Arthritis Pain Is Variable - Expect the Unexpected

It's the Most Difficult Aspect of Arthritis to Understand

Arthritis pain can intensify unexpectedly.
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Pain variation is not unusual -- it's part of the normal course of arthritis. Perhaps you haven't heard it labeled as "pain variation," but if you live with the disease, you've likely experienced it. Pain variation refers to changes in the intensity of arthritis pain. In other words, there are episodes of more intense pain and episodes of less intense pain, as well as the uncertainty of how long an episode will last.

Essentially, pain is not expressed in a straight line — there are peaks and valleys.

Arthritis patients learn how to deal with the long-term, chronic pain which characterizes the disease. But, the short-term, intense fluctuations seem to be the hardest to cope with because of their unexpected nature. Pain levels can fluctuate and worsen month to month, week to week — even hour to hour.

Even if you are compliant with your arthritis medications and treatment, arthritis pain can be unpredictable. That fact is so difficult for arthritis patients to understand and even more difficult to explain to others. It is disruptive and intrusive, as well as unavoidable and inevitable.

The Effect of Pain Variation

The variation of arthritis pain can cause activity limitations, decreased productivity, sleep disruption, and mood changes. Prolonged problems can affect quality of life.

Activity Limitations

An unexpected episode of worsening pain can disrupt routine or planned activities.

People formulate schedules and plan events, with every intention of participating. When pain limits activities, you must accept that this is part of living with arthritis. It's not your choice or your fault, so don't feel guilty. Do your best to relieve the intensified pain and, if possible, plan to make up for whatever activity you're forced to miss.

First and foremost, take care of yourself, and get back on track as soon as possible.

Decreased Productivity

Episodes of increased pain can make it harder for you to do your job, and such episodes can cause you to miss work and lose income, too. Talk to your immediate supervisor and explain the problem you are having, and perhaps take a few days off. If you can get the needed time off and support from your supervisor or employer, you will worry less, and possibly recover sooner.

Sleep Disruption

Pain is known to disrupt sleep. Whether the problem is falling asleep or staying asleep, the resulting fatigue can interfere with usual or planned activities. Sometimes, sleep disruption is not dealt with and it is merely viewed as a consequence of pain. Don't ignore the problem. Talk to your doctor about possible solutions.

Mood Changes

As you might expect, increased pain, decreased productivity, and sleep disruption can lead to mood changes. It's disheartening to experience unanticipated variations in pain: you may feel depressed, disappointed, helpless, and hopeless. Don't let it get you down for more than a short period of time. Know that it will pass and you will be able to get back to your usual self.

Channel the energy it takes to feed a bad mood into taking care of yourself.

How to Minimize the Effect of Pain Variation

It can be very helpful for you to keep a pain diary. The diary will help you recognize patterns of pain. In the diary, you should rate your pain on a daily basis from 1 to 10, and also make notations when you experience a change. You may also notice if there is something that provokes an intensely painful episode.

You should have already discussed with your doctor what to do when variations in pain occur. Your doctor may advise you to increase your pain medication within acceptable limits, and you may have been prescribed a medication that you take only when your pain level is high.

You may also need to rest and adjust your schedule of activities.

The Bottom Line

There are 4 steps you can take to get through variations in arthritis pain:

  • Understand that pain variation normally occurs with arthritis.
  • Know ahead of time what your doctor wants you to do when pain intensifies.
  • Be flexible and willing to change plans when necessary.
  • Know that you will get through it, and that the episode of heightened pain will pass.


The Value of Measuring Variability in Osteoarthritis Pain. The Journal of Rheumatology. Kelli D. Allen, PhD. Volume 34:11. November 2007.

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