Pain and Arthritis
An Information Booklet
Introduction
This booklet is written primarily for people who have long-term (chronic) pain due to arthritis and related conditions. Many people with arthritis live with pain for years. Booklets about the different types of arthritis are available from the Arthritis Research Campaign (arc) and are mentioned in this booklet where appropriate; further sources of information are listed in the 'Useful addresses' section. We have also included a glossary of medical terms (like cartilage). We have put these in italics when they are first used in the booklet. The first part of the booklet explains what pain is and how the brain senses pain. The second part describes some common conditions that can cause pain in and around joints. The last part explains the different methods for helping people to control chronic pain – even if it cannot be cured completely.
What is pain?
Pain is a protective mechanism and acts as a warning. If your hand touches a hot surface it triggers a series of impulses from heat-sensitive nerve fibres. The result is a rapid reflex response. Your muscles react and pull your hand away. Although everyone understands what we mean by the word 'pain', it is difficult to define. Pain isn't just physical; it has emotional effects too – making us feel upset or distressed. Pain may result from a physical injury – for example, a cut, a broken bone or a burn. In other situations the 'injury' is internal and is caused by chemicals produced as the result of a process called inflammation – for example in many forms of arthritis. Our bodies have specialized nerve endings which detect temperature and chemical changes or mechanical stresses. The chemicals produced as a result of inflammation activate these nerve endings which send 'pain' signals via the spinal cord to the brain.
Pain can also be caused when these nerve endings or nerves are permanently damaged and begin to send signals to the spinal cord spontaneously, without needing a specific stimulus. This causes the nerves to signal pain for no reason, or in response to something that would not normally hurt, such as gentle stroking of the skin. Some people with arthritis, as well as some people with other diseases (such as shingles or diabetes), suffer this sort of pain. This type of pain often requires different treatments from the pain caused by stimulation of normal nerve endings.
In some instances it is difficult to explain the exact cause of chronic pain and impossible to make it go away completely, and this can add to the distress or anxiety. This type of chronic pain can be either confined to one part of the body or felt all over the body (chronic widespread pain). Fibromyalgia is one condition that causes chronic widespread pain which is difficult to explain or treat (see arc booklet 'Fibromyalgia'). Such conditions are a challenge to both the patient and the doctor. The fact that is hard to explain where the pain is coming from does not mean the pain is imaginary or 'psychological'. However, psychological factors can affect the way in which the brain senses physical pain.
Pain and the brain
The spinal cord has special 'gate' mechanisms. These interfere with pain messages coming from the nerves, and may block or deflect them so that the pain information which eventually reaches the brain is slightly altered. These 'gates' can either reduce the strength of the pain message reaching the brain or increase it.
Some treatments for pain are aimed at closing these 'gates' to reduce the sensation of pain – for example, transcutaneous electrical nerve stimulation (TENS), which helps to control some types of pain (see 'Other pain control methods').
Once the impact of the pain message gets through the spinal 'gate', it is further changed by even more complex systems in the brain. The pain message can be affected by a number of factors, for example by:
- how much you concentrate on the pain
- carrying out enjoyable activities, which can take your mind off the pain and make it more manageable
- unhappy feelings and thoughts and any anxiety or depression, which can worsen pain. This can happen even if the anxiety or depression was present before the pain started. Of course the pain itself can make you unhappy, which then worsens the pain, and this can create a vicious cycle.
- drugs which have a direct effect on the brain (and can therefore reduce the impact of pain).
Figure 1. Activities can help take your mind off the pain.
Short-lived pain
Most people have had first-hand experience of pain which is easily understandable, is manageable, and doesn't last very long. When someone touches a hot surface, the damage and the cause of pain is obvious. In a child's case, s/he may find it difficult to understand the pain at first, but after a few times it becomes easier to live with because experience tells us the pain will not last. Gout is a form of arthritis that causes short-lived attacks of pain, lasting only a few days (see arc booklet 'Gout').
Learning to cope with short-lived pain is an important part of growing up. The experiences of pain we have as children, and the way we are taught to cope with it, may strongly influence how we cope with pain in adult life.
Some conditions characterized by recurrent or chronic pain
This section describes some of the commonest causes of chronic pain in joints or muscles and the ways in which pain from these conditions can be treated.
Osteoarthritis
In osteoarthritis, the cartilage which covers the surface of the bones in the joints becomes roughened and thin. As a result the underlying bone also becomes damaged, causing pain, stiffness and deformity. Sometimes there may be swelling and a sudden increase in pain. When osteoarthritis affects the hands, the pain will often settle after a few weeks or months, although some deformity and stiffness may remain. In other joints, such as the hips, knees or spine, the pain may last a long time and, in some cases, it may severely limit normal activities. (See arc booklets 'Osteoarthritis', 'Osteoarthritis of the Knee'.)
Pain-relieving and anti-inflammatory drugs help many people. Physiotherapy, exercise and losing weight can also be very helpful. When there is a lot of swelling or fluid in the joint a steroid injection into the joint may also help (see arc leaflet 'Local Steroid Injections'). However, for some people effective relief from pain may only be achieved by surgery. The risk of surgery has to be weighed against the severity of the problem and the likely long-term benefit that surgery will produce.
Rheumatoid arthritis
Rheumatoid arthritis is a form of inflammatory arthritis. This means that the affected joints are inflamed, which makes them red, warm, swollen and painful. The pain may be persistent and difficult to control, but this is not true for everyone. Many people are greatly helped by drugs, periods of rest, and physiotherapy. For some, the arthritis goes away after a few months or years. For others it causes longer-term problems. People with rheumatoid arthritis need to be treated with drugs that are effective in controlling the disease and in reducing the risk of damage. These are sometimes called disease-modifying anti-rheumatoid drugs (DMARDs). They are not painkillers or anti-inflammatory drugs so they are not used to treat pain in osteoarthritis. Treatment with DMARDs is discussed in the arc booklet 'Rheumatoid Arthritis' and in the arc leaflets on various drugs. In the context of pain and arthritis, the important thing is that as these DMARDs control the disease the pain should also decrease.
For about 1 in 10 people with rheumatoid arthritis, however, the chronic joint pain never disappears completely. This pain is generally caused either by uncontrolled inflammation in and around the joints despite the use of DMARDs, or by the damage and instability which come as a result of the inflammation. Pain-relieving drugs and drugs that reduce inflammation may be very helpful (see arc leaflet 'Non-Steroidal Anti-Inflammatory Drugs'). It is also important to rest and exercise sensibly – a physiotherapist can advise on appropriate exercises. Surgery may sometimes be needed for particularly painful or deformed joints.
Neck and back pain
Most people experience short incidents of neck or back pain which improve without specific treatment. If the pain keeps returning, there are preventative approaches which can help deal with the problem. These include:
- doing exercises to strengthen the muscles
- taking special care in choosing the way you sit or the position in which you work
- taking extra care during leisure activities such as gardening or sport
- being careful when lifting heavy objects.
Occasionally spinal surgery is necessary, and it can be highly successful, but some people have pain even after spinal surgery so it should never be undertaken without careful thought and planning. (See arc booklets 'Back Pain', 'Pain in the Neck'.)
For some people back pain spreading down one or both legs (sciatica) is caused by pressure on nerve roots in the spine. This pain may be relieved by x-ray guided spinal injections, such as epidurals or nerve root blocks. These are specialist procedures, which are usually carried out in a day-case operating theatre.
A number of people have back or neck pain that fails to improve and becomes chronic. It is often difficult to understand why this has happened. For these people the pain is disabling and the challenge is to avoid it dominating their whole lives. At the outset it is not easy to predict who will end up in these circumstances. However, some people find that anxiety, depression or long-standing concerns about their health can make the pain more difficult to control. Neck pain after a whiplash injury can be very difficult to control in some people, but most improve with simple measures after a few weeks or months. The process of trying to claim compensation after such an injury is very stressful and this stress may contribute to persistence of the pain.
Chronic pain syndromes
Chronic headaches, facial pains and chronic upper limb pain syndrome – previously called repetitive strain injury (RSI) – are examples of chronic pain syndromes. In all of these situations it is difficult to describe exactly what causes the pain, which is affected by many factors, including the way in which the sufferer walks, stands and uses his/her muscles. In many cases the chronic pain leads to changes in the way people behave – which may then make the pain worse. For example, a person with chronic pain in the right leg may start to stand or walk leaning heavily to the left side, which may eventually lead to pain in the left leg too. When people have chronic pain that prevents them from doing things that they need or want to do, this may often affect their mood and feelings, leading to frustration, anxiety and depression. Just like changes in the way people walk or stand, these changes in mood can make the pain feel worse too. As there is no cure or simple explanation for many of these chronic pain syndromes, people in chronic pain may see a large number of specialists and sometimes receive different, or even contradictory, explanations and a wide variety of suggested treatments. Because the problem seems to worsen without any cure being available, the person in pain may feel let down by modern medicine. Since it is so difficult to explain what causes the pain and why it does not improve, people often find it hard to help family, friends, work colleagues and health care professionals to understand how they are feeling. Those people, in turn, may then find it difficult to deal with the problem. However, there are pain management clinics, specializing in the care of chronic pain, which are set up to enable people in these circumstances to cope better. Your GP should be able to refer you for advice and help.
One condition is called complex regional pain syndrome (or reflex sympathetic dystrophy). It is pain confined to a particular region of the body (e.g. one arm or one leg) and may follow a minor injury, an operation or a stroke. It is difficult to treat unless recognized early and treated appropriately. Even then the condition may become chronically painful, and joints and muscles may become stiff and contracted. If severe, referral to a pain specialist is essential. (See arc booklet 'Reflex Sympathetic Dystrophy (Complex Regional Pain Syndrome)'.)
Pain control
Some people learn to cope with pain with the help of drugs, physical treatments and other techniques. Others find their pain more difficult to deal with. Understandably, it may become a dominating and negative force in their lives. The good news is that there are new approaches available to help manage pain better. These approaches can still be helpful even if the person is already coping well. One of the keys to handling pain is to understand what is happening. It is important to understand what treatments are available, what they entail, and why they are helpful. Understanding more about the pain itself, including its causes and its different characteristics, can also help people to cope better, even though it does not cure the pain.
Drugs
The use of drugs has been the most important advance in the control of pain over the last century or so. Before 1900, aspirin and simple derivatives of opium (similar to morphine) were the only pain-relieving drugs available, but now there are many more. Although the drawback of a growing use of drugs has been an increase in side-effects, in general these risks are far outweighed by the benefits. Nevertheless, the balance of benefit and risk should always be considered.
Drugs may be available under several different names. Each drug will have an approved (or generic) name but manufacturers often give their own brand or trade name to the drug as well. For example, diclofenac, Voltarol and Diclomax are all the same drug. Diclofenac is the approved name; Voltarol and Diclomax are brand names for diclofenac made by different companies. This can be very confusing. The approved name should always be on the pharmacist's label even if a brand name appears on the packaging, but check with your doctor, nurse or pharmacist if you are in any doubt. We will use the approved names in the sections which follow.
Painkilling (analgesic) drugs
Drugs that act specifically against pain are called analgesics. They include simple analgesics such as paracetamol. More complex analgesic drugs are related chemically to morphine, but are much less likely than morphine to cause problems such as addiction. These include codeine, dextropropoxyphene and dihydrocodeine. These are often used more effectively in combination with paracetamol, and are made as compound tablets – e.g. paracetamol and codeine (co-codamol) or paracetamol and dihydrocodeine (co-dydramol). These compounds often cause constipation and may produce drowsiness, especially if taken with alcohol. They may, however, be very helpful for most types of pain. Stronger drugs include slow-release morphine or patches containing fentanyl or buprenorphine. They are necessary in some people with severe pain but are used with more caution.
Non-steroidal anti-inflammatory drugs (NSAIDs)
NSAIDs combine pain-relieving effects with an additional action which reduces inflammation. As inflammation is the main cause of pain in many conditions – including most forms of arthritis – these drugs can be doubly effective. Their development has been a major breakthrough in the care of people with arthritis, spinal pain and other chronically painful conditions. They are also used for painful periods, headaches and kidney pain. They can be used in combination with the simple or compound analgesics mentioned above. They can be helpful even when there is not a great deal of inflammation as, for example, in osteoarthritis.
Ibuprofen is an NSAID tablet which is available over the counter without prescription, reflecting its good safety record – although it can sometimes cause indigestion and ulcers even when it is taken with food. Other commonly available NSAID tablets include diclofenac, naproxen and indometacin. These are only available with a doctor's prescription. NSAID gels which are applied to the skin around painful joints help some people and are safe as long as not too much is applied at any one time. These may sometimes produce local skin irritation.
Indigestion and inflammation of the stomach are relatively common side-effects of NSAIDs, including aspirin. Surprisingly, NSAIDs can make some people constipated while others develop diarrhoea. All NSAIDs can sometimes make asthma worse, and other possible side-effects include skin rashes, headaches, muzziness and dizziness. People with kidney problems or who take high doses of diuretic ('water') tablets should be especially careful. Elderly people are often more prone to side-effects from most drugs and they must therefore use NSAIDs with caution. (See arc leaflet 'Non-Steroidal Anti-Inflammatory Drugs'.) A peptic ulcer is a rarer but more serious side-effect of NSAIDs. Anyone who has had severe indigestion or peptic ulcers in the past should usually avoid using NSAIDs.
A new type of NSAID became available a few years ago. These COX-2-specific NSAIDs, commonly called coxibs, were designed to control pain but with a lower risk of producing indigestion and stomach ulcers. It has become clear, however, that these newer NSAIDs (and probably also the older, less specific, ones) may cause a small but important increase in the risk of heart disease and stroke. Although coxibs were used particularly in people at risk of serious stomach problems – the elderly, those with a past history of peptic ulcers, or heavy smokers or drinkers – they are now used less commonly. They should be avoided in people with a strong family history of stroke or heart disease or who have high blood pressure that is not controlled by medication. Some people take low-dose aspirin to help reduce their risk of heart disease and stroke, but this should not be taken at the same time as other NSAIDs unless your doctor feels this is necessary.
Corticosteroid drugs
Corticosteroid drugs (steroids) may be given either as tablets or by injection. Steroids have had a lot of publicity about their side-effects. Perhaps too little attention has been paid to the fact that they are very effective drugs and can sometimes save lives.
Prednisolone is the most commonly prescribed steroid tablet for inflammatory arthritis (see arc leaflet 'Steroid Tablets'). Side-effects usually develop only when steroid tablets are used for more than a few months, and are more likely to occur with larger doses. The commonest side-effects are increased appetite and weight gain, muscle weakness, and anxiety or sleeplessness. They may also cause thin, slow-to-heal skin or thin, fragile bones (osteoporosis). However, the risk of developing osteoporosis can be reduced by medication (see arc leaflet 'Drugs for Osteoporosis'). It is important that steroids are used appropriately and in correct dosages. They are not themselves painkillers but, by reducing inflammation, they also reduce the pain. In certain conditions steroid tablets are prescribed because nothing else works, such as in polymyalgia rheumatica (see arc booklet 'Polymyalgia Rheumatica (PMR)').
Steroids can also be given by injection – either into the joint itself or into soft tissues near the joint. Steroid injections are usually very effective in relieving pain and the benefit can last from a few weeks to several months. Sometimes the pain may flare up for a day or so just after the injection before settling down. (See arc leaflet 'Local Steroid Injections'.)
Drugs which help nerve pain and other chronic pain syndromes
Low doses of drugs called tricyclic antidepressants (most commonly amitriptyline or dosulepin) are prescribed at night for people who have chronic widespread pain (especially those who have fibromyalgia). Disturbed or unrefreshing sleep is thought to contribute to the ongoing pain. These drugs act in part by improving sleep and in part by helping the brain to control sensations coming from the trunk and limbs. At the doses used in chronic pain they are not truly anti-depressant. Side-effects include dopiness in the morning and a dry mouth, although these are usually not a problem if the dose is increased slowly.
Gabapentin, carbamazepine and pregabalin are members of a group of drugs which are also used to treat epilepsy. They have an important role in controlling some types of pain, particularly pain that is due to nerve damage.
Nerve blocks and other injection techniques for pain
Increasingly, pain specialists are using injection techniques that aim to 'block' pain by a direct action on a nerve or on the spinal nerve root. These injections usually combine a local anaesthetic with a corticosteroid. The exact site for the injection can usually be decided only after special scans, such as magnetic resonance imaging (MRI) or computerized tomography (CT). The specialist can then place the needle accurately by following an x-ray image, which is displayed on a screen. These are skilled techniques used by specially trained pain specialists in pain management centres. They are not suitable for all types of pain. Osteoarthritis of the small facet joints between the spinal vertebrae and compression of nerves in the lower spine are examples of conditions for which these injections can be useful.
Other pain control methods
A variety of different techniques can be helpful in reducing pain. Simple measures include the warmth from a hot-water bottle or heating pad, cold from an ice pack or a cold-water compress, massage (with or without the use of creams which create a sense of warmth), and rest. These techniques are often helpful after an injury and for acute flare-ups of more chronic arthritis or back pain. They do not cure the problem, but they are soothing and safe when used carefully.
Other physical methods are used by practitioners such as physiotherapists, osteopaths and chiropractors. They use a variety of different manual techniques, including massage, manipulation and stretching, to relieve pain and to help return the muscles and joints to normal. They may also use electrical techniques, such as ultrasound, laser or interferential treatment. Exercise programmes, initially supervised by a physiotherapist, may help to control musculoskeletal pain. They help to relax and strengthen the muscles and may also improve general fitness. Pilates exercises are becoming increasingly popular for helping people with back pain. Exercise at a time when you are least stiff and take painkillers before exercise (if required). After exercise, take time to relax and rest.
Figure 2. Physiotherapists use a variety of techniques to relieve pain.
It is important to go to a qualified practitioner, preferably with the advice and guidance of your doctor. If there is no improvement after a few weeks of treatment, further investigations may be needed. It is better to exercise little and often rather than occasionally. Find a form of exercise that you can enjoy so that you are more likely to continue it. It may be helpful to find a friend who can join you in the exercise, encourage and support you.
Transcutaneous electrical nerve stimulation (TENS)
This is a technique that uses small pulses of electricity which produce a tingling sensation. It aims to reduce the sensitivity of the nerve endings in the spinal cord in order to close the pain 'gates'. It does not help everybody, but some people find it is a very effective means of pain control, especially when the pain is due to nerve damage. TENS has few side-effects, although some people become allergic to the jelly used to apply the pads. A physiotherapist will usually advise on the correct position of the pads, how to select the frequency and strength of the pulses, and how long the treatment should last.
Figure 3. The TENS machine can be very effective.
Acupuncture
Acupuncture has become popular in this country recently and is used by doctors and other practitioners for many purposes. It is sometimes used to relieve pain, often with good effect. Very fine needles are inserted into specific points in the body. It is thought to work by diverting or changing the painful sensations which are sent to the brain and by stimulating the body's own pain-relieving hormones (endorphins and encephalins).
Figure 4. Acupuncture is often used with good effect.
Psychological techniques
The role of the psychologist is an important one, which is often misunderstood. Psychologists are specialists who often work as part of the team in pain management clinics, and help in teaching people how to think differently about their pain and other problems and to modify their behaviour accordingly. Sometimes involving groups of people with similar pain problems, these techniques are increasingly used to help people develop better ways of managing their symptoms.
Although some people are suspicious of this approach at first, it has proved to be very successful. Pain is never a purely physical phenomenon. It may make one person feel more isolated, another more irritable, more depressed, or more dependent on others. When the pain is chronic, or its cause is difficult to determine, the psychological and social effects need to be specifically addressed.
Relaxation techniques and sleep patterns
Relaxation techniques are helpful in many conditions. They work partly by relaxing the tense and painful muscles and partly by relieving the anxiety that makes pain more difficult to bear. Relaxation tapes, yoga, special methods like the Alexander technique (which teaches awareness of posture and relaxation to reduce muscle tension) and sometimes hypnosis can be helpful. They are often used by pain management clinics. It is worth asking your doctor's views about these approaches.
It is well-recognized that disturbed or unrefreshing sleep increases symptoms of pain – especially muscle pain. Unrefreshing sleep means that you wake up still feeling very tired. If you have unrefreshing sleep or wake frequently during the night, a doctor or physiotherapist may be able to give you advice about improving this.
Pain management
Unfortunately, for some people pain is long-lasting, does not respond fully to drugs or physical treatments, and cannot be cured by surgery. Time sometimes helps people to adjust, but the pain may continue and come to dominate life. In this case altering your lifestyle may be important. Learning to rest sensibly, avoiding certain activities, asking for help, and using gadgets and home adaptations are all important ways of adjusting and learning to cope. A doctor, social worker, physiotherapist or occupational therapist can help with these changes. New hobbies, new outlooks and the love and support of family and friends can help to make the pain bearable and, for many, make life enjoyable again.
There remains an even smaller minority who – despite everything – still have significant disabling pain. People affected in this way should be referred to a specialist pain management clinic. Often the pain means they have to rest for long periods, or can only walk or move awkwardly. This can result in a vicious circle of pain, anxiety and depression. In this situation, it is easy to become weak and increasingly isolated or dependent on others. But it is possible for people to learn new ways to cope with their pain and keep on living a worthwhile and fulfilling life. It can be difficult to pluck up the courage to do exercises despite the pain, to find other things to concentrate on and to refocus thoughts away from the pain. However, with help from family and friends, as well as from specialists, this can be achieved.
Figure 5. Group discussion is sometimes used by pain management clinics.
Conclusion
Pain can be treated and usually settles by itself over time. For people whose pain becomes a more permanent part of life, there are many techniques available which, alone or in combination, can be effective. In these cases, it is often a question of seeking specialist help and advice from a pain management clinic and then seeing what is effective for you. Your GP or another specialist will be able to refer you to a pain management clinic – a list of clinics can be obtained from the British Pain Society (see 'Useful addresses').
Glossary
Cartilage – strong material on bone ends that acts as a shock absorber. Its slippery surface allows smooth movement between bones.
Computerized tomography (CT) – a type of scan which records images of sections or 'slices' of the body using x-rays. These images are then transformed by a computer into cross-sectional pictures.
Disease-modifying anti-rheumatoid drugs (DMARDs) – drugs used in rheumatoid arthritis to suppress the disease and reduce inflammation. Unlike painkillers and non-steroidal anti-inflammatory drugs (NSAIDs), DMARDs treat the disease itself rather than just reducing the pain and stiffness caused by the disease. Some examples of DMARDs are methotrexate, sulfasalazine, gold, infliximab, etanercept and adalimumab.
Interferential treatment – a type of electrotherapy which uses two stimulating currents delivered via pads placed on the skin. Electrical interference where the two currents cross can help to relieve pain, increase blood flow and reduce swelling.
Magnetic resonance imaging (MRI) – a type of scan which uses a strong magnetic field to build up pictures of the inside of the body. It works by detecting water molecules in the body's tissue which give out a characteristic signal in the magnetic field.
Peptic ulcer – a hole in the lining of the digestive tract. Non-steroidal anti-inflammatory drugs (NSAIDs) can cause peptic ulcers in the stomach.
Spinal cord – a cord which runs down the centre of the spine and contains the nerves which connect the brain to all the other parts of the body. The nerve fibres are surrounded by several protective layers and pass through the bones of the back (vertebrae). The spinal cord and the brain together form the central nervous system.
Useful addresses
Arthritis Research Campaign (arc)
PO Box 177, Chesterfield
Derbyshire S41 7TQ
Phone: 0870 850 5000
www.arc.org.uk
As well as funding research, we produce a range of free information booklets and leaflets. Please contact the address above for a list of titles or, on this website, see Publications for People with Arthritis.
Arthritis Care
18 Stephenson Way
London NW1 2HD
Phone: 020 7380 6500
Helpline (freephone): 0808 800 4050
www.arthritiscare.org.uk
Offers self-help support, a helpline service, and a range of leaflets on arthritis.
Action on Pain
20 Necton Road
Little Dunham
Norfolk PE32 2DN
Phone: 01760 725993
Helpline: 0845 603 1593
www.action-on-pain.co.uk
Provides advice, practical help and support to people living with or affected by chronic pain.
British Acupuncture Council
63 Jeddo Road
London W12 9HQ
Phone: 020 8735 0400
www.acupuncture.org.uk
Publishes a full list of qualified practitioners and general information on acupuncture.
British Medical Acupuncture Society
BMAS House, 3 Winnington Court
Northwich
Cheshire CW8 1AQ
Phone: 01606 786782
Royal London Homoeopathic Hospital
60 Great Ormond Street
London WC1N 3HR
Phone: 020 7713 9437
Provides information on acupuncture and a list of practitioners who are medical doctors.
British Pain Society
3rd Floor, Churchill House
35 Red Lion Square
London WC1R 4SG
Phone: 020 7269 7840
www.britishpainsociety.org
Can supply information for the public and health professionals, including a list of pain management clinics.
Pain Relief Foundation
Clinical Sciences Centre
University Hospital Aintree
Lower Lane
Liverpool L9 7AL
Phone: 0151 529 5820
www.painrelieffoundation.org.uk
Carries out research into relief of chronic pain and provides information for the public.
Society of Teachers of the Alexander Technique (STAT)
1st Floor, Linton House
39–51 Highgate Road
London NW5 1RS
Phone: 020 7482 5135
www.stat.org.uk
Can supply a free list of practitioners of the technique.
Information on drugs
Separate arc leaflets are available on many of the drugs used for arthritis and related conditions. We would recommend that you read the relevant leaflets for more detailed information about your medication.
