10 Ways to Fight Chronic RA Pain

The aches and pains of rheumatoid arthritis can be hard to overcome, but these strategies may help relieve chronic pain.

From fatigue to loss of appetite, rheumatoid arthritis (RA) can impact your life in a number of ways. But the most limiting symptom for many people with RA is pain. And since that pain comes in different forms, you may need more than one strategy to relieve it.
“The primary cause of RA pain is inflammation that swells joint capsules," says Yousaf Ali, MD, an associate professor of medicine at the Icahn School of Medicine and chief of the division of rheumatology at Mount Sinai Hospital in New York City. Joint capsules are thin sacs of fluid that surround a joint, providing lubrication for bone movement.
Dr. Ali explains that the first goal of pain relief is the control of inflammation. “Inflammation can cause acute (short-term) pain or longer-lasting smoldering pain. Chronic erosion of joint tissues over time is another cause of chronic pain. However, there are many options for pain relief.”
10 Strategies to Help Relieve Chronic RA Pain
Getting RA pain under control may take some work. Try the following strategies to discover which are most effective for you:
1. Inflammation medication. "In the case of RA, all other pain relief strategies are secondary to controlling inflammation," says Ali. The No. 1 option in the pain relief arsenal is to control inflammation with disease-modifying anti-rheumatic drugs, called DMARDs. "The most commonly used is the drug methotrexate," explains Ali. "Steroids may be used to bridge the gap during an acute flare. If flares continue, we can go to triple-drug therapy, using newer drugs that are more expensive but also effective.”
The next tier of pain relief includes these additional approaches:
2. Pain medication. The best drugs for acute pain are nonsteroidal anti-inflammatory drugs, called NSAIDs, according to Ali. "Stronger pain relievers, called opioids, may be used for severe pain, but we try to avoid them if possible. These drugs must be used cautiously because of the potential to build up tolerance, which can lead to abuse."
3. Diet. Although some diets may be touted to help RA symptoms, they aren’t backed by the medical community. “There is no evidence that any special diet will reduce RA pain," says Ali. However, there is some evidence that omega-3 fatty acids can help reduce inflammation — and that could ultimately help you find relief. Omega-3s can be found in coldwater fish and in fish oil supplements. A 2013 study published in the Annals of the Rheumatic Diseases also found that people newly diagnosed with RA who took a high-dose fish oil supplement had significantly better responses to DMARD treatment than did people who took a low-dose fish oil supplement.
4. Weight management. Maintaining a healthy weight may help you better manage pain. A study presented at the 2013 annual meeting of the European League Against Rheumatism found that being overweight increases the amount of medication people need to control inflammation and decreases the chances of symptom relief.
5. Massage. A massage from a therapist (or even one you give yourself) can be a soothing complementary treatment to help reduce rheumatoid arthritis pain. A 2013 study published in the journal Complementary Therapies in Clinical Practice involved 42 people with RA in their arms who received either light massage or medium massage from a massage therapist once a week for a month. The participants were also taught to do self-massage at home. After a month of treatment, the moderate-pressure massage group had less pain and greater range of motion than the others.
6. Exercise. Although you may not feel like being active when you have RA, gentle exercises can actually help reduce pain. “Non-impact or low-impact exercise is a proven way to reduce pain," says Ali. "We recommend walking, swimming, and cycling.” In fact, one of the best exercises you can do for RA is water aerobics in a warm pool because the water buoys your body. The Arthritis Foundation also notes that yoga is another option to help reduce RA pain, and traditional yoga poses can be modified to your abilities. But when it comes to exercise, it’s also wise to exercise caution: Talk with your doctor if any workouts are making your pain worse, and, in general, put any exercise plan on hold during an acute flare.
7. Orthoses. These are mechanical aids that can help support and protect your joints. Examples include padded insoles for your shoes and splints or braces that keep your joints in proper alignment. You can even get special gloves for hand and finger RA. A physical therapist can help you determine the best orthoses options for you.
8. Heat and cold. Heat helps to relax muscles, while cold helps to dull the sensation of pain. You might find that applying hot packs or ice packs or alternating between hot and cold helps reduce your pain. Relaxing in a hot bath can also bring pain relief, as well as exercising in a warm pool.
9. Acupuncture. This Eastern medicine practice, which has been around for centuries, is thought to work by stimulating the body's natural painkillers through the use of fine needles gently placed near nerve endings. Some studies have shown that acupuncture can help chronic pain, but there is not much evidence for its use in RA. “I have found acupuncture to be helpful for some patients, but the pain relief is usually not long-lasting,” says Ali.
10. Transcutaneous electrical nerve stimulation (TENS). TENS is a form of therapy that uses low-voltage electric currents to stimulate nerves and interfere with pain pathways. “TENS is usually used for stubborn, chronic pain and not as a first-line treatment for rheumatoid arthritis,” says Ali. If you're interested in trying it for pain relief, talk with your physical therapist.
Remember, you’re not alone — your doctor and specialists can help you find relief from chronic pain. If you’re experiencing more pain than before, or if pain is interfering with your ability to get things done, don’t hesitate to talk to your doctor. Ask your rheumatologist about pain relief options like exercise, massage, yoga, and acupuncture, but remember that the first priority on your pain relief list should be to get RA inflammation under control.