Chronic Pain & Arthritis

Understanding Chronic PainLong-lasting pain can affect all aspects of your life – but relief is possible.

Chronic pain – a common problem for people with arthritis and other rheumatic conditions like fibromyalgia – doesn’t just hurt. It can drain your ability to work, enjoy life and be active. Often, it leads to ongoing problems with sleep, fatigue, depression and anxiety. These factors interconnect, such that difficulties with any of them make the others worse.

People with arthritis can have both acute and chronic pain. Acute pain happens when you have an active injury; it lasts for days or weeks until the injury is healed. Chronic pain persists for three months or longer. A flaring knee joint, for example, can cause acute pain, but the same person may have issues with pain, fatigue and low function for months or years after that joint quiets down.

Ongoing disease can cause ongoing pain. “If inflammation in the joints continues and is not controlled, individuals can continue to experience pain, from the inflammation itself, the damage it’s causing or both,” explains Yvonne C. Lee, MD, assistant professor of medicine at Brigham and Women’s Hospital in Boston.

It’s also possible that, if disease is controlled but has left permanent joint damage, that damage may also contribute to chronic pain, though Lee notes scientists are still working to understand this aspect of chronic pain.

Other Ways Pain Becomes Chronic

Scientists think, in some people, acute pain sensitizes the central nervous system and leads to chronic pain.

“We still don’t fully understand how acute pain becomes chronic, but it’s thought that an untreated acute stimulus, such as pain, inflammation or both may lead to changes in the way the brain and spinal cord regulate pain,” explains Lee. “These changes may cause individuals to feel pain even in the absence of an obvious reason, such as tissue damage.”

Many factors besides inflammation and joint damage go into the development of chronic pain in arthritis.People’s emotions and psychology, for example, can also contribute.

Depression and anxiety can amp up physical sensations, worsening pain and its effects on function. If you have issues with anxiety or a tendency to focus on the worst case scenario (psychologists call this catastrophizing), you’re more likely to develop chronic pain, more intense pain and have a harder time coping with it. 

There are likely many other contributing factors, says Anne-Marie Malfait, MD, PhD, professor of medicine and biochemistry at Rush University Medical Center in Chicago. Studies consistently show, for example, the amount of joint damage in people with osteoarthritis (OA) doesn’t always match how much pain they feel.

Dr. Malfait, who heads a lab studying pain pathways in OA, thinks it’s possible the difference may lie in the levels of soft tissue damage in some people – damage that’s too subtle to show up on X-ray.

Treatment

Getting arthritis under control is the first step in treating chronic pain. The next is working with your doctors and other specialists to develop a comprehensive pain management plan targeting the unique factors influencing your chronic pain.

“Pain is often multifactorial in origin. Thus, I think it is important for physicians to separately identify each possible cause of pain, rather than assuming all pain is a symptom of the rheumatic disease,” says Dr. Lee.

In addition to arthritis medications, such a plan might include drugs or other treatments designed specifically to treat pain, sleep or mood; complementary or alternative therapies; and talk therapy.

Improve sleep. Sleep problems are common among people with rheumatic diseases. Pain can disturb sleep, and vice versa. Practicing good sleep hygiene – avoiding caffeine, alcohol and screen time before bed, for example – can improve sleep.

Track pain and its effects. Keeping track of when pain strikes and how it affects you may help you and your doctor pinpoint causes and solutions. You can use a notebook or one of the many available online tools or smartphone apps.

Work on the mind-body connection. Cognitive behavioral therapy (CBT) – talk therapy aimed at changing negative thought patterns – can ease chronic pain in arthritis and fibromyalgia. Mind-body activities, such as tai chi or yoga, may also reduce discomfort in people with musculoskeletal conditions.

Consider a multidisciplinary plain clinic. Although a rheumatologist or primary care physician can often help manage pain, some people need more specialized care. If pain is still running your life after working closely with your doctor to improve it, consider a consult with experts at a multidisciplinary pain clinic.

These clinics offer a range of interventions, including medications, biofeedback, nerve blocks, injections,  CBT, massage, acupuncture, and other complementary treatments.

Understanding Centralized PainFor some people, chronic pain is its own disease.

First used to describe pain that occurs after a brain, brainstem or spinal cord injury, centralized pain now describes any pain that happens when the central nervous system doesn’t process pain signals properly. The condition can also be called “central sensitization” “central amplification” and “central pain syndrome.” Several conditions, such as complex regional pain syndrome, fibromyalgia, irritable bowel syndrome and temporomandibular joint disorder are examples. In some people, chronic arthritis pain can also become centralized; the pain essentially becoming its own disease.

Most people view pain as having an underlying cause; once you treat the cause, the pain should disappear. Accordingly, getting rheumatoid arthritis (RA) under control by taking disease-modifying drugs (DMARDs) or biologics should eliminate the joint pain. And replacing a joint damaged by osteoarthritis (OA) should eliminate pain in that joint.

Often, these measures work and eliminate or significantly reduce the pain. But as many people with well-controlled RA or artificial joints know, pain often lingers. Why that happens is not well understood, and effective treatment can be hard to find.

Chronic Pain and Brain

Research shows that chronic pain changes the brain itself. Doctors now believe that chronic pain turns independent, essentially becoming its own disease. Its home isn’t in the joint that may have been its initial starting point. If you have inflammation that hurts over long periods of time, that pain message is being sent to the brain continuously. The neurons that carry the message begin to change and may become more efficient messengers. The result? Your brain may begin to misread a small message of pain as a big one. Doctors call this “centralized pain.”

About 20 percent of patients with OA who have had their knee or hip replaced continue to have chronic pain. The pain has likely become centralized—it is no longer caused by the inflammation or injury. Now the pain is driven by dysfunction in the central nervous system (CNS).

How to Get Help With Chronic Pain

More doctors now understand the importance of treating chronic pain and centralized pain as its own disease. Your doctor can help you find treatments that address the changes in the brain in addition to treating the condition that jump-started your pain. Here is how you can help your doctor find the right treatment for you.

Don’t Tough It Out

Chronic pain is pain that has lasted three months or longer, or pain that persists beyond the expected healing time of an injury. Take steps to stop pain before it becomes chronic or centralized. You may be worried about medication side effects or you feel like you can handle the pain. But knowing how pain affects the brain, it may be wiser to take pain relievers just enough to prevent the brain changes that can come with untreated pain.

Give Your Doctor Details

Make your pain a priority. If you don’t say it bothers you, your doctor may not focus on it. Tell him where the pain is, how it feels, and how long it’s been there. Also mention what you cannot do with your pain. For example, “I can’t brush my hair or shower.” Consider keeping a pain diary where you can write down how you feel each day and discuss it with your doctor during your appointment.

Ask About CNS Meds

Some antidepressant medications such as duloxetine (Cymbalta) and certain epilepsy drugs such as pregabalin (Lyrica) are being successfully used to treat centralized pain conditions. Chemicals called norepinephrine and serotonin play a role in the body’s pain-inhibition system. Some antidepressants increase those chemicals, so you have less pain. Pregabalin was the first FDA-approved drug for treating fibromyalgia. In people with fibromyalgia, it changes the way pain signals are processed in the brain, leading to less pain.

Consider a Pain Center

If you’re not getting pain relief, ask your doctor to refer you to a pain center. Look for a one that has a mix of physicians, physiatrists, psychiatrists, physical therapists and psychologists.

Tips for Managing Chronic PainFor many people with arthritis, chronic pain is a constant companion. But there are things you can do to feel better
| By Susan Bernstein.

Many people who have some form of arthritis or a related disease may be living with chronic pain. Pain is chronic when it lasts three to six months or longer. But arthritis pain can last a lifetime. It may be constant, or it may come and go. Chronic pain can make it hard to perform daily activities like cleaning the house, dressing, or looking after your kids. However, there are ways to effectively manage chronic arthritis pain. Here is what you can do to feel better.

Take Your Medications

Diagnosed with rheumatoid arthritis (RA) at the age of 71, Mona Gardner was active and healthy, teaching full time at a local university. One day, she woke up with terrible pain in her hands, feet, and skin.

“I never want to feel pain like that again!” says Gardner, recalling her early flares of joint inflammation. “My skin hurt. My joints all ached. I couldn’t even open the doors of my car.”

Instead of giving in to her pain, Gardner sought treatment from a rheumatologist. She began taking disease-modifying antirheumatic drugs (DMARDs) methotrexate and hydroxychloroquine (Plaquenil). She also pushed herself to stay physically active and maintain a positive attitude about living with arthritis. She started the Arthritis Foundation Exercise Program and dance classes. She continues to work at the university.

Prescription and over-the-counter drugs recommended by your doctor help control inflammation and pain. If you have side effects that keep you from taking your medications, or if you have trouble affording their cost, speak to your doctor. There may be other options.

Manage Your Weight and Stay Active

Steve Wallace played football for years – from high school in Chamblee, GA., to college at Auburn University in Alabama, to the National Football League’s San Francisco 49ers and Kansas City Chiefs.

“It never crossed my mind that I could get an injury that would hamper me for the rest of my life,” says multiple Super Bowl champion Wallace, now 50, who has terrible knee pain from osteoarthritis (OA)

A former offensive lineman, Wallace is 6 feet 5 inches tall and weighed 280 pounds in his peak playing days. Now living in Atlanta, he regularly rides a stationary bicycle and does resistance training in water. Keeping his weight down with exercise and good diet helps to lower the pressure on his knees.

“Ten to 15 pounds makes a huge difference. Otherwise, I would have constant swelling in my knees.”

Excess weight can cause more pressure on the weight-bearing joints and increase pain. Plus adipose tissue (aka: fat) sends out chemical signals that increase inflammation. And being overweight is bad for your overall health, as it increases your chances for heart disease, diabetes and even some cancers. Watch what and how much you eat. Make sure you eat plenty of vegetables, fresh fruit, whole grains and lean protein, such as beans, poultry, and fish. Stay away from processed foods, red meat, and sugary drinks.

In addition to helping control weight, activities like walking, water aerobics at your local gym, or yoga can help reduce joint pain and improve flexibility, balance and strength. Cardiovascular exercise, like biking on a stationary bike, also helps keep your heart in shape. If you are new to exercise, talk to your doctor or physical therapist to find out what may be best for you. With exercise, you will also feel more energetic and it can help you sleep better.

Keep a Positive Attitude

Phyllis Shlecter was an active person who played tennis four days a week and worked full-time as a teacher. At 49, she suddenly developed symptoms of RA. “My feet were swollen. I had to wear slippers because I couldn’t put shoes on. My feet doubled in size and my hands looked like monster’s hands,” recalls Shlecter, now 84 and living in Los Angeles.

Diagnosed in 1976, few treatment options were available for her. “I was told to take 10 aspirin a day and learn to live with my pain,” she says. She went back to teaching, but five years later had to retire.

After joint surgeries and rehabilitation, she used a walker and a wheelchair, and finally lost her ability to walk. Eventually, she got on the road to recovery by taking Plaquenil and NSAIDs.

“I don’t let anybody shake my hands. They have not stopped hurting in 35 years,” she says.

But Shlecter refuses to let pain keep her from enjoying life. “My rheumatologist calls me a denier. I choose to ignore the pain! I do what I can,” she says. “Everybody has their own level of tolerance.”

Despite the effects of her RA, she sticks to regular physical activity, including walking and exercising in the pool and Jacuzzi. “I have a cane and a walker in my closet – but I’m walking!” she jokes. After all the treatments, Shlecter believes that a positive attitude is the most effective weapon against arthritis pain.

Many people with chronic arthritis pain find that a positive attitude can significantly boost their ability to cope with pain. Try not to give in to pain. Find ways to keep your mind off it. Do the things you enjoy – like a hobby or spending time with family and friends – to keep your spirits high. Ask your doctor about how hypnosis, meditation and breathing techniques can help you ease your pain.

For more information about chronic pain and how to manage it, read Understanding Chronic Pain and What Causes Pain and Pain Management Tips.

Chronic Pain Management: Expert Perspective Five specialists discuss the most effective treatments for chronic pain.

Nearly 100 million people in the US have chronic pain, but many do not receive effective treatment for it. The way chronic pain is understood and managed is changing rapidly. Treatment is becoming more multimodal – that is, to use a variety of therapies – and focused on improving function and overall health as well as pain control. To help understand these changes, we asked five experts to discuss how they treat chronic pain and what patients should expect from a comprehensive and effective pain management program.

Our panel included Asokumar Buvanendran, MD, professor of anesthesiology at Rush Medical College and a pain management specialist at Rush University Medical Center, both in Chicago; Vladimir Kramskiy, MD, a neurologist and director of the Ambulatory Recuperative Pain Medicine Program at Hospital for Special Surgery in New York City; Adam Perlman, MD, a specialist in chronic pain and autoimmune disease and executive director for Duke Integrative Medicine at Duke University in Durham, North Carolina; Kimberly Sackheim, DO, a pain management specialist at NYU Langone Medical Center in New York City; and Terence Starz, MD, a rheumatologist at the University of Pittsburgh Medical Center.

All the experts emphasize that chronic pain is a complex disease requiring an integrated, interdisciplinary approach. They routinely use various combinations of drug-based, interventional, psychological and nonmedical therapies. “It’s not unlike blood pressure medications,” Dr. Buvanendran says. “They don’t work very well if you don’t exercise and control your diet. In the same way, we take a multidisciplinary approach to chronic pain.”

Nonopioid Pain Medications

There’s a place for the judicious use of nonsteroidal anti-inflammatory drugs (NSAIDs), such as naproxen, celecoxib and ibuprofen, many doctors say. The key, they say, is finding the most effective drug for each patient and using it only on an as-needed basis.

“There are many different NSAIDs, and patients respond to them differently. Finding the correct agent takes trial-and-error,” Dr. Kramskiy says. “Patients often think if one doesn’t work, we’ve failed, but that’s often not the case. NSAIDs should only be used when they are needed most – for example, first thing in the morning or after exercise – to avoid serious gastrointestinal, cardiac and renal side effects.” He also stresses that pain relievers should be used within the larger context of lifestyle changes and therapies that help slow disease progression. “We want to minimize symptoms and improve function to avoid long-term [use of painkillers],” he says.

Dr. Starz adds that although medications can block pain, they don’t change the underlying disease process. Finding and treating the source of the pain is an integral part of managing it, he says.

Atypical Drugs

Certain people may get additional relief from drugs that aren’t typical pain medications. These include anti-convulsants such as pregabalin (Lyrica) and gabapentin (Neurontin) for fibromyalgia; the anti-depressant duloxetine (Cymbalta) for nerve, back and osteoarthritis (OA) pain; and muscle relaxants for spasms that can develop in response to arthritis pain.

Supplements such as glucosamine and chondroitin may also benefit some patients. Although results of most research have been mixed, a 2015 study in Annals of the Rheumatic Diseases found that a combination of glucosamine and chondroitin was as effective as celecoxib in reducing pain, stiffness and swelling in people with severe knee OA. “Patients often report that glucosamine and chondroitin work for a time, then stop working.” Dr. Perlman says. It’s challenging for patients to figure out what works and what doesn’t.”

Topicals

Dr. Sackheim favors topical pain relievers – lidocaine or NSAID ointments and patches. She particularly likes specially formulated creams that contain gabapentin or stronger anesthetics. “Topicals may not always take away the pain, but they take the edge off, allowing oral medications to be more effective,” she says. “They work best for localized pain, especially in the small joints [such as the hand].” Topicals also avoid the systemic side effects associated with oral pain medicine, she says.

Injections

Injecting hyaluronic acid, which occurs naturally in cartilage, or a corticosteroid into painful joints may give some patients with osteoarthritis weeks or even months of relief. Dr. Kramskiy says that in the best scenarios, people with early disease may respond well to injections for years before the arthritis progresses to the point of needing surgery.

For more severe or acute pain, doctors may suggest a nerve block – injections of a local anesthetic or anesthetic plus steroids that interrupt pain signals. Nerve blocks allow some people to postpone joint replacement surgery or undergo more aggressive physical therapy before or after surgery, Dr. Buvanendran says. One newer treatment uses radio waves to destroy the small genicular nerves in the knee, which may provide complete pain relief for some people with OA.

Psychological Support

Dr. Starz believes understanding the psychological and emotional aspects of pain is an integral part of pain therapy. “Some pain signals are processed in the same parts of the brain that control emotions and sleep, and these are important considerations in any pain management program,” he says. “We need to understand how the brain processes information and the enormous effect that can have on the rest of the body.”

Nonmedical Interventions

A growing number of rigorous studies have found that a variety of nonmedical interventions, including meditation, relaxation techniques, massage and acupuncture can significantly reduce chronic arthritis pain. Dr. Buvanendran often recommends acupuncture to his patients, with the caveat that it is most effective when used in combination with a healthy lifestyle.

Dr. Perlman says “the next great frontier for health” is the effect of food and the microbiota – the trillions of bacteria in the human intestinal tract -- on inflammation and chronic pain. “Certain foods increase inflammation, and changing the diet may significantly decrease it,” he explains. “Unrecognized food intolerances may stimulate further inflammation, leading to increased intestinal permeability and a corresponding increase in systemic inflammation. So we are using elimination diets to try to identify foods that may be causing problems.” Like the other experts, Dr. Perlman says a healthy lifestyle – appropriate exercise, adequate sleep and stress reduction – is the cornerstone of effective pain management.

Are Pain Clinics Right for You?People with arthritis and related diseases may benefit from the integrative care offered by pain management centers.

Medications have come a long way in treating arthritis and other related diseases. But when pain persists even with early and aggressive treatment, you may wonder if it is time to consider a pain clinic.

Daniel Clauw, MD, rheumatologist and director of the Chronic Pain and Fatigue Research Center at the University of Michigan in Ann Arbor says if inflammation is the main driver of your pain -- probably not. “A rheumatologist is the best person to manage that kind of pain because they are the ones who really have the expertise and know what medications need to be added to a regimen to get inflammation under control,” he explains.

But if your inflammation is well managed (or your arthritis-related disease is not inflammatory) and you are still having pain, a pain clinic or pain management center may be your next step.

What Is a Pain Clinic?

Pain clinics focus on controlling chronic pain and there are two general types. “One is for procedures, such as injections to deal with specific areas of pain, for example, neck and back pain. The other offers integrative services, which include medications as well as physical, behavioral and psychological therapies,” explains Eric Matteson, MD, professor of medicine and rheumatologist at the Mayo Clinic in Rochester, Minnesota.

This latter type, often called an interdisciplinary clinic, helps patients manage chronic pain with non-narcotic medications; nerve blocks; physical and behavioral therapy; patient and family education; lifestyle changes; and complementary and alternative medicine (CAM). CAM therapies may include biofeedback, cognitive behavioral therapy, acupuncture, hypnosis, water therapy, massage and meditation. Services at multidisciplinary centers extend beyond doctors and may include physical and occupational therapists, social workers, psychologists and vocational rehabilitation experts.

A 2009 issue of Baylor University Medical Center Proceedings evaluated data from 108 people and found that after four weeks of this kind of comprehensive pain-management care, patients saw improvement in pain, emotional distress and function. Another study that same year found a multidisciplinary approach helped people with fibromyalgia symptoms, especially when treatment was tailored to a patient’s individual needs. Dr. Matteson says people with disabling neuropathic pain from rheumatic diseases, like peripheral neuropathy associated with lupus or vasculitis, also often benefit from integrative pain management services.

More Than Medication: The Importance of Self-Management

Patients with arthritis and other related conditions should not seek out pain clinics that primarily offer narcotic medications. These drugs can be addictive. They don’t treat inflammation, can interact with other medications and don’t help the widespread pain of fibromyalgia. They can actually make fibromyalgia pain worse.

“Most pain management doctors are aware of the downsides of narcotics. People can have increased pain when on narcotics because the medications change the way their endorphin system works,” explains Seth Waldman, MD, director of the division of pain management at New York City’s Hospital for Special Surgery. “There are some people who benefit from narcotics. But it’s a mistaken impression if you think going to a pain center means automatically getting started on them.”

Rheumatologists say chronic pain clinics are most helpful when they encourage people to be¬come active partners in their pain relief. That means focusing on self-management techniques like adopting an anti-inflammatory diet, starting low-impact exercise, identifying a personal support system and making self-care a priority.

A study published in 2009 in the journal Qualitative Health Research conducted 46 interviews of people with chronic pain and 46 interviews of people with RA-associated pain. They found that “for those living with pain, a sense of well-being is achieved not through pain control alone, but also through various mind/body techniques for managing pain, accepting new limits and adjusting the way people relate to themselves.”

What To Look For In A Pain Clinic And Questions To Ask

Health care providers make referrals to pain clinics and interdisciplinary centers, whcih are often affiliated with university hospitals.

When you call the pain management program, ask:

• What kinds of therapies and treatments do you offer? (You want the answer to be wide ranging and more than just oral and injectable medications.)
• Do you have physical therapists, occupational therapists and psychologists at your clinic?
• What non-drug treatments do you offer, such as cognitive behavioral therapy, meditation, physical therapy and occupational therapy?
• Are your pain doctors board certified, trained in fellowships and accredited?
• Do you treat fibromyalgia?
• Do you organize online and in-person patient support groups?
• Can I speak with patients with arthritis and related diseases who have completed your program?

Sleep and PainThe vicious cycle that could make your arthritis worse.

As many as 80% of people with arthritis have trouble sleeping. With achy, stiff and sometimes swollen joints, getting comfy, dozing off and staying asleep can be a tall order. 

Most individuals attribute their restless nights as an unfortunate side effect of arthritis pain. But new research is finding that the relationship actually works both ways – poor sleep can make your joint pain worse, and even increase the likelihood that you may become disabled or depressed.

“Patients often attribute sleep problems to pain. While pain can certainly contribute to sleep problems, the more we learn about sleep, pain and inflammation, the more we find the relationships are likely to be multidirectional,” says Yvonne Lee, MD, Assistant Professor of Medicine at Brigham and Women's Hospital in Boston. “Different problems start first in different people, but once one of these issues occurs, they lead to the others and can come full circle.”

Poor Sleep Linked to Pain, Disability and Depression

A 2015 study published in Arthritis Care and Research found that individuals with osteoarthritis pain who have sleep problems were more likely to experience depression and even become disabled over time.

The study involved 367 adults with osteoarthritis of the knee. Participants responded to questionnaires about sleep disturbances, pain, functional limitations and depressive symptoms. A year later, 288 participants answered the same series of questions.

Nearly 70% of the participants reported having sleep disturbances including having difficulty falling asleep, waking up in the middle of the night, or rising too early in the morning. Results showed that sleep problems predicted increases in depression and disability at the follow-up questionnaire.

“Research continues to show that not sleeping at night exacerbates pain the next day, but what is most concerning is that there is something about sleep disruption that predisposes folks with arthritis to become more disabled over time,” says lead study author Patricia Parmelee, PhD, Director of the Alabama Research Institute on Aging, University of Alabama at Tuscaloosa. “This is a scary finding that suggests we really need to treat the sleep problems so they do not contribute to the progression of the disease.”

Dr. Lee found a link between pain and sleep among people with rheumatoid arthritis (RA) in her research. Published in 2009 in Arthritis Research & Therapy, she found that sleep problems were associated with decreased pain thresholds in women with RA at numerous body sites when pressure was applied. The sites included both joints that are commonly affected by RA and non-joint sites that are not affected by the disease.

What Causes Sleep to Affect Pain

The big question is why does disrupted sleep affect pain? The culprit, Dr. Lee says, may be deficits in the way the central nervous system (CNS) processes pain.

Dr. Lee explains that their findings suggest the CNS pathways (the spinal cord and brain) that regulate pain may be abnormal in people who are not sleeping well.

A 2013 study in Arthritis and Rheumatism compared CNS pain pathways in 58 women with rheumatoid arthritis and 54 healthy women without chronic pain. The research showed the pathways that inhibit pain were not as robust in people with RA compared to the controls.

“Our analysis suggested that these abnormalities in pain processing may partially be explained by the observation that RA patients had greater sleep problems than the controls,” says Dr. Lee.

Similar findings have also been uncovered in healthy individuals. Research presented in 2016 at the American Pain Society’s 35th Annual Scientific Meeting examined 35 men and women without any history of sleep disorders. Participants who were purposefully deprived of sleep were less likely to tolerate putting their hand in a cold-water bath when compared with those who had eight hours of consistent sleep.

Another theory, Dr. Lee says, is that sleep problems may lead to increased inflammation throughout the body.

“Studies in healthy individuals have found that sleep deprivation is associated with an increase in inflammatory markers measured in the blood,” she explains. “It is possible that an acute inflammatory response to sleep deprivation could lead to more long-term problems, such as the development of chronic inflammatory conditions, in certain individuals. More research is needed in this area.”

How You Can Sleep Better

Since pain, sleep and inflammation are inextricably linked, Dr. Parmelee says treating insomnia is an important step in managing arthritis. A restful night’s sleep often starts with developing good sleep hygiene, such as avoiding electronic devices and caffeine, and adhering to a strict bedtime schedule. Learn more strategies that can help you sleep soundly.

“We are a sleep-deprived nation. When arthritis is in your face with pain, we tend to focus on treating the symptoms and less on our overall health picture,” says Dr. Parmelee. “A good night’s sleep is central to taking care of yourself so you can better cope with the disease.”