Something that doesn’t always get talked about is how stressful it can be to live with a chronic pain condition like arthritis. Being in pain can be very stressful in itself, which in turn can affect your physical and mental health.
“Stress and pain are closely connected; this is what we call the mind-body connection,” says Bayu Prihandito, Founder at Life Architekture, Certified Psychology Consultant & Life Coach. “When you’re stressed or anxious, your body goes into a ‘fight or flight’ mode, which creates tension in your muscles and increases inflammation. Over time, chronic stress will amplify the pain, making it harder to manage.”
When your body is stressed for a prolonged period of time it can contribute to inflammation – which is bad news if you have an autoimmune condition like rheumatoid arthritis. In these conditions, your immune system starts attacking healthy cells in your joints, spine and potentially other organs. If you’re living in a constant state of stress, your immune system may think you’re under attack and try to keep you safe, but because the stress is being caused by you feeling unsafe rather than bacteria, a virus or a mutation, the body can’t fight it in that way.
“Stress worsens arthritis and arthritis worsens stress. It’s a vicious circle,” says Deborah Lee from Dr Fox Online Pharmacy. “This can be any type of stress – work, relationship, marital, financial, bereavement, or bullying, for example. It’s a long list. However, it also includes the stress of having a chronic disease such as arthritis. Rheumatoid arthritis is an autoimmune condition, and stress can trigger rheumatoid arthritis symptoms. However, osteoarthritis, which is not an autoimmune condition, is also likely to worsen with stress.”
What is acute and chronic stress?
Some degree of stress is an inevitable part of life, and can actually be helpful in the short term. We developed our fight and flight response to help us respond to danger – like a lion running up to us. In the short term, stress and the hormones released as a result can help your body fight infections, push you to complete a goal and help enhance physical and mental performance.
“When the amygdala in the brain perceives the body is under acute stress, it sends a message to the hypothalamus which activates the sympathetic nervous system (SNS), the body’s involuntary ‘fight, fright and flight’ pathway,” says Dr Deborah Lee. “The hypothalamus produces hormones which tell the adrenal glands to produce cortisol and adrenaline which raise blood pressure and speed up the heart rate to enable the body to flee from danger. Your heart is pounding, your breathing is faster, you start to sweat, and your pupils are dilated. There is an outpouring of the stress hormones, adrenaline and cortisol. After the stress has passed, the parasympathetic nervous system (PSNS) takes over. This counteracts the SNS by slowing the heart, lowering blood pressure, slowing the breathing rate, stopping sweating and allowing pupils to constrict. You now feel calm again.”
The problem, however, is when stress becomes chronic and continuous. “When stress continues over a long period, the SNS becomes stuck in overdrive,” says Deborah Lee. “Chronic stress can cause an enormous range of symptoms, and these are just a few: headaches, dizziness, palpitations, hot flushes, nausea, gastric reflux, IBS, chest pain, stomach pain, shortness of breath, fatigue, muscle pain, joint pains and raised cholesterol. Chronic stress can also worsen arthritis symptoms. We know that chronic stress impairs immune function.”
Long term stress can lead to autoimmune conditions, a decreased quality of life, less sleep and so on. “Here’s the good news,” says Dr. Deborah Lee. “We can improve our immune function by controlling our emotions, lowering stress and being in good mental health. Optimism and hope are linked to better resilience and improved quality of life. Medical studies have established that relaxation techniques such as mindfulness lower stress, modulate the immune response, reduce levels of proinflammatory cytokines, and improve the immune profile.”
So how can you manage stress when you have arthritis?
1. Learn to manage stress and arthritis
The first step to managing stress is to learn stress management techniques which work for you. “Learning to live with and manage your arthritis is vital,” says Dr Deborah Lee. “This means awareness and acceptance. The symptoms of arthritis are very much influenced by how you feel every day, and how you cope with your stress and emotions. Understanding this and developing a proactive routine that helps you stay calm and have a positive outlook is just as or even more important than taking your medication.”
2. Get connected
Living with arthritis can be isolating. Human beings are social creatures and need people around them – and it can really help if some of those people understand what you’re going through. “Don’t suffer in silence,” says Dr Deborah Lee. “Reach out and talk to others. It’s absolutely true that a problem shared is a problem halved.”
Dr Deborah Lee suggests the following support services for people living with arthritis.
- Versus Arthritis has an online support group. They also have a free Helpline plus a wide range of online resources.
- The National Rheumatoid Arthritis Society runs local group meetings which are a great opportunity for sharing with others.
- Arthritis Action runs a range of group meetings and events across the country.
3. Practice Mindfulness
“Mindfulness teaches you to observe your pain without immediately reacting to it,” says Bayu Prihandit. “So, instead of resisting or focusing on the pain, mindfulness encourages you to simply notice its presence. This change in perspective helps reduce the emotional and physical intensity of the pain, making you feel more in control, present, and less overwhelmed.”
If you want to learn stress relief techniques, the best place to start is with your breath. Breathing into your stomach for a count of four and out for a count of four is a really simple way that you can come back into your body and calm down your nervous system.
“One of the easiest ways to start is with deep breathing,” says Bayu Prihandito. “When you focus on slow, steady breaths for a few minutes, it will send a signal to your brain to calm down. This naturally helps relax your muscles and reduce any tension or discomfort in the body. It’s something you can do anytime, whether you’re sitting at home or even in the middle of the day at the office. This technique helps you stay more present, grounded, and avoid getting overwhelmed by the pain as it comes up.”
4. Keep Moving
It’s a really harmful myth that exercising when you have arthritis makes your pain worse. Exercising helps strengthen your muscles, improves balance and can actually reduce pain in the long term.
“Many arthritis sufferers feel they shouldn’t move their joints when they are painful,” says Bayu Prihandit. “However, in most instances, this is not the case. Joints are made to be used, and if you don’t use them, they stiffen up and swell. Even arthritic joints need to be kept mobile. Exercise keeps the muscles and ligaments around the joint strong. It also improves the blood circulation, bringing oxygen to the cells in the joint and removing waste products. When you exercise you are improving your cardiovascular fitness, and helping curb obesity. Regular exercise will help you lose weight.”
In addition to the physical benefits of exercise, it can also do wonders for your mental health. “Exercise raises endorphins, the chemicals in the brain that give you a natural high,” says Bayu Prihandit. “So, after exercise, you will feel less stressed, and your mood will have improved. Suitable exercises might be walking, cycling, aerobics, dancing or swimming. We are all recommended to do 30 minutes of moderate-intensity exercise 5 times a week. It can be done in short bursts, such as 3, 10-minute walks a day. Walking in nature, in green spaces and even walking in the rain, all have health benefits. If you prefer to exercise indoors, why not try Yoga or Tai Chi? A physiotherapist can suggest a suitable exercise programme, even if you have to do these sitting down on a chair. Hydrotherapy is particularly good for arthritis sufferers.”
5. Distract
Mindfulness can help you learn how to live with your pain and bring you into the present moment, whereas distraction techniques can help you focus on something else. Different things work for different people and you may find you need to do both things at different times.
“Medical studies have shown that taking up a hobby can result in significant improvements in mental health and overall well-being,” says Dr Deborah Lee. “Taking time out to indulge in something you enjoy has so many benefits. It can mean getting out of the house, engaging with others, and developing creativity. You become distracted from your problems and feel uplifted, more positive and cheerful. Your new hobby could be anything from joining a walking group, singing in a choir, gardening, or playing a musical instrument. Reading (try audiobooks?), doing crossword puzzles, or any mind-building exercises are also all likely to be helpful. Having a good laugh relieves tension and raises dopamine levels, making us feel happier. It has also been shown to lower cortisol levels and raise levels of certain immunoglobulins. You could do this by watching or listening to comedy programmes or podcasts, for example.”
6. Develop a positive, grateful mindset
We know that being told to ‘just be positive’ can be really frustrating. However, having a positive mindset can help give you more things to be positive about.
“Having a positive mindset can boost your immune system,” says Dr Deborah Lee. “In a 2004 study, 334 adults were assessed as having a positive or a negative mindset. Then, they were deliberately exposed to one of two types of rhinovirus – a virus which causes the common cold. Those with a positive mindset were less likely to become infected and develop a cold.
“Try and see things from a cup half full rather than a cup half empty perspective. Instead of thinking: ‘Arthritis is terrible, and I’ll never get better,’ try thinking” ‘There’s lots that can be done to improve arthritis, I just need to give it a try.’”
Having a gratitude practice can also help you change the way you view your life and the way you interact in the world. “Practice gratitude – Write down 3 things you are grateful for every day,” says Dr Fox. “Praise yourself when something goes well. Write thank you notes and letters to others. This will help build your self-confidence and self-esteem. In turn, these help strengthen resilience – the way your body deals with stress.”
7. Be kind to yourself
Living with arthritis can be really hard and it’s important that you’re kind to yourself, listen to your body and respect your own needs.
“Be kind to yourself – give yourself ‘me time.’ Don’t push yourself too hard,” says Dr Deborah Lee. “Listen to your body and take time out to relax with a cup of tea, sit in the garden, take a short walk, have an afternoon nap. Your body needs nurturing. Also, be kind to others. Could you babysit, walk a neighbour’s dog, bake cakes for a coffee morning or drop in to visit someone who is lonely? Being kind to others also helps us feel good about ourselves and has the same positive outcomes. One way to do this – if you have time – is volunteering.”
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