Rheumatoid Arthritis Pain Management

Rheumatoid arthritis is a chronic inflammatory condition of the joints.

The disease, which affects up to 1.3 million Americans, most often manifests in the joints of the hands, wrists, and knees. (1)

Rheumatoid arthritis symptoms, particularly joint pain, can interfere with daily activities, ultimately decreasing quality of life. There are numerous options to help get RA-related pain under control.

Medication is the standard treatment for RA. Most often, doctors will prescribe disease-modifying anti-rheumatic drugs, or DMARDs, after diagnosing a person with RA.

These drugs, including newer versions called biologic DMARDs, slow the progression of the disease and reduce inflammation and symptoms. But they are not used for acute pain management.

For acute joint pain, doctors instead recommend nonsteroidal anti-inflammatory drugs (NSAIDs), such as naproxen sodium (Aleve), prescription meloxicam (Mobic) and celecoxib (Celebrex), and corticosteroids like prednisone and prednisolone. These drugs, particularly corticosteroids, can quickly improve joint pain and other symptoms of RA. (2) Taking NSAIDs may pose risks related to heart, kidney, and GI health. Ask your doctor if it makes sense for you to start over-the-counter or prescription NSAIDs first.

Research suggests some supplements may be helpful for RA-related joint pain.

Omega-6 fatty acids, particularly gamma-linolenic acid (GLA), found in evening primrose oil, borage seed oil, or black currant seed oil, are “probably” effective at improving RA pain, according to a review published in 2021. (3)

Fish oil, which contains high levels of omega-3 fatty acids, may also ease symptoms of rheumatoid arthritis. Research found that omega-3 fatty acids can help reduce joint swelling and pain, morning stiffness, and the need for anti-inflammatory drugs in people with RA. (4)

Another study found that marine oil supplements can help reduce pain in patients with RA. (18)

RELATED: 15 Herbs and Spices for Rheumatoid Arthritis Symptom Relief

But these supplements should be taken with caution. Both GLA and fish oil may increase bleeding risk, especially if you’re taking blood thinners, which include most NSAIDs and anticoagulants like warfarin (Coumadin). (19,20)

Note that there are numerous supplements that people with RA should avoid. Thunder god vine (Triperygium wilfordii Hook F), high doses of vitamin B6, and St. John’s wort, for instance, all have concerning side effects. (5)

Be sure to talk to your doctor before taking any supplements.

While marijuana is often prescribed for chronic pain, research suggests that cannabis has a worse risk-to-benefit profile than all other pain-relieving medication, save for opioids. That is, though it generally reduces pain, cannabis’ mental and heart-related side effects make some rheumatologists apprehensive to prescribe it for rheumatic conditions.

But the benefits and risks of medical marijuana for RA vary depending on the mode of transmission.

For example, topical CBD oil can provide immediate pain relief for a few hours, but the need to reapply can make the treatment expensive. Edibles, on the other hand, can provide medicinal effects for up to eight hours (which is good for pain that is consistent and severe), but the dosages are inconsistent and the effects can vary between uses.

RELATED: Should You Take CBD for Arthritis Pain? A New Guide Aims to Help You Decide 

Rheumatologists discourage RA patients from smoking marijuana because smoking carries risks for many diseases, particularly heart and lung disease. In general, one should never smoke anything — the toxins can hurt your lungs and cause permanent damage.

Two of the simplest measures for relieving RA pain are heat and cold treatments.

Heat treatments, such as heating pads, hot tubs, and warm paraffin wax, enhance circulation to soothe stiff joints and tired muscles, making physical activity easier and less painful.

On the other hand, cold treatments, such as ice packs and ice baths, slow circulation and numb nerve endings to reduce acute pain. (6)

Some small studies suggest whole-body cryotherapy (WBC), in which the body is temporarily exposed to temperatures lower than minus 200 degrees F (minus 129 degrees C), may be beneficial for RA by reducing pain and joint-disease activity. (7)

What’s more, a review that investigated small studies that were not specific to RA patients found that WBC appears to decrease inflammation and stiffness and improve sleep. But this review was also hampered by the lack of research available and the standardization across studies. (8)

Importantly, the U.S Food and Drug Administration (FDA) has not approved or cleared any WBC devices for the treatment of chronic pain or various conditions, including RA. (9)

The pain and stiffness of RA often causes people with the disease to become less active. In fact, 71 percent of people with RA don’t exercise regularly, according to research, but poor physical fitness only worsens symptoms. (10)

An exercise plan designed by an experienced physical or occupational therapist can help relieve RA symptoms, including pain, and increase quality of life. It can also help you maintain a proper weight, taking further pressure off your joints. (10)

The exercise regimen for RA should include a combination of low-impact aerobic exercises, flexibility exercises, strengthening exercises, and body awareness exercises, according to the American College of Rheumatology. (11)

High-intensity interval training, barre work (a type of warm-up exercise often used for ballet), and spinning may also be beneficial exercises for people with RA.

Additionally, Pilates, a low-impact physical fitness technique, can strengthen abdominal muscles, taking pressure off painful joints and improving flexibility and mobility in people with RA. Pilates can also strengthen the muscles around joints, possibly reducing pain.

It’s also important to pay special attention to hand and foot exercises. Research found that resistance exercises involving the hands improved hand pain, as well as hand function, grip strength, and range of motion in people with RA. (12)

Vagus nerve stimulation is a treatment in which an implanted electronic device delivers electrical pulses to the vagus nerve — the same cranial nerve involved in the vasovagal response, in which your heart rate and blood pressure drop in response to certain emotional triggers.

A proof-of-concept study found that vagus nerve stimulation reduced markers of systemic inflammation in patients with RA, as well as RA signs and symptoms — including pain. (21) A follow-up pilot, placebo-controlled study reported similar findings. (22)

This treatment is not ready for clinical use, however, and the few studies on it had a small number of participants.

People have proposed numerous alternative and complementary therapies to help with RA-related pain and other symptoms. Though many of these therapies have scant scientific evidence for their efficacy, some may be promising for RA.

These potentially helpful therapies include body awareness exercises such as tai chi and yoga, (13,14,15) which help improve:

• Posture
• Balance
• Proprioception (joint and body position sense)
• Coordination
• Relaxation (11)

There’s little evidence that tai chi reduces RA-related joint pain, but the exercise appears to help improve mood, quality of life, and physical function. (14) A review found that tai chi may confer some benefits on various RA comorbidities, including depression and anxiety, lung disease, fibromyalgia, and lower back pain. (15)

As for yoga, small studies have found that the ancient practice can improve the physical and psychological health of sedentary people with RA, as well as reduce pain if practiced consistently. (13,14) A randomized controlled trial published in 2019 found that yoga reduces pain perception, disability, disease activity, and depression severity in people with RA. (23)

But more research is necessary to fully reveal the helpfulness of tai chi and yoga for RA pain. And note that when it comes to RA, not all types of yoga are equally beneficial.

While acupuncture has long been used to treat pain, literature reviews have largely shown that the treatment is not effective for RA pain, though it may help relieve the pain of osteoarthritis, which people with RA often develop. (16)

Some therapies for RA pain and symptoms focus on a kind of mind-over-matter principle. These include:

• Mindfulness meditation, such as mindfulness-based stress reduction (MBSR)
• Spiritual practice
• Acceptance and commitment therapy (ACT)

Some research suggests that this approach doesn’t affect inflammation or the disease itself, but rather people’s experience of RA — and they appear to work. For example, one study found that an eight-week MBSR course reduced stiffness, pain, and tenderness of the joints. (17)

Other unconventional therapies for RA pain include biofeedback — a therapy that uses technology to teach you how to notice and change your responses to stimuli — and therapeutic ultrasound.