Treating Pain in Autoimmune Disorders: What Works and What Doesn’t
Key takeaways:
People with autoimmune disorders can experience significant pain, which can impact their quality of life.
There are medications that relieve autoimmune pain short term, as well as some that can help control pain by treating the underlying cause of the disease.
Exercise can also have a positive effect on pain you’re experiencing from your autoimmune disorder.
Autoimmune disorders like rheumatoid arthritis, lupus, and ankylosing spondylitis can lead to inflammation in different parts of the body. This inflammation can also cause significant pain that impacts your quality of life, especially if your condition isn’t properly controlled. The good news is that there are medications and lifestyle changes that can help manage autoimmune disorders and the pain that they can cause.
Here we’ll cover what you should know about different options for pain management in autoimmune disorders and their potential side effects.
Why do autoimmune disorders cause pain and inflammation in the body?
Autoimmune disorders are caused by your immune system (the system in your body that fights outside infections) becoming “overactive” and attacking your own organs and tissues. There are many types of autoimmune disorders, and they can target different parts of the body. However, many have overlapping symptoms. One common symptom of most autoimmune disorders is inflammation.
The role of inflammation in autoimmune disorders
Inflammation occurs when the immune system “fights” a certain part of the body. White blood cells, which are the key “fighters” of the immune system, will move to an area where there is injury and bring blood and other “fighters” with them. This can cause swelling, redness, and pain.
There are two types of inflammation: acute and chronic. Acute inflammation can be a helpful response to fight off an infection or heal a wound, and it typically resolves when the infection is gone or the wound is healed. Chronic inflammation can be more dangerous and bothersome. This is the kind of inflammation that we worry about with autoimmune disorders.
For example, the temporary discomfort you feel after a papercut is a type of acute inflammation used to help your body heal the wound. But with autoimmune disorders, the inflammation lasts much longer, and the target could be your joints in your hands or knees. In this case, your body isn’t fighting off anything, and the pain you experience can become chronic.
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That said, while inflammation is the underlying driver of autoimmune disorders, it may present differently depending on your condition. More on this next.
Rheumatoid arthritis
In rheumatoid arthritis, pain and inflammation will typically occur in your joints, particularly those in your hands, wrists, and feet. Multiple joints are usually affected at once, and the pain is the worst when you wake up in the morning.
Lupus
People with lupus commonly report joint pain similar to rheumatoid arthritis, especially when they first start experiencing symptoms of the disease. But since lupus affects many different areas of your body, you may experience muscle pain, rashes, and fatigue, too.
There is also a strong correlation between lupus and fibromyalgia, which is a condition that presents with pain all over the body. In fact, about 30% of people with lupus also have fibromyalgia.
Ankylosing spondylitis
With ankylosing spondylitis, the inflammation targets your spine, which can cause pain and stiffness in your back.The first symptom of ankylosing spondylitis is most commonly a specific kind of back pain, which worsens with rest and improves with movement. Joints all over the body can also be involved and painful, including the hips, shoulders, hands, and feet.
Can over-the-counter pain relievers treat pain caused by autoimmune disorders?
Yes, over-the-counter (OTC) pain relievers can treat pain caused by some autoimmune disorders. However, they do have side effects to be aware of if you are going to use them regularly.
The most common OTC medications used to treat this kind of pain are non-steroidal antiinflammatory drugs (NSAIDs). They work well to lower inflammation, but they can have serious side effects including kidney damage and stomach ulcers.
Because of this, you should talk to your provider before using them if you have an autoimmune condition that affects your digestive tract, like Crohn’s disease or ulcerative colitis, or if you have kidney problems from lupus.
Due to the potential side effects, alternative medications may be recommended to use long term, including those that treat the disease itself. Even though many NSAIDs are OTC, you should talk to your healthcare provider if you are using them regularly.
What are the medication options for autoimmune treatment?
There are several medications approved for the treatment of autoimmune disorders, and new medications are currently being researched. These include medications that will help manage your symptoms like pain, as well as those that treat the underlying disease to prevent it from getting worse.
Short-term symptom management
While it is better to get control of your underlying disease and prevent symptoms like pain from ever bothering you, this does not always work. When you are actively in pain, you sometimes have to use medications to make yourself more comfortable.
NSAIDs: As discussed above, several of these medications are available OTC, but you can also get them at higher strengths with a prescription from your provider. They can be used short term to treat the pain and inflammation from autoimmune diseases. Examples include ibuprofen, naproxen, and meloxicam.
Keep in mind that these medications can potentially cause kidney damage and stomach ulcers, especially if you are using higher doses or using them long term.
Steroids: These medications are available in several different dosage forms, including oral and injectable products. They also reduce inflammation throughout the body. Steroids are typically used for brief periods of increased symptoms (“flares”) due to long-term side effects. Examples include prednisone, dexamethasone, and methylprednisolone.
Oral steroids can be tolerated well for a short period, but they do have significant side effects if taken longer, including weight gain, increased risk of infection, and bone loss. If you do need to take them for an extended period of time, it is best to take the lowest dose possible that brings your symptoms to a manageable level.
Steroids can also be given as an injection (typically into a joint — this is called an “intra-articular” injection) to reduce inflammation in one specific area. There can be a small amount of pain with the needle being inserted into the joint for the injection, but people generally tolerate these injections well. That said, it isn’t entirely clear how much of a benefit these injections actually provide for joint pain.
Disease-modifying treatments
There are several medications that work to combat the underlying autoimmune disease, rather than temporarily treating pain caused by it. While these medications don’t directly cause pain relief, you tend to experience less inflammatory pain when you’ve got better control of your autoimmune disorder.
We call these medications “disease-modifying anti-rheumatic drugs” or “DMARDs,” and they fall into two major categories: nonbiologic and biologic.
Nonbiologic DMARDs: These medications are also referred to as “traditional” or “conventional” DMARDs, and they have been around for decades. They work by broadly targeting different parts of the immune response to “dampen” your body’s ability to attack itself, and they are typically the first choice for treatment.
Some commonly used nonbiologic DMARDs are methotrexate, sulfasalazine, and hydroxychloroquine. These are all taken orally, but methotrexate is also available as a shot.
These medications have some overlapping side effects, as well as some that are unique to the specific treatment. For example, all of these medications weaken the immune system and make you more likely to get an infection, as well as cause headaches, upset your stomach, and lower your appetite.
Additionally, hydroxychloroquine can sometimes cause serious vision changes and irregular heartbeat, and sulfasalazine can make your skin more sensitive to sunlight. And it’s important to note that methotrexate also has a boxed warning (the most serious warning) about potential damage to different organs in your body, including your liver, kidneys, and lungs.
Biologic DMARDs: These are newer medications that were created with advanced technology to specifically target known parts of the immune response. These medications are not taken orally — instead, they are given as injections or infusions.
Biologic medications, while typically well tolerated, can have serious side effects in some people. For example, your infection risk goes up when taking a biologic since it affects your immune system. And this includes serious infections, too.
There is also a risk of reactivating (getting sick again from) a previous or current infection like tuberculosis (TB) or hepatitis B. Because of this, you’ll need to have a negative TB test and other bloodwork done before starting a biologic. They may also increase your risk of different cancers, but research related to this is ongoing.
Are medications that treat pain caused by autoimmune disorders covered by insurance?
NSAIDs are available OTC or by prescription. They are typically inexpensive over the counter, and insurance does not usually pay for them without a prescription. But if you are prescribed a high-dose prescription NSAID, it’ll typically be inexpensive through your insurance or if you pay cash.
Conventional DMARD medications that are taken orally like methotrexate, sulfasalazine, and hydroxychloroquine are all available as lower-cost generics that may be covered for a small copay. And even if they aren’t covered by your plan or if you don’t have insurance, you can still save over 60% off the retail price by using GoodRx.
Most biologics, however, are only available as expensive brand-name medications. Your insurance coverage will likely depend on which medication is preferred by your plan. But if your copay is still too expensive, check to see if the manufacturer offers a copay savings program to make it more affordable.
Can surgery help treat joint pain caused by autoimmune disorders?
Most people with autoimmune disorders (like rheumatoid arthritis) don’t get surgery, but some might elect to get a procedure to help with their pain if there is significant damage. This can be a complex decision with a lot of considerations. Below are a few examples of surgeries that are sometimes used to help alleviate pain and discomfort in joints that have been damaged by autoimmune disorders.
Joint replacement
A joint replacement (also called arthroplasty) can be a useful and successful procedure for a joint with a lot of damage. This procedure is most commonly done with larger joints (like hips and knees), but in certain situations can be done with smaller joints, too. Joint replacement is a good option if you have significant irreversible damage to a joint that impacts your ability to move or function.
Joint fusion
Joint fusion (called arthrodesis) is the surgical connection of two bones that are not normally connected. This procedure was used more often before joint replacements became easier and more successful. This is an option for someone who is experiencing severe pain in a joint that cannot be replaced, or for a joint replacement that failed.
Synovectomy
Synovium is the tissue surrounding a joint, and it can become inflamed or irritated in autoimmune disorders. Synovectomy is the removal of that tissue to try to relieve pain. This can be used when one particular joint is especially painful and not responding to medications.
Can exercise or physical therapy help treat muscle pain or back pain caused by autoimmune disorders?
Exercise and physical therapy provide many benefits for people with chronic health conditions, and they may help alleviate muscle pain or back pain caused by autoimmune disorders. We have good data from studies that confirm the positive effects of exercise for autoimmune-related pain.
In rheumatoid arthritis, exercise can help to decrease pain and improve strength. Exercise has also been shown to decrease fatigue in lupus. And for people with ankylosing spondylitis, exercise can lower overall disease activity to lessen pain and improve physical function.
Can dietary changes help prevent autoimmune flare ups?
We don’t know the answer to this question for sure, but ongoing research is promising that dietary changes may be able to lower overall body inflammation. In theory, this could help to prevent autoimmune flare-ups.
The bottom line
Autoimmune disorders are serious medical conditions that can lead to pain that interferes with your quality of life. Luckily, there are medications that specifically address autoimmune disorders and can help relieve your symptoms. If you have an autoimmune disorder, you should discuss treatment options (including medications and lifestyle changes) with your healthcare provider.
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