ensure that you always have a certain level of medication in your system, which will keep you ahead of the pain.

Exercise and a Healthy Diet

Another important tool is a balanced diet and exercise routine. You want to make sure that you're as healthy as possible. Eating a well-balanced diet with plenty of fruits and vegetables will help build your physical resources and the right diet may even help you control inflammation. For instance, the Mediterranean diet has been shown to have anti-inflammatory properties. If you're overweight, consider trying to lose some of the extra pounds as it can ease the stress on your joints and help you manage pain.

Exercise is part of becoming healthy. Not only does it keep you fit, but it will keep your joints moving and strengthen your muscles, which will offer extra protection from joint damage. Ask your doctor for a referral to a physical therapist who can put together an exercise program that will help you get fit while avoiding exercises that are bad for your joints. Swimming and exercising in water, yoga and tai chi are examples of exercises that can accomplish your goal (check out AmyAria's post on exercise and Sara Nash's post about yoga).

Work within Your Limits

When you have a good day, it is so tempting to overdo -- you never know if tomorrow is going to be bad and it's easy to get caught up in being able to work in your garden, write, clean the house, etc. The problem with getting carried away is that it practically guarantees that tomorrow will be a bad day, likely followed by several more bad days. However, if you work within your limits -- stopping before you start getting tired or before that first twinge -- you will be able to do more of the same tomorrow. This one requires mental discipline and the ability to beat down the part of you that says "just five more minutes." I'm still learning how after 40 years with RA. However, much to my surprise, I've recently learned that working within my limits actually gets more done in the long run.  Pretty revolutionary stuff.

Plan Flexibility

We've all been there. You go to bed feeling fine and have a list of things to do the next day that shouldn't be a problem. Until you wake up to a monumentally bad day and spend it limping around carefully, being very frustrated that you can't get to your list. Having a Plan   A, B and C can be good for your mental (and physical) health -- if you're too wrecked to clean the house, a less physically intensive task like paying the bills or making a few phone calls can help you feel productive even on days where you have to sit still and rest.


And speaking of rest, get some. Whether it involves curling up on the couch with a blanket and a good book or having a nap in the middle of the day, taking a rest can be an important part of maintaining your energy and reducing pain. After explaining for the 47th time that I wasn't napping as an indulgence, I renamed my mid-afternoon downtime to Mandatory Rest Periods. Feel free to use the term if you need to emphasize the necessity of a rest to clueless family and friends. If you need more reasons to nap, check out this article -- it has 19 of them.


Taking 20-30 minutes a day for yourself to meditate makes you feel refreshed, relaxed and can help you get in touch with your body, enabling you to pay better attention to the messages it sends you. The audio program Mindfulness for Beginners by Jon Kabat-Zinn is an excellent introduction to the practice of mindfulness which can be a tremendous help for people living with chronic illness and pain.   As an added bonus, the program also contains several meditation lessons.


Counseling can do more than help you adjust after a diagnosis -- a good counselor can give you valuable coping mechanisms you can use for the rest of your life. Cognitive therapy can be especially valuable, as it helps you discover the way you think about your life and your disease and it can help you change your thinking, making it easier to live with a chronic illness. A pain management course is also a terrific idea, but if you can't find one in your area, try a course in stress management -- many of the coping skills you learn in a stress management course can be applied to living with pain.   Stress management courses are sometimes offered through your employer, colleges, continuing education courses, job centers or in numerous places on the internet.

You can read more of Lene's writing on The Seated View.