Arthritis & Chronic Pain

Arthritis is not one condition but a group of more than 100, all affecting joints and the tissues around them. Chronic pain means pain that lasts longer than three months, whether it comes from arthritis, an old injury, damaged nerves, or a cause that is never fully identified. Between them they account for more long-term disability in Canada than anything else.

What arthritis and chronic pain are, and what they are not

Arthritis is not a single diagnosis, and the difference between types changes the care you are offered. Osteoarthritis, the most common kind, has a page of its own. Inflammatory types such as rheumatoid arthritis work differently, and are usually managed by a rheumatologist. Working out which type you have is the main purpose of assessment, and the section below sets out the main groups.

Chronic pain is also not simply arthritis that has gone on too long. Pain lasting more than three months can continue after tissue has healed, because the nerves and pain-processing pathways stay sensitised, and it is real, measurable and treatable. Pain that centres on the back, on damaged nerves, on widespread tenderness, or on a recent injury is covered separately on our pages for low back pain, peripheral neuropathic pain, fibromyalgia and acute pain.

The main types of arthritis

The differences decide which tests are ordered, which specialist you see and what treatment is offered.

Osteoarthritis

The most common type. Cartilage and the bone beneath it change over time in a joint that has been heavily used, injured or loaded, most often the knees, hips, hands and spine. Pain tends to build with activity and ease with rest, at least early on, and stiffness after sitting still usually loosens within a few minutes of moving.

Inflammatory arthritis

Here the immune system attacks the lining of the joints. Rheumatoid arthritis commonly affects the same joints on both sides of the body, especially the hands and feet, with morning stiffness that can last more than 30 minutes. Psoriatic arthritis occurs in some people who have psoriasis, and can involve whole fingers or toes, the spine, and the points where tendons attach to bone. These conditions can affect more than joints, including the eyes, skin and lungs, and they bring a tiredness out of proportion to activity.

Gout

Gout is caused by crystals of uric acid forming inside a joint. It usually arrives as a sudden attack, often overnight and often in the big toe, leaving a joint that is intensely painful, hot, red and swollen. Attacks settle and then recur, and the joint can feel normal in between. Because a hot swollen joint can also mean infection, a new episode is assessed rather than assumed.

Signs and symptoms

• Joint pain, tenderness or aching that lasts weeks or longer
• Joint stiffness, especially in the morning, which can last more than 30 minutes in inflammatory arthritis
• Swelling, warmth or redness over one or more joints
• Pain in the same joints on both sides of the body, which is common in rheumatoid arthritis
• Feeling very tired, low in energy or generally unwell
• Sleep broken by pain, and low mood or anxiety that travels with ongoing pain
• Trouble with everyday tasks such as opening jars, climbing stairs, dressing or working

Symptoms differ a great deal from one person to the next, and most people have better stretches and worse ones rather than a steady level of pain.

Acute pain and chronic pain

Acute pain is an alarm. It follows an injury, an operation or an illness, it is roughly in proportion to what happened, and it fades as tissue heals.

Chronic pain works differently. When pain signals keep firing, the nerves that carry them and the parts of the spinal cord and brain that process them become more sensitive, so less input produces more pain. That is a measurable change in a system, not an exaggeration by the person feeling it. It is also why more scans are not always the answer: an image of a healed structure cannot show a sensitised nervous system.

For that reason chronic pain is now treated as a condition in its own right rather than as a symptom of something not yet found. It has its own assessment, its own treatments, and in Canada its own national plan through the Canadian Pain Task Force.

What raises the risk

Some risk factors cannot be changed:

• Getting older, since most types of arthritis become more common with age
• Being female, which is linked to higher rates of both arthritis and chronic pain in Canada
• Family history and certain inherited genetic markers, which matter most in rheumatoid arthritis and related conditions
• A previous joint injury or operation, or an earlier episode of severe or poorly controlled pain

Others can often be worked on, usually with support from a health care team:

• Smoking, which is a recognised risk factor for rheumatoid arthritis
• Carrying extra body weight, which increases load on the knees, hips and spine
• Physical inactivity, and work involving heavy lifting or repeated joint strain

Arthritis at any age

Arthritis is often pictured as something that arrives with old age. Arthritis Society Canada reports that half of Canadians living with arthritis are under 65. Inflammatory types in particular often begin during working years. Children develop arthritis too: juvenile idiopathic arthritis begins in childhood and is treated by paediatric rheumatology teams. Age matters at the other end as well, with around 1 in 3 Canadians aged 65 and older living with chronic pain, and being older is not a reason for pain to go unassessed.

How arthritis and chronic pain are diagnosed in Canada

Assessment usually starts with a family doctor or nurse practitioner, who takes a history of your pain, examines your joints, and asks how the pain affects sleep, mood, work and daily life. Blood tests such as inflammatory markers and antibodies, along with X-rays or ultrasound, help tell inflammatory arthritis apart from osteoarthritis, and rheumatoid arthritis is often confirmed by a rheumatologist. For chronic pain there is no single test, so clinicians rely on your account of the pain alongside an examination and, where needed, imaging or nerve testing to look for a specific cause.

Treatment and day-to-day management

Clinical research for Arthritis & Chronic Pain is enrolling. See the current studies ↓

Care in Canada is usually built from several parts at once rather than one treatment, and it is aimed at pain, function and sleep together. Depending on which condition you have and what matters most to you, a health care team may discuss:

• Physiotherapy, occupational therapy and exercise therapy, including supervised strengthening and aerobic programs and pacing strategies
• Psychological and self-management care, such as cognitive behavioural therapy for pain, mindfulness-based approaches, and group self-management programs
• Medicines for pain and inflammation chosen with a clinician, including acetaminophen, anti-inflammatory medicines, topical agents, and certain antidepressant and anticonvulsant medicines used for pain
• Disease-modifying antirheumatic drugs and biologic or targeted synthetic therapies for rheumatoid arthritis and other inflammatory types, usually managed by a rheumatologist
• Procedures and surgery, such as joint injections and joint replacement, plus referral to interdisciplinary pain clinics where they exist

Opioid medicines sit inside this picture rather than outside it. In Canada the 2024 Canadian Opioid Prescribing Guideline for chronic non-cancer pain sets out how clinicians and patients weigh potential benefits and harms together, including where non-opioid options have already been considered, and it also covers switching between medicines and tapering. What suits one person will not suit another, and these are decisions for you and your own clinician rather than something this page can settle.

Movement, activity and pacing

Movement is part of care rather than something to be earned once the pain has settled. Muscles that support a joint take load off it, and regular activity affects sleep, mood and how strongly the nervous system amplifies pain signals. Long rest tends to work the other way: strength drops, joints stiffen, and the amount of activity that provokes pain gets smaller.

Hurting during or after activity does not automatically mean harm is being done, which is one of the harder things about living with arthritis. It is also why the amount and the type matter, and why a physiotherapist tailors a programme to your joints, your other conditions and what you want to be able to do, rather than handing over a general routine. Occupational therapists approach the same problem from the other side, changing how a task is done so a joint is loaded differently.

Pacing is the term for spreading activity out so a good day is not paid for with three bad ones: shorter blocks, breaks planned before the pain arrives rather than after, and increases held for a while before the next one. It is one of the parts of care that continues at home between appointments.

Sleep, mood and pain

Pain, sleep and mood move together. Pain breaks sleep, short or broken sleep lowers the threshold at which pain is felt the next day, a run of poor nights pulls mood down, and low mood and anxiety make pain harder to live with and harder to stay active through. The loop can be entered, and worked on, from any direction.

Canadian pain care combines physical, psychological and medical approaches for this reason. Cognitive behavioural therapy for pain and for insomnia, mindfulness-based programs and group self-management courses address the sleep and mood side directly, and clinicians treat persistent low mood alongside the pain rather than after it.

When to talk to a doctor

• If a joint suddenly becomes hot, red, very painful and swollen and you have a fever or feel very unwell, seek medical care the same day, and go to an emergency department or call 911 if you are very unwell, because a joint infection is a medical emergency.
• If you have new weakness, numbness, or loss of bladder or bowel control along with back or limb pain, call 911 or go to an emergency department right away.
• If joint pain and stiffness are new and lasting more than six weeks, or come with unexplained weight loss, fevers or night sweats, book an appointment promptly, since early assessment matters in inflammatory arthritis.

Why clinical research matters for arthritis and chronic pain

Even with the care available today, many people in Canada still have pain that limits sleep, work and daily activity, and access to interdisciplinary pain care and rheumatology is uneven across the country. Researchers cannot yet reliably predict who will develop long-lasting pain after an injury or a flare, or who will respond to a given medicine, and nothing available has been shown to halt the joint damage of osteoarthritis. Studies now under way include non-opioid analgesics and drugs aimed at specific pain-signalling pathways, newer targeted therapies and treat-to-target strategies in rheumatoid arthritis, neuromodulation devices, and exercise and psychological programs delivered digitally or at a distance.

Clinical studies are how any of that gets tested. Taking part is voluntary, you give informed consent before anything begins, and you can stop at any time without affecting the care you get from your own doctor. Joining a study does not mean giving up your current treatment, and no one can say in advance whether a study will help you personally.

Learn more from Canadian sources

• Arthritis Society Canada
• Health Canada: Canadian Pain Task Force reports
• Pain BC: pain support line, education and self-management programs
• Public Health Agency of Canada: rheumatoid arthritis in Canada