Does Pain Tolerance or Pain Perception Vary Among People Who Have Arthritis?

Question: Does Pain Tolerance or Pain Perception Vary Among People Who Have Arthritis?

Do arthritis patients vary in how much pain they can tolerate before needing treatment? Does one patient reach for pain medication sooner than another for what would be considered the same level of pain? What accounts for the variance in pain tolerance? Is it a mental issue or a physical issue? Are certain arthritic conditions more painful than others?

Answer: One of the biggest mysteries I see as a rheumatologist is the differences in pain perception among my patients. There are some patients with severe deforming rheumatoid arthritis who complain of minimal pain and other patients with non-inflammatory fibromyalgia who have severe disabling pain. There is limited research as to what causes the difference.

Many factors must be involved. Pain seems to be less tolerated during an acute stage of an illness. Some possible explanations include the fact that the pain is new and there is concern as to whether or not it will improve; uncertainty of the cause will often increase anxiety which in turn increases pain. In other words, emotional issues can clearly accentuate the perception of pain. Once patients have an explanation for their pain and treatment plan, many tolerate it better.

Finally, pain and anxiety about the symptoms may disrupt sleep. Non-restorative (non-restful) sleep can by itself aggravate pain. Thus, a viscious cycle occurs where patients pain and anxiety lead to disruptions in their sleep which further increases their pain.

Some non-pharmacological ways to help deal with pain include:

• aerobic exercise
• acupuncture
• hypnosis
• biofeedback
• yoga
• tai chi
• meditation
• prayer

_{Dr. Zashin is clinical assistant professor at University of Texas Southwestern Medical School and an attending physician at Presbyterian Hospitals of Dallas and Plano. Dr. Zashin is author of Arthritis Without Pain - The Miracle Of TNF Blockers. The book is useful for anyone on one of the biologic drugs or considering the biologic drugs.}