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Seniors hear of "self-management" techniques for arthritis

Thursday, June 18, 2009

Amber Phelps, standing, health program specialist at the University of Missouri Regional Arthritis Center, speaks to senior citizens at the Slater Senior Center on the topic of arthritis pain management following a meal Tuesday evening, June 16.
(Geoff Rands/Democrat-News)
Amber Phelps, health program specialist at the Central Missouri Regional Arthritis Center, came to the Slater Senior Center Tuesday evening, June 16, to give her presentation titled "Managing arthritis so it doesn't manage you" to the more than 15 senior citizens assembled there.

There are more than 100 forms of arthritis, Phelps said, and the key to a managing someone's arthritis is to first know what kind of arthritis is having an effect.

The most common form is osteoarthritis, and the second most common is rheumatoid arthritis. But, added Phelps, "Anything that ... affects your muscles or your joints (is arthritis)," including fibromyalgia, lupus and even lyme disease. Each of these arthritic conditions requires different treatment.

"(Arthritis) is the most common cause of disability in our nation and in this state," Phelps said.

She mentioned a number of myths about arthritis, the first of which was the belief that there is nothing one can do to treat arthritis. Another myth she spoke of was the belief held by many that arthritis is "just aches and pains." Phelps explained that arthritis can attack the internal organs of those affected, and can even cause death.

Osteoarthritis can be developed at any stage of life, she said, though its most common causes are injury, repetitive motion or lifting.

One way to self-diagnose arthritis is to look for pain and swelling around a joint that continues for more than two weeks straight.

Although use of pain relievers such as aspirin may help to manage the pain of arthritis, Phelps had a few recommendations for other ways to deal with pain.

Physical activity was one thing Phelps said helps with arthritic pain. Thirty years ago, she said, a doctor would tell an arthritic patient to rest and lie in bed, though now doctors know that inactivity is one of the worst things for arthritic conditions.

"If you don't use it, you..." prompted Phelps.

"Lose it," came the chorus from attendees.

Phelps warned those present about the "pain cycle." Tenseness, she said, causes more pain and stiffness. This pain and stiffness causes stress, which causes fatigue, which causes tenseness.

"The goal in self-management is breaking that cycle," she said.

She asked attendees what causes them pain, to which "Riding my lawnmower," "Standing at the sink doing dishes," "Getting down on your knees," "Riding in a car" and "Walking" were all yelled out.

To that list, Phelps added being tired, inactive, over-active and having weak or tense muscles.

"The purpose of physical activity is building the muscle around the joint to support it more," said Phelps. "If your muscles are weak or tense, either because they don't have the strength that they need or they're injured or damaged, that can cause you to have more pain."

Depression contributes to pain, Phelps said. Even though people may be "doing everything right ... if you're depressed, that in and of itself can cause depression."

In dealing with treatment of pain, said Phelps, "the earlier you start to treat it, the better. The key is don't wait until you're feeling a lot of pain, because by that time, it might be too late; it's going to take a long time for your pain medications to work. ... Don't wait to see if it's going to get worse, because if you're in pain, it's probably not going to get better on its own."

Management of pain does not always require a significant change in lifestyle, Phelps said.

"Small changes make a big difference. I don't know if you are like me, but I have the tendency (toward an) all-or-nothing belief system. If I can't take care of all of the pain, then it doesn't matter. But little changes that you make in your routine make a big difference in your pain management."

Activities aimed at self-management of arthritis symptoms, Phelps said, are unlikely to be pain-free.

"Pain is also a way to judge if you've done too much in certain activities," she said.

Phelps told attendees about the "two-hour rule," which states that if, after two hours of light activity or inactivity following a more strenuous activity, a person still feels pain, "you've overdone it. You either used too much weight or did it for too long a period of time or got your heart rate up too high."

"So," she continued, "pain can be a good thing, it can tell us that something's wrong."

She advised people to "listen to your body. It knows you better than I do. You've been with your body a lot longer than you've known me, so you're a better judge of what you're feeling than I would ever be for you."

Planning a day ahead of time can also help manage pain, she said. "If you know you have certain activities, ... mixing activity with rest is a great way to manage your symptoms."

Another valuable skill, said Phelps, is "learning to say 'no,'" though she added that a more positive way to look at it is "learn not to say 'yes.'"

"Sometimes, we get so caught up in doing for everyone else that we have to stop and take care of ourselves along the way."

The way people hold things can also contribute to pain, she said. The smaller the joint, the more stress something will put on it.

Using a purse as an example, she asked if a hand-held purse, one held in the crook of an elbow or one slung over a shoulder would contribute the least to wear and tear of joints. The correct answer was a purse held over one's shoulder, as it is the largest of those joints.

One universally-accessible tool for pain management held by all, Phelps said, is the mind. She took her audience through a few guided meditations to show them the power their minds hold over physical sensations. First, she told them to close their eyes and imagine themselves holding a large yellow lemon. She instructed them to imagine smelling it, then biting into it, feeling the juice dribble down their chins. When she asked them to open their eyes, one person reported an increase of saliva after "biting" the lemon.

"Your body reacted to that thought," she said, which showed that it is possible to "use your mind to get through activity with less pain."

She suggested counting backwards from 100 by threes, thinking of a boy's name or a flower for each letter of the alphabet or just trying to accurately recall all the lyrics to a song as ways to focus one's mind on something besides pain.

Phelps told them to choose "something you can do anywhere and everywhere."

But, she said, being distracted from pain for too long, such as becoming engrossed in a movie, can lead to a greater level of pain when the distraction is removed.

She also stressed that one should never distract one's self from chest pain, as that is a sign of a serious and immediate problem.

Programs including PACE, which stands for People with Arthritis Can Exercise, and Stay Strong, Stay Healthy take place at the senior centers in Marshall and Slater.

PACE is aimed at strengthening joints and is held in Slater Tuesdays from 10:30 to 11:30 a.m. In Marshall, it is held Tuesdays and Thursdays at 1 p.m.

Stay Strong, Stay Healthy is a program aimed at increasing muscular strength by using stretching bands and free weights. This program is held in Slater Wednesdays from 10:30 to 11:30 a.m., and will be coming to Marshall in fall 2009.

There is no cost to participate in either of these programs, nor is there any lower or upper age limit.

Contact Geoff Rands at marshallreporter@socket.net

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