RheumaBlog

Same dragon, different day.

I was browsing around the Internet this morning and happened upon, as we do, a series of CNN Health webpages about rheumatoid arthritis.

Now, I consider myself fairly well informed about RA. I’ve read and read and read about this disease, everything from what it is to how it can damage the joints, soft tissues and organs. Still, I keep reading. I might find something new and hopeful.

As I clicked through the various sub-heads on the page about different aspects of RA, I saw one that asked, “Is Your Pain Threshold Low?” Huh? I clicked. The headline on the new page: “Are People with RA More Sensitive to Pain?”

They can’t be serious, I thought, my hackles rising. If anything, those of us who cope with RA pain and disability every single day have very high pain thresholds. We have to handle pain well or we’d never be able to get anything done. Surely, I thought, they’re going to acknowledge that in this article, so don’t jump the gun. Just read it.

So I did.

I wish I hadn’t. Because now I’m angry and frustrated. What the article said, in essence, is that people with RA have very low pain thresholds because of stress, lack of sleep and (oh, what a word!) catastrophizing.

Now THIS is a catastrophe.

Now, I can’t argue too hard against the stress and sleeplessness that go along with serious chronic pain. They’re both real. Both can make rheuma pain worse. The article even acknowledges (without going into any detail) the vicious loop that can occur with RA pain: You hurt, which causes stress, which make your muscles tighten up, which causes more pain and stress, which brings on sleepleness, which causes even more pain, stress, sleeplessness… and so on. In this case, any help we can get to lower stress and sleep better is precious.

But… but… catastrophizing?

The article defines the word thusly: [It’s] “a word used to describe a particular response to pain: feeling pessimistic and helpless, resulting in an even greater sensation of pain.” Honestly, I think that everyone, RA or no RA, does this at one time or another, usually briefly. Feeling blue and pessimistic goes hand in hand with any painful injury or illness, particularly injuries or illnesses that cannot be healed or cured. In such circumstances, anyone would “catastrophize.”

The article goes on to state that “[p]eople who catastrophize have a tougher time coping with pain and are more sensitive to pain than others. Studies involving people with RA have found that those who catastrophize experience greater disease activity and inflammation. Why? One study found that, when exposed to painful stimuli, people who tend to catastrophize experienced a greater boost in levels of interleukin-6, the inflammatory molecule that can increase pain.”

Okay. So science proves that stress can cause a rise in the level of inflammatory molecules in the bloodstream, and that this rise can increase pain, presumably because it increases inflammation.

And that singles out RA patients, how? It proves that they have lower pain thresholds, how?

It doesn’t prove the premise of the headline, “Are People with RA More Sensitive to Pain?” (which implies that we are, because why would anyone ask that question in the first place?).  Increased inflammation can cause more pain regardless of its cause. For example, if I sprain my ankle—the sprain being caused by injured ligaments that, because of the injury, become inflamed and thus, painful—and then I put my full weight on that sprained ankle accidentally and irritate it further, I’m going to suffer increased pain. If I’m stressed because now I can’t get to work in time for a presentation to the boss and clients I was scheduled to give, then naturally, the pain is going to feel worse, since stress causes a further release of interleukin-6 into my bloodstream. And if the pain in my ankle keeps me awake all that night, and I have to stay home from work again the next day and get even more stressed out, then… well, you get the idea. It’s a nasty loop of pain, stress, sleeplessness and pain.

And that’s without  even having RA. Again I ask, why single out RA patients for this pain threshold question? It can apply to anyone.

And what about the “people who tend to catastrophize” part of the statement? What does “tend to” mean. Does it mean they studied people who have frequent, intractable pain who complain about it a lot? How did they find those people? How was the RA pain they complained about categorized? As “mild?” “Moderate?” “Severe?” How long had they had the disease? Was their RA being treated? Were they taking pain medications? Did their pain keep them from working, playing with their kids, or doing things they loved? Did it stop them from doing little, everyday things like lift a coffee cup, fold laundry, open a jar of peanut butter or even button their own clothes?

An accusation of “catastrophizing”—and that’s what it feels like to me—better have a lot more depth beneath it if it means to be taken seriously.

This is not the first time I’ve seen RA patients’ pain trivialized—even pooh-poohed—like this. A couple of years ago the Arthritis Foundation magazine also ran an article that suggested that those of us with RA “catastrophize” our condition, thus making it seem worse than it really is. It was a not-so-subtle implication that, far from being the tough, courageous and often stoic people we actually are, we’re all doom-and-gloomers. Weaklings. Head-cases. Wimps.

I take serious exception to that premise. You probably do, too.

7 thoughts on “Why do they think we’re wimps?

  1. Mary says:

    Oh yes, I do take exception to that premise. I have had multiple injuries throughout my life and I can tell you I have a very high threshold for pain. Broke my foot and didn’t even know it until years later when I broke my ankle and the x ray tech said oh you broke your foot and the bone is floating around in there. News to me. Yes my foot hurt sometimes but eh. Dislocated my shoulder (now that hurt) but didn’t get it treated for a day because I thought it would be ok. Broke my elbow in a biking accident and went back to work the next day, before it was cast. I know and can handle pain and RA is painful. Boy, this kind of thing burns me up. Let them walk around with this pain day in and day out year after year and then write that article. Catastrophizing REALLY???

    Your points are well made and I think that study should have included the additional parameters you mentioned before it was ever published.
    Catastrophizing my a#s. Articles like that are why people have a poor understanding of RA and people can’t find the support they need. Ok off my high horse. Catastrophizing mumble mumble mumble.

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  2. Mary says:

    I forgot to point out in the above response that every time I went to the doctor after one of these injuries they said “Doesn’t that really hurt.” Yes it hurt but I have a high pain tolerance. I believe anyone with RA has a high pain tolerance. Geez after an hour I am still grumbling.

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  3. Wren says:

    I’m right with you, Mary. This sort of article, which purports to be helpful to people with RA and their families and friends really only causes us to feel embarrassed, and them to feel like suckers. It’s so wrong.
    By the way, you really ARE a tough cookie, walking around with broken feet and dislocated arms. Yeeeeowch! Thanks for all your kind words and support over time. I really do appreciate it. 😉

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  4. brilliantmindbrokenbody says:

    Uck, what a horrid article! I mean, if you live with pain as a daily (or at least frequent) companion, you HAVE to develop a high pain tolerance. It’s that or feel miserable all the time.

    I did want to point something out – you’ve conflated threshold with tolerance. Threshold is the lowest sensation where you register pain; tolerance is how much of it you’re able to cope with. I, for example, have a tremendously low threshold nowadays – it takes very little damage to my body to cause me a great deal of pain, like Hudson grazing me with his nails or stepping on my foot, which is sometimes so painful it brings tears to my eyes. I also have very high pain tolerance, so I’m able to just keep going through relatively nasty pain, so even though I have tears in my eyes, I still finish feeding the dog, letting him out, and so on. I hope I’m making sense. The insomnia bug bit HARD last night, so my brain is still kind of…wobbly.

    ~Kali

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  5. abcsofra says:

    I often believe these types of articles are written to excuse the medical profession of treating pain for ra. This CNN article is horrid! As if we don’t already have enough pain issues with ra that we now have to combat this type of ridiculous article that lays blame (once again) at our feet for the pain in the first place. I am so tired of this perspective. How about CNN writing something meaningful like…why isn’t ra pain treated effectively in the first place? Now that is an article I want to see written!

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  6. remicadedream says:

    I recently walked around on a sprained ankle for three weeks without realizing it. Low pain threshold? I don’t think so.

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  7. Stephanie says:

    Ugh, I hate stuff like this. Of course we have a high tolerance for pain. It frustrates me so much that they look at our bad days (those days where we do feel less capable of handling the pain, which happens occasionally when you live in pain for YEARS), and see that as weak. Nevermind all the other days when we deal with the same or far greater pain and no one knows because we are so awesome at dealing with it and hiding it. Grrr.

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