Like many chronic conditions, the symptoms of osteoarthritis can fluctuate. Experiencing these ‘exacerbations’ in pain from osteoarthritis can be very challenging and can affect the quality of your life. This fact sheet has been written for you to understand the impact of personal factors contributing to your experience of pain and learn techniques that may help you manage pain. Sources of further information are also included. 

What causes osteoarthritis pain? 

Osteoarthritis pain can be caused by: 

• decreased physical activity and sedentary lifestyle. 
• inflammation, the process that causes heat and swelling in your joints limited joint movement. 
• different factors related to your personal lifestyle and living/working environments.
• avoiding physical activity and other personal responses to pain. 

Sudden but temporary increases in pain are common in osteoarthritis. This is where you experience pain above what you usually experience. Yet, while exacerbations in pain are common, the underlying reasons for pain are not fully understood.¹ 

The impact of personal factors on the experience of pain 

Pain is a complex sensation which is influenced by a variety of physical, emotional, social and environmental factors, rather than solely related to changes in the joints. 

Pain is linked to your personal situation, including, but not limited to:

• your life stage 
• mental health 
• social life and relationships 
• lifestyle 
• other conditions and overall health status.

Pain, stress, fatigue (tiredness) and depression all affect each other. For example, people who feel depressed or anxious have been found to be more sensitive to pain.² The good news is that this pain can be managed by using some of the strategies described below. 

The good news is, you can manage your pain! 

Pain may change how you perform your daily activities. But it doesn’t have to control your life. Your mind plays an important role in how you feel pain. Thinking of pain as a signal to take positive action rather than being scared or worried about it can be helpful^.3 Also, you can learn ways to manage your pain. What works for one person may not work for another, so you may have to try different techniques until you find what works best for you. 

Here are some things you can try: 

Exercise and physical activity. Research has shown that staying physically active and doing regular appropriate exercise can help reduce pain. It also keeps your joints moving, strengthens muscles to support your joints, reduces stress and improves sleep. A health professional (such as a physiotherapist) or your doctor can help you work out a program suitable for you. See the Physical activity information sheet. 

Take care of your joints and pace your activity. Looking after your joints during your daily activities can help reduce pain, stress and tiredness. It involves simple habits such as: 

• Undertake gentle movements with frequent rest periods 
• modifying activities to reduce pain, and break up activities through the day 
• using aids and assistive devices (e.g. walking stick, braces) can make tasks easier. 
• ask for help if you need it. 

Take medicines wisely. Some medicines can help control the pain of osteoarthritis. Your doctor or pharmacist can help you understand which medicines are right for you and how best to use them. See the Medicines and arthritis information sheet. 

Use heat and cold. The benefits of heat and cold for osteoarthritis are yet to be proven by research. However, these treatments can be soothing and safe when used carefully. Heat relaxes your muscles and stimulates blood circulation. You could try a warm bath or place a heat pack or hot water bottle over the painful area for 15 minutes. Cold numbs the painful area and reduces swelling. Applying cold treatments, such as ice packs, to the painful area for 15 minutes may be especially useful for hot, swollen joints, such as during a ‘flare’. You can repeat heat or cold treatments throughout the day. Make sure the temperature of your skin has returned to normal before re-applying, to prevent any skin irritation. Ask your doctor or physiotherapist whether heat or cold is best for you. 

See the managing fatigue information sheet 

Other things you could try for osteoarthritis pain: 

Mind techniques 

Relaxation: Relaxation techniques, such as deep breathing and visualisation (mental pictures), can help you reduce stress and muscle tension. These techniques need to be practised and you may have to try several methods before you find one that works for you. There are many podcasts and books available to help you learn relaxation techniques. 

Distraction: Focusing your attention on something other than your pain can also help you cope with pain. This might involve exercising, reading, listening to music or other methods to take your mind away from your pain. 

Cognitive Behavioral Therapy (CBT): for pain management is a therapeutic approach that addresses pain by targeting negative thought patterns and behaviors associated with it. This evidence-based method involves challenging and modifying irrational beliefs about pain, introducing behavioral strategies such as relaxation techniques and gradual activity pacing, setting realistic goals, and incorporating mindfulness to enhance awareness and acceptance. While CBT doesn't eliminate physical pain, it empowers individuals to cope more effectively, improving their overall quality of life and helps lessen the emotional impact often associated with pain conditions.

Contact your local Arthritis Office for details of self-management courses that can teach you these techniques. You may also find it useful to see a psychologist to learn other mind techniques to help you cope with pain. To find a psychologist contact the Australian Psychological Society on 1800 333 497 or visit www.psychology.org.au 

Massage. There are limited scientific studies that show massage may temporarily improve pain and mobility of joints and muscles4. Make sure the massage therapist has experience working with people who have arthritis. You can find a qualified therapist by contacting the Australian Association of Massage Therapists at www.aamt.com.au or 1300 138 872, or the Institute of Registered Myotherapists of Australia at www.myotherapy.org.au or (03) 9418 3913. See the Massage and arthritis information sheet.

Acupuncture. Acupuncture is an ancient Chinese practice of putting small, thin needles into the skin at specific points on the body to block the pain signal. The benefits of acupuncture for arthritis are not proven by research and this treatment can be expensive.5 However, some people may find it useful alongside other proven recommendations, such as physical activity and exercise. The Australian Acupuncture and Chinese Medicine Association can help you find an accredited practitioner at www.acupuncture.org.au or 1300 725 334. 

Transcutaneous electrical nerve stimulation (TENS). A TENS machine applies very mild electric pulses to block pain messages going from the painful area to your brain. The benefits of TENS for arthritis are yet to be proven by research.^4,5 TENS may be useful for longer term pain but does not work for all people. See a physiotherapist to trial a TENS machine, and to learn how to use it correctly, before you buy one.

Your healthcare team can give you more advice and information about whether any of these or other treatments might be useful for you. 

Other Resources

 State/Territory Arthritis Offices 

Your local Arthritis Office can provide further information to assist you and will have a range of education and support activities. Click here to find your local office. 

Physiotherapist 

To find a physiotherapist, talk to your doctor, see the Australian Physiotherapy Association website at www.physiotherapy.asn.au 

Podcasts 

Osteoarthritis flares with Dr Martin Thomas - https://shows.acast.com/joint-action/episodes/osteoarthritis-flares-with-dr-martin-thomas

Websites 

painTRAINER is an interactive, online program based on scientific research that teaches you effective strategies to manage your pain - https://www.paintrainer.org/login-to-paintrainer/ 

Online chronic pain program - https://thiswayup.org.au/programs/chronic-pain-program/ 

Managing an arthritis flare - https://www.arthritisnsw.org.au/managing-an-arthritis-flare/ 

Arthritis Research UK: www.arthritisresearchuk.org 

Arthritis Foundation (US): www.arthritis.org

References 

1. Malfait AM, Miller RE, Miller RJ. Basic Mechanisms of Pain in Osteoarthritis: Experimental Observations and New Perspectives. Rheum Dis Clin North Am. 2021;47(2):165-180. 
2. Stubbs B, Aluko Y, Myint PK, Smith TO. Prevalence of depressive symptoms and anxiety in osteoarthritis: a systematic review and meta-analysis. Age and Ageing. 2016;45(2):228-235. 
3. Oliveira Bird, Smith AJ, O'Sullivan PPB, et al. ‘My hip is damaged’: a qualitative investigation of people seeking care for persistent hip pain. British Journal of Sports Medicine. 2020;54(14):858-865. 
4. Gibbs AJ, Gray B, Wallis JA, et al. Recommendations for the management of hip and knee osteoarthritis: A systematic review of clinical practice guidelines. Osteoarthritis and cartilage. 2023;31(10):1280-1292. 
5. Gray B, Gibbs A, Bowden JL, et al. Appraisal of quality and analysis of the similarities and differences between osteoarthritis Clinical Practice Guideline recommendations: A systematic review. Osteoarthritis and Cartilage. 2024.