Understanding Pain and What Can Actually Help

In this Go With Us! episode from EULAR 2025, patient advocate Deb Constien dives into one of the most talked-about topics at the conference: chronic pain. If you live with autoimmune or autoinflammatory arthritis, you know pain isn’t just a symptom—it can affect every part of your life.

The day began with a powerful, patient focused session led by Nadia Malliou, President of Pain Alliance Europe, psychologist, and PhD student. She started by grounding the conversation in lived experience, which immediately resonated with many in the room.

One of the first clarifications she made was the difference between acute and chronic pain. Acute pain typically lasts up to three months. Chronic pain extends beyond that timeframe and often becomes a condition of its own.

Common symptoms of chronic pain go far beyond aching joints. Many patients experience:

• Persistent pain that does not fully go away
• Fatigue and stiffness
• Sleep disturbances
• Mood changes and social withdrawal
• Sensitivity to touch
• Appetite changes
• Cognitive difficulties or brain fog

She also explained that chronic pain is not a single category. There are several overlapping types:

• Chronic primary pain: which lasts longer than three months and is linked to emotional distress and functional limitations
• Chronic secondary pain: which comes from an underlying condition like rheumatoid arthritis, osteoarthritis, or cancer
• Nociplastic pain: such as fibromyalgia or widespread pain syndromes, where pain processing itself is altered
• Neuropathic pain: caused by nerve injury or disease, like sciatica or spinal cord injury

Many patients live with more than one type at the same time, which helps explain why pain can feel unpredictable or hard to treat.

Coping Strategies That Support The Whole Person

Rather than focusing only on medications, this session highlighted tools patients can use alongside medical care. These recommendations included physical therapy, pacing daily activities, and asking simple questions like whether something truly needs to be done right now or can wait.

Psychosocial support was emphasized as essential, not optional. Cognitive behavioral therapy, mindfulness practices, peer support groups, and mentoring can all help patients manage pain more effectively. Adaptive tools and technology were also discussed as practical ways to support daily function.

A key takeaway was the role of healthcare professionals. Empathy, respect, and listening matter. Not every rheumatologist specializes in pain, and pain specialists can play a critical role when pain becomes overwhelming. Shared decision making and individualized care planning were repeatedly emphasized.

Preventing Acute Pain From Becoming Chronic

The second session focused on a difficult but important question: how do we prevent acute pain from turning into chronic pain?

An integrative physician led this discussion and began by guiding the audience through a short mindfulness exercise, reminding everyone how awareness and regulation are part of pain care.

Some sobering statistics were shared. About 67 percent of healthcare visits are related to pain. Chronic pain is widespread, costly, frustrating for both patients and providers, and often associated with fragmented care, confusing diagnoses, medication side effects, and loss of productivity.

One resource highlighted was the US Academy of Medicine report on relieving pain. This work supports coaching and self care education as part of routine care. Studies show that this approach can reduce the risk of chronic pain and substance misuse, improve long term outcomes, increase patient satisfaction, and lower healthcare costs.

Risk factors like poor sleep, chronic stress, repeated strain, inactivity, and nutrition all influence pain progression. Protective factors, including movement, stress management, and support, can help slow that progression. Walking was specifically mentioned as one of the most accessible and effective activities for many people.

Unfortunately, training patients in whole person self care is still often overlooked in standard medical care.

Medications, Mixed Pain, and Why Pain is Underestimated

The next session explored pharmacological treatment of chronic musculoskeletal pain. One important concept introduced was the idea of a biological clock. In people with rheumatic and musculoskeletal diseases, this clock may be accelerated, contributing to more severe and persistent pain over time.

Pain severity is often underestimated because it does not always show up clearly on imaging or blood tests. When providers cannot see pain, patients may be unintentionally stigmatized or dismissed. This reinforces the need to believe patient reports and understand pain as multidimensional.

The speaker emphasized that pain is rarely just one thing. Many patients experience a mix of nociceptive, neuropathic, and nociplastic pain, sometimes all in the same day. This mixed pain model helps explain why single treatment approaches often fall short.

Cannabinoids were also discussed. Current evidence is considered low quality, and at this time THC and CBD are not broadly recommended for chronic musculoskeletal pain. At the same time, the speaker acknowledged that many patients report subjective benefit, highlighting the gap between research and lived experience.

Emerging pain treatments were briefly reviewed, including therapies targeting specific receptors and pathways. These are still largely in development but reflect growing interest in more targeted pain care.

Non Medication Approaches That Actually Help

The final session focused on non pharmacological treatments and showed just how important these approaches can be. Chronic pain affects about 20 percent of adults, and up to half of those individuals also experience severe depressive symptoms. One third live with high impact chronic pain that significantly limits daily life.

Non-drug treatments discussed included:

• Exercise therapy, which consistently improves pain and function
• Cognitive behavioral therapy and other psychological approaches
• Non-invasive brain stimulation
• Patient education and lifestyle changes
• Multidisciplinary care that addresses physical, emotional, and social health together
  
  

Acupuncture and multidisciplinary programs were shown to reduce pain and improve function. Psychological therapies were also found to be effective, reinforcing that pain is not just physical.



Non-invasive brain stimulation techniques were introduced, including repetitive transcranial magnetic stimulation (TMS), which is similar to Vagus Nerve Stimulation but doesn’t require surgery. TMS may help some patients with conditions like fibromyalgia.

The Big Picture Takeaway

Pain is not a failure of treatment or a sign of weakness. It is complex, deeply personal, and influenced by biology, emotions, environment, and experience. The strongest message from these sessions was that effective pain care must be personalized, integrated, and compassionate.

Medication can play a role, but it is rarely enough on its own. Supporting mental health, encouraging movement, addressing sleep and stress, and truly listening to patients are just as important.

As research continues to evolve, one thing is clear. People living with autoimmune and autoinflammatory arthritis deserve pain care that sees the whole person, not just a diagnosis.