Living with psoriatic arthritis often requires a complex approach to pain management, simply because the effects of the disease can be so widespread. If you suffer from this chronic and debilitating condition but are still trying to understand what you can do to get relief, here's the answer to a couple common questions.
Should you try heat, cold, exercise, or rest? The answer is, "Yes!" to all four. Although the advice sounds contradictory, it's really not, because of the wide array of symptoms you may be suffering. The trick is to know when to use which method of pain control:
- If your pain feels "burning," try cold packs (or a nice bag of frozen peas) over a towel to protect your skin for 15 minutes at a time.
- If you wake up stiff and sore, heat therapy can get your day moving in the right direction. If only a couple joints are affected, heat packs can be used with the same precautions (a towel to protect your skin and no more than 15-20 minutes of use at a time). If you have widespread pain, consider taking a hot shower or warm bath in the tub instead.
- Gentle exercise is best on a regular basis because not moving can eventually allow your joints to deteriorate further. Low-impact exercise like stretching, yoga, walking, and swimming keeps pain off your joints and relieves swelling.
- If you're having an especially bad flare, however, and exercise seems to be excruciating and makes you feel worse, it's time to stop, rest, and try other methods of pain management for a while.
Should I be seeing my rheumatologist, dermatologist, or pain management doctor for help?
The answer to this question is that you should be seeing all 3 of them for different parts of your pain because each of them has a role in treating your complex condition.
- If you have a lot of active psoriasis on your skin and you find it painful or distressing, the dermatologist will be able to provide you with the right sort of topical creams to treat the patches of red, flaky skin. The itchiness can be controlled with salicylic acid-based topicals and tar-based topicals, but they aren't right for every person. Your dermatologist can help figure out what will get you relief from the itching and pain that goes along with the disease. Your dermatologist may also prescribe UVB therapy, which can go deep into skin cells and inhibit their growth—though some patients have skin that worsens with light exposure, so your individual reaction has to be considered carefully.
- Your rheumatologist probably made the diagnosis of psoriatic arthritis, simply because the skin condition, or psoriasis, is its own disorder. Not everyone with psoriasis goes on to develop arthritis as well. Frustratingly enough, there's no clear diagnostic test and about 91%-95% of patients have a negative rheumatoid factor when tested. Your rheumatologist will discuss disease-modifying drugs that can help both relieve pain and slow down the devastating effect of the conditions on your joints. Older drugs like methotrexate and cyclosporine may be tried first, before moving onto biologic agents like Enbrel, Humira, or something similar.
- Pain management care is also necessary for many patients. Psoriatic arthritis also affects the spine, and can even lead to painful areas in the hips and buttocks because of the way that the spine is affected. A pain clinic can help you find the right pain medication to use either daily or during particularly bad flair-ups. Many pain clinics also offer steroidal injections in the spine that can help block spine pain for months at a time.
Because psoriatic arthritis is a complex condition, the approach to treating it can be equally complex. If you're just starting to get treatment, it can overwhelming to know where to direct your specific concerns until you break them down by specialty. If you have a symptom you aren't sure how to treat, ask any of your medical care providers for help—if they can't help you, they can likely direct you to the right type of specialist for that particular concern.
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