RheumaBlog

Same dragon, different day.

Interesting how one kind of pain can “cancel out” another.

In the weeks since the dog bite, I’ve had only very light rheuma pain in my hands, and none in any other joints. And Terry, who writes the blog, “Dual Sports Life,” writes today about his recent relaxing vacation in the sun and how his pain disappeared until he went back to work a couple of days ago. When things like this happen, I wonder (a bit uncomfortably) if my rheuma pain really is in my head.

Of course, I know it’s not. There are real, measurable, physical proofs of the existence of rheumatoid arthritis. The inflammation we all experience in our joints is a reality. It does cause stiffness. It does cause fatigue. It is, frequently, very painful. Even agonizing. When I went to a rheumatologist two years ago for help, there was no question after he examined me and got the blood test results back that I have rheumatoid arthritis.

But I also know that stress absolutely can make rheuma worse. When I was diagnosed 22-plus years ago, I was living in a foreign country, had a demanding job (that I loved), was raising my small daughter 3,000 miles away from my old support system of close friends and family, and was only recently married to a man I discovered was an alcoholic. Thinking back, I don’t recall feeling terribly stressed (at least, not all the time; there were many good times mixed in with the bad). The timing of my RA onset was probably just coincidence; I loved living and working overseas. Nevertheless, the disease was far more painful and disabling then than it is now. And after I returned to the U.S., ended the destructive relationship, and found my way back into daily American life here close to family and friends, my rheuma pain gradually eased over a period of years – and then stopped altogether without drugs.

Was stress causing my symptoms?

According to Marikje Vroomen-Durning, RN and Cynthia Hayes, MD in a short article in Everydayhealth.com,

“(R) esearch shows that stress may play a role in the actual inflammation that causes pain, inflammation in RA is partly caused by molecules called cytokines. While cytokines can be released for a variety of reasons, stress also releases them. If you’re stressed and are releasing more cytokines, you probably will develop more inflammation. This may result in more pain.”

So perhaps stress contributed to the intensity of the RA symptoms I experienced back then. But it didn’t cause them. RA itself did that.

My dog-bitten right hand is almost completely healed. There’s very little discomfort left in it, which is a blessing. But it’s also been a blessing that, while my right hand was infected and pain-full, my rheuma-dragon didn’t pile on with more pain and stiffness in that hand or elsewhere in my body. Well, let me qualify that. It did once, briefly, when it flared in my right wrist a few days after the initial bite. That, however, was likely because that wrist was being held immobile by a  splint and wrappings. Once I took them off my hand, the rheuma flare eased.

The pain and temporary disability from the dog bite was, simply, a different kind of pain than I’m used to. Puncture wounds are sharp, stingy things, and the emotional toll involved in the decision to euthanize my beloved old dog was heavy. Yet given all that stress, shouldn’t my RA have flared, big-time?

Well, it didn’t. And it’s only been the last couple of days that my hands have started feeling achy and twingy again with unmistakable rheuma pain.

“Aw, you’ve got a headache? Hold still. I’ll kick you in the knee and you’ll forget all about your head.” That’s an old joke, but maybe there’s some truth in it.

9 thoughts on “Stress and pain

  1. Kris says:

    My dad and I were just talking about this last night. He has had RA for probably the last 30 years but until he was in his early seventies it was misdiagnosed as being related to an accident he had when he was a highway patrol officer. I have RA and/or psoriatic arthritis diagnosed six months ago. Both of us have found that it’s a vicious cycle. The pain wears you out, and the more tired you become the less you can tolerate the pain. So by the end of the day, and the end of a week, you hurt more.

    Both of us, too, have found that work-related stress makes it worse. Some of that is physical–not being able to have total control over when you sit, stand, etc. But some of it seems related to having our “coping skills” split between work stress and pain. And I, too, have had that experience of one pain distracting me from another.

    This kind of stuff has made me doubt myself. And I particularly fret sometimes that the fatigue is in my head. But all it takes is one good flare up to remind me that this disease is not imagined. And all I have to do is look at old pictures of myself to remember that I’m not lazy or malingering–that’s not in my nature. And looking at my dear dad–who after 30 years of RA refuses to stop kayaking–tells me that this disease can, and often does, strike the most active and determined people.

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    1. Wren says:

      It’s good that you and your Dad can talk about this, and that he understands and empathizes with your arthritis pain, and vice versa. What a shame that his RA was misdiagnosed for so long — but how incredible it is that he still goes kayaking in spite of it, and I’ll bet a lot more, too. You’re absolutely right, too, about how pain wears us out, and the more tired we become, the less energy we have to cope with pain. I’m glad, Kris, I’m not the only one who sometimes doubts my RA. It’s such an odd disease, there one day, gone the next. Thanks for your thoughtful comment.

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  2. Mary says:

    Stress can certainly cause increased pain and fatigue. When my parents became ill 3 years ago my RA went wild. Between splitting my time between the hospital and work my stress level was very high. It is a vicious circle at times. The stress prevents you from sleeping well, which causes increased fatigue which exacerbates the pain and on and on. After my parents passed away I went to see my Rheumatologist and we spoke at length about the effects of stress and RA. He was not suprised that I had been in a flare for months.
    Sometimes I have wondered if the RA symptoms could be all in my head but during this period I had a visible increase in joint destruction and swelling and I know that was not imagined. It is a tricky disease that that can make you doubt yourself and makes you wonder if it could be your fault.

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    1. Wren says:

      Stress can definitely cause flares, or at least, make the flares worse. Sometimes, in cases like you went through with your parents, it seems pretty obvious. But there are the other times, when life is just going along, and nothing seems any more or less stressful than usual, that stress can also affect RA. Those are the times when I start doubting, because I can’t pinpoint a “reason” for the flare. I like to think I know “why” my RA flares — and when this happens, I end up frustrated. Thanks for your comment; it’s good to know that I’m not alone in this.

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  3. Leslie says:

    I agree that stress can exacerbate RA. I also believe that when something else happens…like your dog bite..that the pain of RA can be pushed into a corner as the more intense pain takes over. Maybe that’s the body’s way of saying it just couldn’t handle too much pain at once! Glad you are doing better! I know it’s been a rough time.

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    1. Wren says:

      Ah, Leslie, I LIKE your theory! Maybe this “canceling out” of one pain by another really IS the body’s way of saying “WHOA! Gimme a break!” Thanks for the kind words — I’m doing much, much better now, and my sadness about Logan is easing up some. He’s taking his place among all the other beloved pets I’ve lost during my lifetime, and my memories of him are just as fond and make me smile. Funny how we do that, isn’t it?

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  4. ValleyWriter says:

    I have noticed that when I’m sick (sinus infection, cold – that sort of thing), my RA pain seems to subside. I’ve always thought my immune system had something else to crunch on, so it was leaving my joints alone… but maybe it’s because when I’m sick, I give myself more of a break than I do most days. As soon as the overriding illness goes away, I’m back to my old tricks – and so is my RA. Perhaps not such a coincidence!

    I’ve also noticed that my pain levels and patience levels are inversely proportional. (I feel a little sorry for my coworkers on that one. Maybe I should have signs on my desk – “I’m in pain today,” “I’m not in pain today,” etc. 😛 )

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    1. Wren says:

      I think both your theories are right, Amber. And I also have less patience when I hurt. I hate it when I’m like that, though. The people around me — co-workers, family, friends — aren’t responsible for my pain, even if they do get on my nerves sometimes. Warning signs would certainly help them steer clear of me on those bad days, though … 😉

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  5. Chelsea says:

    You’ve all touched on it. RA and it’s nuances. Wren, I’m glad to hear your hand is so much better. I’m sorry about Logan. I’m glad you have fond memories and that he was yours (and you were his!).

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