Stress is a factor in everyone’s life, but when illness strikes it only seems to make matters worse. In fact, many doctors and healthcare providers point out that stress can actually make arthritic conditions worse. Stress may even hasten the progression of the disease.
In particular, researchers discovered that stress in dealing with family members and others appears to worsen arthritis patients’ reports of pain and joint tenderness, and these anecdotes are supported by laboratory-measured physiological markers of increased disease activity.
“How we deal with and adapt to various problems in our lives has a direct relationship with the course of illnesses that we may have,” says Alex J. Zautra, Ph.D., of Arizona State University, Tempe.
“People with a chronic illness like arthritis must learn not only to manage the negative emotional consequences of having a painful disease, they also need to preserve some positive engagement with activities that do not simply revolve around managing illness and pain. Both of these tasks are important, not only in terms of their quality of life but perhaps also in terms of affecting the course of the disease.”
Studies on Stress
In one study, Zautra and his colleagues followed 41 women with rheumatoid arthritis for 12 to 20 weeks, interviewing them weekly about stressful events and encounters with family members and their overall pain and functioning. During particularly stressful weeks, clinicians drew blood from the women to assess immune system activity and inflammation, and rated the overall severity of their disease.
Stressful encounters with family members, particularly spouses, were the women’s primary sources of stress. During the stressful periods, the women not only reported significantly more pain, the clinical exams revealed more joint tenderness and swelling. Their blood samples also had greater T-cell activity and levels of another immune system component, interleukin 2-receptors, signaling an increase in inflammation.
Zautra and his team also found that the effects of stress were not as severe for women who remained actively engaged with others, particularly spouses. For those who tended to withdraw, as people often do when they are also depressed, stress had a stronger effect on arthritis symptoms.
“That kind of response may not only worsen arthritis patients’ quality of life and their ability to adapt to the disease, but we suspect it may also affect the disease itself,” Zautra says.
More recently Zautra and colleagues have been examining the effects of stress and depression in 100 patients with rheumatoid arthritis, 90 patients with osteoarthritis, and 90 healthy controls.
Both RA and OA affected by stress
Preliminary results show that both rheumatoid arthritis and osteoarthritis patients report more pain, joint tenderness, and swelling when stressed, Zautra says. Those who were depressed showed a greater reaction and more sustained increase in arthritis symptoms and activity in response to stress.
Additionally, rheumatoid arthritis patients seemed to get more depressed in
response to stress than did osteoarthritis patients.
“We think there is an important difference between rheumatoid arthritis patients and osteoarthritis patients and how depression affects their reaction to stress,” Zautra says. “And we suspect it is regulated through immune changes, both as a function of having depression and having an autoimmune disease.”
Ways to cope with stress
So how can an already sick person handle stress? There are several tried and tested ways that are easy and accessible to everyone. One thing that many of us need is time to ourselves and with the demands of family, however well-meaning they may be, it can be very difficult to get five minutes alone. But that may be all that is needed to help get a handle on stress – five minutes.
If you keep an appointment book try scheduling in those five minutes – it may be easier to keep an ‘appointment’ with yourself that way. Or just put it on the calendar, refrigerator or bulletin board for all family members to see, and know that you won’t be available at that time.
Once you have that time set aside, what will you do with it? First, breathe. Often we forget to breathe deeply enough, only inhaling short shallow breaths from our upper chest. Place your hand on your stomach over your belly button and breathe into this area. Close your eyes and feel the movement of the body as you inhale nice, long deep breaths.
Do a slow count to five if it helps you to lengthen the duration of the breaths. Breathe deeply like this four or five times. You’ll be surprised how this one tool can help you get through a painful episode, or simply help you to calm down from all the pressures around you. And all it takes is five minutes.
Sometimes people who suffer from chronic pain need more than five minutes to help them. There are several well-known stress management programs available for chronic pain sufferers, and often the programs are affiliated with a medical or research institution.
Stress management programs for chronic pain sufferers
Jon Kabat-Zinn, Ph.D, Associate Professor of Medicine and Director of the Stress Reduction Clinic founded one of the foremost stress-management programs in the country at the University of Massachusetts. The program is called Mindfulness-Based Stress Reduction. The clinic is designed to teach people with a wide range of medical conditions including chronic pain and stress-related problems how to take better care of themselves as a complement to their medical treatments and care.
People can access the techniques taught at the clinic by listening to the cassette tapes from the course or by reading Zinn’s book Full Catastrophe Living: Using the Wisdom of Your Body and Mind to Face Stress, Pain, and Illness (Delta, 1990). Alternatively, you can email the clinic for more information at firstname.lastname@example.org.
There are many other resources and programs available. The Arthritis Foundation has local chapters all over the USA and they have many tips on stress management. They can put you in touch with a support group or sign you up for an Arthritis Foundation Self-Help Course. Learning how others cope can be a valuable source of ideas for handling your own difficulties.
Remember, the less stressed you feel and the more you know about dealing with stress in your life, the more likely your arthritis symptoms will be kept at bay.
Additional material used with permission of the Center for the Advancement of Health Studies