Chronic Pain VS. Acute Pain In RA
About two months ago, I injured myself during kickboxing. I think I was doing a squat and turned my knee inward.
My knee hurt afterward, but I figured that maybe once I had my next dose of Humira, it would feel better. This was kind of nonsensical because while I’ve had knee pain with my arthritis, it hasn’t been one of the more significant areas of my body impacted by my arthritis.
So I let it go. My Humira dose came and went, and my knee still hurt.
I wasn’t really paying that much attention to the knee pain, but the kicker (no pun intended) was when, in another episode of kickboxing, I did a side plank (if you don’t know what that is, see: https://www.mayoclinic.com/health/core-strength/SM00047&slide=12), putting all of my weight on my knee, and it completely collapsed.
After a week of the pain getting worse, I went to the doctor, and was told that I had misaligned my kneecap. I was sent to physical therapy, which I have been doing for the past several weeks. The physical therapist has suggested that I have pes anserine bursitis, with the potential of involvement of the meniscus.
For me, it seems that pes anserine bursitis is the primary issue here, as classically, pes anserine bursitis causes pain that "increases with knee flexion, exercise and/or stair climbing," which were my exact symptoms with this injury (2).
After doing a lot of icing and taping, which has made a vast improvement, my knee is finally feeling better.
I provide this background information as it gets to a bigger issue, as far as RA is concerned.
How do you distinguish between the chronic pain caused by RA and the pain of an acute injury?
In general according to the Cleveland Clinic, "Pain is an uncomfortable feeling and/or an unpleasant sensation in the body. The presence of pain often is an indication that something is wrong" (3).
“Acute pain begins suddenly and is usually sharp in quality. It serves as a warning of disease or a threat to the body [”] Acute pain might be mild and last just a moment, or it might be severe and last for weeks or months. In most cases, acute pain does not last longer than six months, and it disappears when the underlying cause of pain has been treated or has healed. Unrelieved acute pain, however, might lead to chronic pain" (3).
“Chronic pain persists despite the fact that the injury has healed. Pain signals remain active in the nervous system for weeks, months, or years. Physical effects include tense muscles, limited mobility, a lack of energy, and changes in appetite. Emotional effects include depression, anger, anxiety, and fear of re-injury. Such a fear might hinder a person’s ability to return to normal work or leisure activities [”] Chronic pain might have originated with an initial trauma/injury or infection, or there might be an ongoing cause of pain. However, some people suffer chronic pain in the absence of any past injury or evidence of body damage" (3).
The difference between acute and chronic pain, according to the Cleveland Clinic is that "There might be no known cure for the disease (such as arthritis or phantom pain) that is causing the chronic pain" and "The cause of chronic pain might be unknown or poorly understood" (3).
In other words, acute pain is pain that goes away, whereas chronic pain does not. As people with RA, we are no strangers to chronic pain. But acute pain can be disconcerting, for a variety of reasons.
For me, after a while, I knew that the pain I was feeling in my knee was different from any pain from RA that I’ve felt in my knee previously.
I’m sure that any chronic inflammation in my knee was exacerbated by the acute inflammation caused by the injury, or vice versa.
Of course, pens anserine bursitis is complicated by RA. According to Brigham and Women’s Hospital: "[The] RA-patient may be at greater risk of infection; cyst formation may appear on radiograph, and the cyst may communicate with bursa" (2).
This is all to say that if you think that you have an acute injury, or you develop a significant change in your RA-related symptoms, you should definitely see a doctor.
I know that I get frustrated when I have to go to the doctor and say, "I’m not sure if this is my RA or something else."
Because it is definitely hard to distinguish. RA can cause the knee to be hard to bend, and can also cause buckling (1), two of my main symptoms with this acute injury.
But obviously, it can cause more harm than good if you do have an acute injury that you do not take care of.
I am glad that I am still allowed to do kickboxing, even though I had to take a week off.
The other problem with acute injuries is that they can not only exacerbate chronic pain issues, but they can also increase RA-related limitations.
So the best piece of advice I can offer is that, whether you think you have an acute injury or a flare-up of your RA, see a doctor.
1. American Academy of Orthopaedic Surgeons. 2007. "Arthritis of the Knee." <https://orthoinfo.aaos.org/topic.cfm?topic=a00212>.
2. Brigham and Women’s Hospital. 2007. "Standard of Care: Pes Anserine Bursitis."
Cleveland Clinic. 2009. "Acute vs. Chronic Pain." <https://my.clevelandclinic.org/services/pain_management/hic_acute_vs_chronic_pain.aspx>.
Leslie wrote for HealthCentral as a patient expert for Rheumatoid Arthritis (RA).