Pain is no stranger to rheumatoid patients. It is a distress signal given by your body because of injury or illness. Some people have a high tolerance for pain; others have a low tolerance or little tolerance at all. Pain is unique to each individual: what severely affects one patient may seem only a slight annoyance to another patient. But it is real regardless of how severe it is. Pain affects our entire life and our relationship with the world. It affects body, mind and spirit, especially chronic or constant pain regardless of severity. Pain grows when you dwell on it. Over time it can even suppress the immune system.

Pain is probably the beginning of the downward spiral, which is a series of reactions by patients. Pain causes the muscles to tense all over the body, this tension in the muscles and tissues of the body causes fatigue. This fatigue makes it more difficult to tolerate any pain and so builds more tension that, in turn, builds more fatigue, which builds more pain. This series of reactions can continue to spiral downward making the patient less and less able to sleep and function normally. Sleeplessness and its accompanying pain lead only to more of the same until the patient is virtually non-functional or bedridden.

You must break this downward spiral if you ever hope to continue improvement or return to normal. Giving in to it leads to depression, hopelessness, despair, uncontrolled pain and eventual crippling as you give your disease the unopposed upper hand. During a downward spiral that I believe all rheumatoids suffer at some point to greater or lesser degree, both encouragement from others and medical assistance from your doctor can help, but in the end it is the patients themselves who must take "the bull by the horns" and decide to get better. To stop the spiral and begin improving, the patient must take action and break the cycle caused by this spiral. The spiral can be broken at any point. Diminishing any one part of the spiral helps to diminish all parts of the spiral.

What follows are a few suggestions for beginning and continuing the destruction of the spiral.

Breathe: Learn to focus on breathing slowly and deeply. Focusing on anything else takes your mind off the pain. Focusing on breathing can be done anywhere anytime, either sitting up or lying down. Breathe through your nose. Inhale into your stomach, your chest should move much less, and then exhale, also through your nose, as slowly and completely as you can. Focus on the process of slow inhaling and slow exhaling as deeply as you can. It is very difficult to remain tense if you are focused on the act of trying to slow down deep breathing.

Getting Loose: Muscle tightness is a common side effect of pain and also of arthritis because it is the collagen that supports the tissues and muscles that is attacked in arthritis. Take a few deep breaths and with each exhalation imagine your body sinking more deeply into the surface you are lying on. Then alternately tense and release your muscles, one group of muscles at a time. Begin with your face; tighten all the muscles of your face - make the worse face you can imagine, then completely release those muscles. Proceed to do this with your neck, your shoulders, upper and lower arms, hands. Then proceed on down the rest of your body. Tense a muscle group then relax it and keep it relaxed as you tense the next group of muscles.

Body Survey: Once you teach yourself to will your muscles to relax, take a few minutes during the day to close your eyes and mentally go over your body as you did in "getting loose" relaxing any tight muscles you find. This survey and relaxation can be used anytime and as frequently as you want.

Distract yourself: Deliberately distract yourself in difficult tasks, which will help you get through brief but painful activities. Count as you climb stairs or say the alphabet, one letter per step. Listen to music. Focus on the music, picture yourself at a concert and see the conductor, the violinists, the percussionists, etc. Guide your imagery to give yourself a full concert or a day on the beach or whatever you fancy. This distraction relaxes you and releases tension.

Make positive changes: Frequently we focus on what we cannot do, rather on what we can. Write down three things each day that are real positive things that happened that day for which you are thankful. (You got up for breakfast, walked down a hall, enjoyed a movie, etc.)

Get Moving: It used to be that if you were an arthritic you were constantly told to be careful. Not true, your have a disease but you won't break, so begin to exercise. Your joints, muscles and tissues require movement to stay healthy. You will only make yourself feel better in the long run. Take a walk, but each day try to walk a bit further, a few steps, a few yards, a block. Stretch to the limit of your ability. Open your hands as wide as you can, walk your fingers up a wall, using a chair for support bend at the waist, lift your legs, etc. Try to do a little more each day.

Build Muscle: Muscles help to stabilize our joints and support our structure. The stronger your muscles, the less pain you will have in moving around and the more you will be able to do. The more you do, within your limits that day, the better you will feel. Remember that you didn't get into the downward spiral overnight, just as you didn't get arthritis overnight. Take small steps but keep taking them. A general rule to follow is if the discomfort caused by beginning to move weak and unused muscles lasts more than a few hours after you finish, you probably overdid it. Slow down a bit, but don't quit. As you get stronger, you will be able to do more. Realize that you are stopping the downward spiral and you are getting closer to normal and return of health.

Your doctor may be able to refer you to a physical therapist that can teach you specific exercises to help you strengthen. Find a pool and swim or ride a bike. Just don't stop once you gain momentum.

Reference: AARP Magazine, November & December, 2006

© Carol Lange & Pat Ganger, 2006