Understanding the Cycle of Pain in Rheumatoid Arthritis

How to Manage Your Chronic RA Pain

A man sits, holding one of his hands. He rubs one hand with his other, as though trying to relieve pain in his hand.

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If you have rheumatoid arthritis (RA), your body and your mind find different strategies to cope with chronic pain. However, the pain cycle may actually cause you to feel more chronic pain over time. 

After you have an injury or develop a painful condition, your body will try to adapt. For example, if you develop rheumatoid arthritis in your knees, you may find that you walk more stiffly or bend your back to pick something up instead of relying on your knees.

Medical professionals call this process of adapting to pain “the pain cycle”. To avoid feeling pain, you may unwittingly avoid using a part of your body that hurts. Over time, that unexercised body part becomes stiffer and more painful, which perpetuates this cycle of pain.

For people with rheumatoid arthritis, the pain cycle can impact their social and mental wellness. You may begin to isolate yourself at home as you avoid activities or hobbies that might cause you discomfort. The pain cycle can make people feel lonely and exhausted. Fortunately, RA patients can break this cycle by managing their pain and their mental health.

Physical Pain

Why does RA cause chronic pain, in the first place? If you have rheumatoid arthritis, your joints become inflamed. However, unlike other forms of arthritis, RA causes your immune system to attack the soft tissues that cushion your joints. These soft tissues usually help you move your hands, arms, legs, and back.

When your immune system attacks those soft tissues, your joints become stiff. You may notice that you can’t move as quickly or as easily as you could before your RA diagnosis. And that inflammation can manifest in painful sensations like aching, burning, twisting, or pinpricks deep in your skin.

The pain cycle perpetuates the joint stiffness and soreness that you may already have. It’s a natural reaction to avoid using a part of your body that hurts. If your back aches when you bend over, then you will likely avoid bending over so you can avoid pain.

However, RA patients can prevent further joint damage if they exercise or move their stiff limbs. Many RA patients report feeling more pain in the morning after they’ve laid in bed for hours. However, after they begin to move about their day, they may feel their joints opening up a little, or perhaps they can focus on things other than their pain.

Similarly, your rheumatoid arthritis symptoms can actually become worse if you don’t gently move your joints. A study published in the Journal of Aging Research describes how you can maintain maximum mobility when you exercise, even if that movement does cause some initial discomfort.

If you feel any pain from your rheumatoid arthritis, contact your healthcare provider to discuss the best exercise plan for your lifestyle. Consider low-impact activities that won’t damage your joints such as walking, swimming, or yoga. Do not begin a new exercise plan without first seeking advice from a healthcare professional. 

Muscle Tension

Muscle tension is a common symptom of RA, and it can contribute to your overall pain. According to a study in EBioMedicine, RA patients often experience muscle weakness that prevents them from being able to hold objects or walk steadily.

With weaker muscles, it becomes more difficult to move or exercise. However, that same study cited regular physical exercise as an important way to mitigate RA pain. 

Muscle tension can have two origins—mental or physical. For RA patients, their muscles may have to overcompensate to try to move stiff joints. In moderate to severe rheumatoid arthritis, the immune system may impact deeper tissues, like muscles, or even bone.

However, the emotional stress of living with RA can also cause muscle tension. In turn, this emotional tension can cause you to feel even more physical pain. When we are stressed, we often hold that emotional tension in our bodies.

Common places that people tend to hold stress are in their necks, hips, back, or shoulders. Coincidentally, these parts of your body are sometimes the first to be impacted by rheumatoid arthritis. If these muscles near your joints become tighter or more painful, you may feel even more discomfort on top of your normal RA symptoms. 


If your RA makes you feel fatigued, you’re not alone. A study in Current Rheumatology Reports found that fatigue is one of the most common symptoms of rheumatoid arthritis. That fatigue can negatively impact an RA patient’s life. 

Fatigue contributes to the pain cycle because, like muscle tension, it can dissuade you from moving. When you’re exhausted, the last thing you may want to do is to take a walk or stretch.

Excessive rest can be counterintuitive, though. Sitting inside for extended periods of time can spark seasonal depressive symptoms and weight gain, both of which can cause you to feel further fatigue.

However, in a study of almost 7,000 participants, 90% of people reported feeling less fatigued after they exercise. Why? Physical movement increases your circulation and releases endorphins throughout your body. Increased blood flow and endorphins help you feel more alert, even if you were tired before you started exercising. 

Negative Emotions

The pain cycle is both physical and mental. Chronic pain can contribute to stress, negative emotions, and mental illnesses. Coping with the pain of RA can cause patients to feel stress, anxiety, and depression.

In fact, people who are chronically ill are more likely to attempt suicide. Furthermore, a study in the International Journal of Clinical Rheumatology states that people with rheumatoid arthritis are four times more likely to have depression than are people without RA. 

Rheumatoid arthritis is not a proven cause for depression and anxiety, but they are closely connected. The stress of RA may cause depression, or it may exacerbate existing depressive symptoms.

Researchers continue to study the relationship between chronic pain and mental health. In any case, mental illness can cause you to feel more fatigued, more socially isolated, and more aches and pains. 

As you work with a healthcare provider to address your RA health plan, consider your mental health as well. Meditation, therapy, and a strong social support system can help you navigate through the psychiatric and physical aspects of your pain cycle.

Breaking the Pain Cycle

When you have a chronic illness like rheumatoid arthritis, your wellness is an ongoing journey. As your RA develops, you may find that your symptoms become more or less painful over time. You may feel new pains in different parts of your body. However, you can break the pain cycle when you become more aware of your symptoms. 

As much as possible, take note of the pain in your body and talk with a healthcare provider about how you can cope with your pain as you try to carry out your normal daily activities. Adhere to your daily social, work, and exercise routine as much as possible.

An active lifestyle can help you combat other complications from RA, such as further joint or tissue damage. If you begin to notice symptoms of depression or anxiety, contact a psychiatrist for help. 

The pain cycle may feel constant, but you don’t have to spiral. By working with your healthcare provider to come up with a plan for your physical and mental health, you can live your best life possible, even with RA pain.


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9 Sources
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