What a pain in the neck!

          One of the least talked about but most painful and intrusive side effects of RA is neck pain, often responsible for subsequent headaches as well.  I believe I had neck pain long before my RA was even diagnosed and yet I do believe it was an early marker of the disease that was just entering my life.

     I can clearly remember several months before I really began to manifest more definitive signs of RA, that my neck was stiff, painful and tight much of the time.  I now believe that it was just the beginning of what would become a journey with a chronic and painful disease.   

     The challenge, of course, is how to deal with it and not let the pain and discomfort derail your ability to handle your RA.  As with all aspects of chronic disease, there are tools we can acquire and include in our RA Tool Box to help us manage this too!  

     I have found that stretching exercises when done regularly (and that is probably the biggest challenge) and correctly can be the key to relief and even prevent further issues.  There are a number of great links to sites that show a variety of great exercises...here is one of my favorites.

http://tranquilitycs.wordpress.com/2008/08/25/three-simple-neck-stretches-to-relieve-neck-pain-and-stress/

One of the reasons I like this site is that there are excellent illustrations that accompany the descriptions and I find them very useful.  I tend to be a visual learner so good visual diagrams are most appreciated!

     In addition to stretching exercises, many experts recommend strength training for increasing mobility in your neck, back and shoulders.

     If you are in good enough condition to do them on land then by all means go for it and carefully select those that will accommodate your RA.  If like me, however, you cannot do them on land thanks to hand/wrist/shoulder issues then aqua strength training is great!  

     These are the exact ones I use and the reason is in the grip.  As you can see you simply slide your hand in one side and through the other so that you don't need to have a hearty grip to keep them in your hands.  This means I can do my strength training even when my hands are flaring!  Beyond that, I am able to do many more repetitions and sets in the water since it is joint neutral with no stress or pain to your joints while doing it.  I now do 20 different exercises and repeat each one 15 times for really good overall strength training workout.  I also do some of my neck exercises in the water as well.

      Another very useful tool is therapeutic massage.  I am a huge proponent of massage for any type of pain but in addition it is a proven stress reliever and that is one of the many causes of neck pain.  So it is a win/win situation to get a great massage from a reputable therapist who knows how to work with people with RA and chronic pain.

     I have found that at least a once a month massage makes a big difference, not only physically, but also mentally.  So often we "carry" stress in our necks so if you are tense or anxious, which many times accompanies RA and other chronic pain conditions, this may well manifest as tight neck muscles which then means pain...and more pain..often spreading out to shoulders, back and head.  Which brings me to yet another dilemma I have been dealing with of late.  HEADACHES!  

     I am not certain that my headaches are entirely related to RA but I know they can be.  This site examines some of the links between neck pain, headaches and RA and offers some great ideas to relieve them.

http://www.everydayhealth.com/rheumatoid-arthritis/when-rheumatoid-arthritis-gives-you-a-headache.aspx

In addition there are some useful tips to responding to RA headaches such as:

• Question your RA treatment. If you’ve taken Tylenol several days in a row and your headache is sticking around, you might want to talk to your rheumatologist to make sure that it’s not a side effect of your treatment or a new symptom (especially if you suspect that your shoulders or neck might be affected by rheumatoid arthritis).
• Consider your stress level. One possible reason that people with complicated health problems like RA also have headaches is stress. Stress management techniques, including appropriate exercise, deep breathing, or meditation, can help cut back on headaches as well.
• Stay hydrated. Independent of RA, you can get headaches if you don’t drink enough fluids during the day. You probably know how important it is to care for yourself, but even the most dedicated patient can forget to drink water when life gets busy.
• Get enough sleep. People who don't get high-quality sleep may also experience more headaches. Because RA pain can interfere with sleep, it may also contribute to headache pain. If you are having a hard time sleeping, let your doctor know. Likewise, any caffeine you may be relying on to get over fatigue can also contribute to headaches.
• Avoid cigarette smoke. For some people, smoking and being around secondhand smoke can trigger headaches — yet one more reason to avoid cigarettes and secondhand smoke exposure! 

    I personally have found some additional tools that work for me.  One of them is guided imagery.  There are many CD's on the market but without a doubt my favorite is Belleruth Naparstek.

     If I can get to a quiet, comfortable setting just as the headache begins, guided imagery, more often than not, will provide me with significant relief if not prevent it entirely.

She also has others that are wonderful including ones for arthritis, wellness, stress, etc.  They are all fantastic!

     Another strategy for me is an old fashioned but nonetheless surefire reliever, a cold cloth or ice pack AND drink lots of water!

     If the moment pain starts I place a cold cloth on my forehead or temples AND drink lots of water, I find it to be very helpful as the headache takes hold, often reducing the degree of pain and the length of the headache itself.   The key is to get to it promptly and not try to be a hero and keep on trying to "work through the pain".  That never works for me and just adds to the stress.

     One thing you may have noticed as you have read through this blog is that I have not mentioned medications.  That in no way means you should not consider them if you and your doctor believe that is the best alternative.  I offer other options here as much for their preventative value as for the fact that we are so inundated with medications for RA I wanted to present some alternatives to add to your ever growing RA Toolbox.  So not just when, but also BEFORE, you get that next headache and/or neck pain, try some of these tips and see if it does not work for you!

Nan