Rheumatoid Arthritis – Can Hypnotherapy Help?

The term “arthritis” simply means inflammation or damage of the joints, and depending on who you ask, there are up to 200 different causes for it!

Osteoarthritis is the most common from of joint damage, affecting around 9 million people in the UK. It is often referred to as “wear & tear” arthritis, as it is more common in those over 50, with the joints showing damage to the cushioning cartilage of the joint. This is damage that accumulates over the years, or following overuse, injury or extra stress on the joints – for example, in sport or with obesity. It is characterised by temporary stiffness in the morning, and pain that gets worse with prolonged use of the joint. Most of us can expect osteoarthritis to affect a joint or two as we age, but it can generally be managed with mild painkillers and managing how much and how heavily we use that joint. Eventually, we may need to replace the original joint with an artificial one to maintain mobility, which generally works well.

Rheumatoid arthritis, on the other hand (and foot, and knee, and hip….!) results  from damage to the lining of the joints, which is caused by an ‘autoimmune’ response. This is where, for reasons that are not fully understood, the body’s immune system ‘attacks’ its own tissues, causing long term inflammation, leading to damage, or destruction of the joint. If not treated, the joint can become permanently deformed, even becoming fused and immovable.

Unlike osteoarthritis, RA as it is often known, usually affects both sides of the body symmetrically, whether or not they are the most used joints – it is commonly noticed in the small finger or toe joints first.  Additionally, the raised inflammation eventually has effects in other parts of the body unrelated to the joints, such as eyes, blood cells or heart, and often causes sufferers to be more fatigued than usual.

What causes someone to develop Rheumatoid Arthritis?

This is still a matter for research; but for now, scientists can tell us that for the 1% of the population in the UK with RA, both genetics and environment play their part. Triggers such as a virus, infection or stress and trauma may be the catalyst that starts the autoimmune response, and we know that smoking also makes developing RA more likely. Like many other autoimmune diseases, it is also more common in women, and it’s lifelong course means it is often associated with other physical and mental health issues such as pain, anaemia, depression, fatigue, and side effects from the medication are problematic.

How does the NHS treat Rheumatoid Arthritis?

RA can have such a detrimental effect on the whole person if left untreated, resulting in disability and a very much reduced quality of life that once diagnosed (which can take a while, due to the similarity of RA to many other diseases) treatment is often aggressive. Drugs to reduce the  inflammation are usually started by a specialist rheumatologist, with ongoing monitoring to manage both the progression of the RA and the side effects of the medication.

Due to its autoimmune cause, NICE (the National Institute for health and Clinical Excellence, the NHS body that oversees quality and efficacy of treatment)  recommend treating new cases of RA with drugs which slow the progression of the damage to the joints. These ‘disease modifying anti-rheumatic drugs’ or DMARDS can halt the destruction of the joint and improve symptoms dramatically, although they are slow to work, often taking weeks or months to show an effect. For this reason, ‘non-steroidal anti-inflammatory drugs’ or NSAIDS are often used alongside them, to reduce pain and swelling.

Both these classes of drugs have a long list of side effects, often requiring other medicines to counteract them – for example, NSAIDS can cause stomach ulcers, especially in older people, so should be given with ‘stomach protectants’ like omeprazole to prevent that.  DMARDS are often older medicines, with broad side effects, whose anti-rheumatoid effects are secondary to what they were developed for. For example, hydroxychloroquine was originally used against malaria before being co-opted in to the fight against RA; but its side effects include nausea, stomach cramps, diarrhoea and more serious effects such as changes in vision, anaemia, liver failure and eye or mouth blisters. Many of the other DMARDS have similarly unpleasant side effects and so they are commonly used as a cocktail of two or more drugs at lower doses, in order to get maximum joint sparing activity with minimum side effects.  Even then, patients are recommended regular liver function and blood tests to check their bodies are coping with the regime.

Newer developments in RA treatments include using powerful antibody based therapies, discovered during anti-cancer research, to block the body’s attack on its own tissues These are expensive, with the  side effects you’d expect from damping down the immune response – infections, increased cancer risk, and allergic reactions, but they can be life changing for patients that can cope with them.

What else can be done to help?

Well, as with most lifelong complaints, drugs are not the only story, and other organisations outside the NHS aim to promote awareness of other options.  NRAS, the National Rheumatoid Arthritis Society in particular aims to promote more ways to help those with RA live life to the full. They are a UK charity devoted specifically to being the voice of RA sufferers, championing the fight against RA & supporting, informing and empowering patients and carers. They are also working with healthcare professionals by advising, collaborating and educating – ultimately hoping to see more patient-centred development in RA care. They are a great source of information and I have included links to their website at the bottom of this article.

To minimise the long-term impact of RA, all the organisations I have mentioned – NICE, the NHS, NRAS – agree that it is imperative to minimise the damage to the joints; and the most effective way to do this is to maintain the anti-inflammatory control that drugs provide. But they also agree that drugs are not the only option. Using complementary therapies alongside the array of medication most patients are on has been shown to improve quality of life for RA sufferers by improving pain management, relieving the depression and anxiety common to the disease, and by making patients feel like they are in control of the RA rather than being its slave.

What is recommended? And, importantly, what has been shown to work?

There are many complementary therapies available outside the NHS framework, including acupuncture, craniosacral therapy, and some traditional herbal remedies. While many RA sufferers find these useful, there are limited studies that show their efficacy beyond their placebo effect, although most agree that with the exception of herbal medicines (which may interact with prescription drugs), there is no harm in trying them.

As a pharmacist, I am obviously well placed to advise my patients on how to get the most from their medicines. If you need more information here, all high street pharmacies offer a ‘medicine review’ service to give you information and improve your understanding of what your drugs do and how to get the best from them.

As a clinical hypnotherapist, I also believe that there is a real role for hypnotherapy in managing Rheumatoid Arthritis.

Hypnotherapy has long been seen as almost a ‘dark art’, mystical and full of drama with its watch swinging and mind control! Yet I’d like to feel that this is changing, with hypnotherapy becoming a credible clinical therapy. The modern, solution-focused hypnotherapy (SFH) that I practice as part of the nationwide Inspired To Change team, is a long way from the stage show version of hypnosis. Rooted in neuroscience, and with an emphasis on teaching you more about how your brain works, it has an ever-growing wealth of evidence for efficacy in several areas relevant to helping with RA.

All RA sufferers will probably agree that their RA was initially diagnosed following some sort of trigger, as I mentioned above; often a stressful life event, or physical crisis. It has long been accepted that ‘stress’, that bodily state characterised by high levels of the hormones adrenaline and cortisol, is damaging to our health. High levels of these stress hormones raise our body’s immune response to DEFCON 1, ramping up the inflammation, flooding the joints with tissue-attacking compounds and counteracting the effects of those NSAID and DMARD  medicines I discussed above. SFH can’t insulate you from all of life’s crises, of course; but it is immensely effective at changing how we manage that stress. It offers a variety of tools and techniques that rewire the brain, changing our clients’ mindset and approach to events. This not only gives them a real resilience to ride out challenging times, but does so in a way that keeps the stress hormone levels to a minimum, actually resulting in greatly reduced levels of cortisol and adrenaline. This limits the likelihood of flare ups in their RA, and potentially slows the course of their illness.

Secondly, managing such stressful situations better also allows clients to reduce their levels of anxiety, allowing them to focus on what they are able to achieve and enjoy despite their RA. This sense of fulfilment helps to prevent the depression that is common in those with RA, reducing both the risk of failing mental health and the daily medication burden that that can entail, if it were treated with antidepressants, sedatives and anti-anxiety drugs.

It goes without saying that as a chronic condition, RA is commonly associated with pain, whether from the swelling of the affected joints, the intrinsic tissue damage within, or the effects of inflammation elsewhere in the body.

RA patients are what healthcare professionals call ‘expert patients’, familiar with their condition and its likely complications, and so GP’s and specialists are often comfortable prescribing them several different strengths of pain medication – most sufferers have a selection of different types that they juggle to deal with their daily discomfort. These might include the NSAIDS that I mentioned earlier, combinations of high dose codeine & paracetamol and stronger opiate medication, often as slow-release capsules, or patches.

Hypnotherapy has long been used as an alternative to painkillers and teaching RA sufferers self-hypnosis can have a real place in reducing the amounts of prescription medication that they use to manage their pain. The sensation of ‘pain’ is very much mediated by the brain, so learning to alter our perception of pain as a stimulus can result in a much lower amount of medication being needed.

Clearly, reducing the level of opiate prescribing reduces the likelihood of dependence & side effects associated with the use of powerful drugs like morphine & fentanyl as well as avoiding the drowsiness and limitations to driving that result.  But I think self hypnosis can be even more valuable to patients by giving them back a sense of control over their pain.

When your body is under stress, or perceived threat, it reduces the energy it puts into those processes deemed ‘non essential’ for survival such as growing, healing, learning, digestion, or fertility. This makes sense from an evolutionary point of view – why use precious resources for these processes when your body thinks you may not survive to tell the tale? This is why when we’re under stress, we struggle to control our weight, to conceive, stay healthy & fight off illnesses or perform well.

Conversely, once we have reduced our physical and mental stress – they are inextricably linked – the body’s immune response is under control, with minimal levels of stress hormones, our bodily hormone systems ‘work’ better. Our weight, cholesterol and sugar control is better managed by insulin and other food related hormones, our fertility is improved and wounds and injuries heal quicker, while being more resistant to infection and illnesses. Given that RA patients already have a compromised immune system, it makes sense to make the most of what they can call on, and to maintain beneficial levels of sugars and cholesterol, helping to stave off cardiovascular problems and diabetes – both of which seem to be more common in RA patients.

Another little known bonus of using hypnotherapy is its ability to help recover movement after surgery, or injury. The brain, in its bony box, cannot tell the difference between events that are happening right now, and  being recalled as memories. So, imagining a limb moving activates the same nerve cells in the brain as actually moving that limb. RA patients can harness this to strengthen and mobilise the muscles around a joint after surgery, to hasten recovery by repeatedly visualising its movement.

In summary, hypnotherapy would seem to be a useful way of relieving stress, preventing flare ups and slowing down the disease progress, while allowing patients to deal better with pain, anxiety and reducing the amount of medication required on a daily basis.

Unfortunately sessions with an Inspired To Change therapist are not yet available under the NHS, but we’d love to change that which is why we are a part of a large research project collecting data and evidence of how helpful hypnotherapy can be.

To find out more about help and information on RA try www.nras.org.uk or https://www.nhs.uk/conditions/rheumatoid-arthritis/

If you would like to explore how hypnotherapy can help you overcome an addiction get in touch to book your FREE initial consultation with your local Inspired to Change hypnotherapist. Inspired to Change Hypnotherapists are based across the UK in Bristol, Cambridgeshire, Devon, Kent, Leicestershire, Northamptonshire, Norfolk and Somerset.

Inspired to Change Hypnotherapists are all recognised by the National Council for Hypnotherapy, the UK’s leading not-for-profit hypnotherapy professional association.

To find out how you can train as a solution focused hypnotherapist click here for our hypnotherapy school information

About the Author: Claire Noyelle practices from her tranquil garden therapy room at her home in Bearsted, Maidstone East, in the heart of the garden county of Kent. Claire is a member of the Association for Solution Focused Hypnotherapists, National Council for Hypnotherapy and the Complimentary and Natural Healthcare Council and a member of both the General Pharmaceutical Council and the Royal Pharmaceutical Society.