Lupus and Pain Management

November 6, 2015

Lupus is a chronic, autoimmune disease that can damage any part of the body (skin, joints, and/or organs inside the body). 90% of lupus patients experience joint or muscle pain.  To learn about how lupus patients could find optimal pain relief, Salonpas sat down with Dr. Donald E. Thomas, the author of The Lupus Encyclopedia.

Dr. Donald E. Thomas, the author of The Lupus Encyclopedia.

Dr. Donald E. Thomas, the author of The Lupus Encyclopedia.

Dr. Thomas is an assistant professor of medicine at the Uniformed Services University of the Health Sciences and teaches rheumatology at the Walter Reed National Military Medical Center. He is a practicing physician and currently serves as a member of the Medical-Scientific Advisory Council of the Lupus Foundation, DC/MD/VA chapter:

What are the different types of Lupus-related pain?  “People who have Systemic Lupus Erythematosus (SLE) can have lots of different types of pains,” says Dr. Thomas.  Some of these include:

  • Arthralgias – Pain in the joints with no evidence of actual joint inflammation on examination
  • Arthritis – Actual inflammation of the joints usually accompanied by either swelling of the joint and/or decreased range of motion on physical examination, or prolonged morning stiffness in the joints. Arthritis found in at least several joints satisfies one of the classification criteria often used to diagnose SLE.
  • Tendinitis – The tendons can become inflamed and painful in SLE. An example of this would be trigger finger where there is pain in the palm side of the hand and the finger can get stuck in flexion where the person has to straighten it back out using the other hand to do so.
  • Myositis – Inflammation of the muscles. Sometimes this can cause some achiness in the muscles when it occurs. It is usually accompanied by elevated muscle enzymes on blood tests as well as muscle weakness.
  • Neuropathy – If SLE causes inflammation of the nerves of the hands or feet, this can sometimes cause nerve pain that can feel like a burning pain, “pins and needles”, or electrical type pain. This is also one of the classification criteria used to diagnose SLE.
  • Fibromyalgia – 30% – 50% of people who have SLE can develop a problem where the pain nerves of the body are working over-time, sending pain messages up to the brain from many parts of the body. This can cause pain, often times severe, from the muscles, joints, and bones. It is also often accompanied by fatigue, trouble sleeping, and headaches. This is one of the hardest pain problems to treat in our patients who have SLE.
  • Headaches – Many patients with SLE will have recurrent headaches. SLE itself can cause inflammation of the head and/or brain causing a “lupus headache” which gets better with treatment of the lupus, but most of the time, the headaches are due to migraine or tension headache and are treated the same ways as in people who do not have SLE.
  • Serositis – Inflammation of the tissues around the lungs (pleura), heart (pericardium), and abdominal contents (peritoneum) can occur due to SLE causing chest pain or stomach pain. We call these problems pleuritis. This is also one of the classification criteria used to diagnose SLE, pericarditis, and peritonitis respectively. The chest pain is usually ‘pleuritic’ meaning that the pain occurs while breathing in, making breathing difficult.
  • Chondritis – When lupus causes inflammation of cartilage, this may cause pain at the cartilage of the ears, nose, and chest wall.
  • Raynaud’s phenomenon – Some people with lupus can have smaller than normal diameter arteries of the feet and hands. Cold weather and stress normally cause these arteries to constrict and become smaller. When someone with lupus has smaller than normal arteries, they can develop decreased blood flow to the hands and feet causing them to turn blue and/or white when they get cold or become stressed. If this blood flow is low enough, it can be accompanied by pain.

How does stress acerbate symptoms?

Stress can actually cause pain of any cause to become worse.

What are the medical treatment options for lupus pain?

These are numerous. Since SLE is an autoimmune disorder where the immune system is attacking the body, we use medicines to calm down the immune system (immunosuppressants and immunomodulators). We also use many different types of pain medicines (pills, creams, and patches). Complementary therapies such as stress reduction techniques, proper sleep hygiene, acupuncture, yoga, tai chi, biofeedback, exercise, physical therapy and others can be helpful in many patients. Depression and anxiety disorders can make pains feel worse; therefore these conditions must be addressed and treated as well to help with pain.

What role does physical therapy play in controlling lupus pain?

Many patients can benefit from either physical therapy or occupational therapy. It is important to learn how to protect painful joints as well as perform appropriate exercises to strengthen the muscles around the joints, retain flexibility, and maintain good range of motion. Physical therapists can also use modalities such as massage and ultrasound to help with pain as well.

Are there any mind-body techniques you recommend to reduce lupus pain?

None of the mind-body techniques have been proven to work for the pains of lupus; however, they also have not been studied very well. Yoga, Tai Chi, acupuncture, biofeedback, and mental imagery/breathing techniques may be helpful in reducing the severity of pain in some people.

What is your point of view of massage and should a lupus patient go to a masseuse with lupus experience?

Patients who have a lot of muscle spasm, such as those who have fibromyalgia, may benefit from massage therapy.

Is there a cure for lupus?

There are no cures for lupus. However, with today’s therapies, a large number of our patients are able to be clinically quiescent (also called remission), but require ongoing medical treatment.

How does someone get lupus?  Are there family connections?

Over 50 genes have been identified that cause lupus. Most people who inherit these genes never develop lupus. The more genes someone inherits, the more likely they are to develop the disease.

Many of the autoimmune diseases share many of these genes, so it is common to have other family members who have autoimmune disorders such as thyroid disease, rheumatoid arthritis, Sjogren’s syndrome, scleroderma, polymyositis, vasculitis, and pernicious anemia.

It is currently felt that viral infections such as Epstein Barr virus and parvovirus can ‘trigger’ these genes to ‘turn on’ causing the immune system to become over active and attack the body.

Other triggers of lupus include cigarette smoking, sun-light, tanning booths, low vitamin D levels, and some medications such as sulfa (sulfonamide) antibiotics. The herbal product Echinacea has been associated with an increased risk of developing SLE. Alfalfa sprouts and mung bean sprouts have also been associated with lupus; they are high in an amino acid called L-canavanine which may play a role in increased immune function.

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