The term arthritis covers many different conditions (over 100 of them), which fall into two categories: osteoarthritis (OA) and inflammatory arthritis (IA). OA is the most common type of arthritis, and occurs when the cartilage between bones wears down, causing bones to become less protected (2).
IA, in contrast, occurs when joint inflammation is caused by the immune system, rather than mechanical wearing down of cartilage. Common types of IA include: Rheumatoid arthritis - A disease that occurs when the immune system attacks its own tissues, including membranes that are found in the joints. Ankylosing spondylitis - Arthritis of the spine that can cause spinal bones to fuse.
Gout - A condition where extra uric acid (a bodily waste product) turns into hard crystals that accumulate in the joints causing pain (usually in the joint of the big toe).
Psoriatic arthritis - A disease that causes inflammation of both the joints and skin.
People with arthritis typically experience pain, stiffness, and swelling in their hips, knees, hands, and/or spine, although other parts of the body can also be affected.
First of all, it is important to understand that osteoarthritis is universal. From our early 20’s and until we die, cartilage wear-down occurs in the joints of every human being.
However, these structural changes are not predictors of pain. Osteoarthritis is best thought of as “wrinkles on the inside”: normal, non-dangerous changes in the joints that occur over a person’s lifespan, which are not inherently painful. In fact, some people have advanced osteoarthritis, but little-to-no pain; others have mild osteoarthritis, but extreme joint pain.
The same is true for inflammatory arthritis: some people with IA experience little-to-no pain, while others experience extreme pain. Furthermore, though people with IA may experience bouts of increased inflammation, their pain may continue long after the inflammation has subsided.
If structural changes (like cartilage wear-down and inflammation) are not strongly correlated with pain levels, then what causes arthritic pain?
The answer is that all pain that humans experience is biopsychosocial. This means that the pain we experience is related to our biological reality (for example, the wear-down of cartilage in our joints), our psychological reality (for example, our thoughts, mood, fears, and past experiences of pain we’ve had in our lives), and our sociological reality (for example, our socioeconomic status and access to medical care).
In other words: our pain is impacted by many factors that are not purely biological. In light of the biopsychosocial nature of pain, it is helpful to assess whether your arthritis pain is primary, secondary, or a combination of the two.
Primary arthritis pain is caused by the nervous system amplifying pain signals and/or interpreting neutral sensations as painful, and can be successfully treated by addressing psychosocial pain drivers.
Numerous studies have found evidence that Primary Pain plays a role in both OA and IA. Secondary arthritis pain, in contrast, is caused by structural issues (such as inflammation or tissue damage).
Since the brain moderates all pain, the sensation of Primary and Secondary pain is similar -- but the drivers are very different. Assessing whether you have primary pain, secondary pain, or a combination of the two is crucial for identifying the most effective treatment for your arthritis pain.
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