Does Rheumatoid Arthritis Pain Ever Stop? A Physio's Case

Does Chronic Pain From Rheumatoid Arthritis Ever Stop?

For some people, yes. Research shows that pain often continues after RA reaches remission, because it can come from structural change left behind in the joint and from changes in how the nervous system processes pain. In my 30 years as a Hong Kong registered physiotherapist, I have seen that pain and stiffness can ease with SESM® (Subtle Structural Manipulation). One young woman in her early twenties, after seven years of juvenile arthritis pain, regained normal daily function over eight visits in four months.

SESM® is a trademarked, gentle, hands-on connective tissue method I developed and use in every session at DeepBody Matrix in Central, Hong Kong.

I'm Sheryl Hooi. I have worked with people whose RA was stable, whose blood tests looked good and whose doctors were pleased. They were still in pain, and their hands, wrists and knees still didn't move the way they once did.

Why Does RA Still Hurt When the Disease Is in Remission?

Many people assume that remission means the pain should be gone. The research says it often isn't.

A systematic review by Ishida and colleagues in Modern Rheumatology (2018) found that patients in remission or low disease activity still report substantial residual symptoms, especially pain, fatigue and difficulty with daily function. Michaud and colleagues reached a similar conclusion in Arthritis Care & Research (2021). Residual symptoms remain an unmet need in people whose disease is considered controlled.

This doesn't mean your treatment has failed. Medication is very good at calming the autoimmune process. Pain is a separate question.

Is the Pain Always Coming From Inflammation?

No. Researchers describe residual pain as having more than one source.

Sensitized pain processing. A meta-analysis by Duffield and colleagues in Rheumatology (2018) found that about 21% of people with RA also have fibromyalgia, which is linked to central sensitization. In these patients, disease-activity scores ran 1.24 points higher without a matching rise in swollen joints or inflammatory markers. The pain was real, but active inflammation wasn't driving it.

Pain that outruns the inflammation. Medapati and colleagues, in Arthritis Care & Research (2018), found that markers of pain sensitization were linked to higher disease-activity scores and tender-joint counts. A sensitized system can make a joint look busier than it is.

Controlling the disease and resolving the pain are two separate jobs.

What Does the Joint Itself Carry?

This is my clinical interpretation, not a research finding. When RA was active, it did real work on the joint and the tissue around it. Even after the disease calms, the joint can be left with stiffness, restricted movement and altered mechanics, and the connective tissue around it, including fascia, ligaments and tendons, can stay restricted. The body also guards a painful joint, and over years that guarding can become part of the problem.

I wrote about this in my earlier article, Rheumatoid Arthritis "In Remission" But Still Struggling. Shortly after I published it, I met a young woman who could have been its main character.

What Does It Look Like When RA Pain Eases? A Real Case

I met her by chance at a social event. When she asked what I did and I said I was a physiotherapist, she held up her hand and said, "I have RA."

In her early twenties and had lived with juvenile arthritis for seven years. Her disease was stable, on consistent medication, and she kept up regular medical follow-ups. Her wrist, though, had been stuck at the same limit for years, with stiffness and sharp, jolting pain when triggered. Which was easily and even perhaps with no obvious reason at all.

How Had RA Changed Her Daily Life?

She had reorganized her life around her hand. She told me about it herself:

• No buttons, no jeans and no pretty handbags

• Brushing her teeth with her other hand

• Blow-drying her hair with her other hand

• Struggling with tight bottle caps and jars

• Avoiding handshakes, and definitely no high fives though she loves to greet people.

She wasn't complaining. She had accepted it. "This is just my life now" was how she lived. I asked if she would like to try SESM®, if I could help change it. A few minutes of application and she was elated at the possibility ! Her wrist definitely felt freer and could move more!

What Did I Find When I Assessed Her Wrist?

She was very guarded about it. The hand was tender, and stiffness came with jolts of side bending avoidance pain whenever I tried to move it further. There was very little wrist movement, and almost no side-to-side motion or rotation. One joint, after the initial tenderness and extreme pain was dealt with the radiocarpal joint was found to be the main limit on both pain and movement with a hard stop. The rotation was less than neutral for a handshake.

What Changed With SESM®?

I treated her with SESM® (Subtle Structural Manipulation). It is very specific and applied only where it's warranted. She came for eight visits over four months, each made up of two 45-minute sessions. The visits were weekly at first, then spaced further apart as she improved.

I don't think of SESM® as something I do to the body. I think of it as something the body responds to. Some sessions bring faster change and some bring slower change, depending on how the tissues answer.

This is a case study for general readers, not a clinical trial. I recorded what she told me and what I observed.

Here is how her progress unfolded:

Initial SESM® application, February: Very little wrist movement, with pain and guarding.

One week later: She reported she could clap, palm to palm for the first time in years. It was a light clap but a real one. Clapping and handshakes were possible again.

Early April: Handshakes with normal pressure, high fives, turning a door knob normally and holding her phone normally.

Mid-May : By the seventh visit- Opening tight jars and bottle caps, brushing her teeth and blow-drying her hair with her normal dominant hand again, carrying a handbag over her shoulder, and wearing tight jeans and fitted button-up blouses. Essentially, normal activities again!

Early June, the eighth visit: We cleared up what remained of that wrist

Her progress was steady. There were no steps backward, and the improvement never reversed between sessions, even through the six week gap in the schedule.

I also think part of the relief is the body no longer needing to protect itself. When a painful area is seen and helped, the protective response can relax.

If you recognize yourself in her story, you can read more about SESM® or message me directly.

What Happened After the Sessions Ended?

I haven't treated the wrist since June. In late September, more than three months after her last visit, she told me she had started doing pull-ups at the gym. She mentioned that her wrist felt slightly tighter afterward.

That is what I'd expect. A gym workout asks far more of a wrist than buttons and handbags do. I think of it like car maintenance. A body that carried seven years of pain may need an occasional tune-up when it's asked to do more. But a woman who once avoided handshakes is now doing pull-ups, and the jolting daily pain that shaped seven years of her life has not returned. To me, that is a significant change.

I assess people by what they want to do, not only by daily tasks. For someone who wants to lift, climb or play sport, the wrist has to meet a higher standard than ordinary life requires.

Does Hands-On Therapy Help RA? What the Research Says

The trials I found report some improvement in pain with gentle manual therapy. What I saw with the young woman was larger than that, which is why I wanted to document it.

The research on manual therapy in RA is still small and early.

Levitsky and colleagues, in the Journal of Manipulative and Physiological Therapeutics (2019), ran an assessor-blinded randomized crossover trial of gentle, low-grade mobilization of the finger joints in people with RA. It was feasible and safe, and it was linked with improvements in hand pain.

Medina-Luque and colleagues, in Evidence-Based Complementary and Alternative Medicine (2020), found in a small randomized pilot study that muscle relaxation techniques combined with low-grade knee mobilization reduced knee pain more than standard exercise did.

These are small studies, and neither tested SESM®. Her story is one case. I share it because it's what I have seen, and because it's the kind of result that makes me want to document more.

Should I Try SESM® for RA Pain in Hong Kong?

In my experience with SESM®, the pain can ease significantly. I can only speak for SESM®, because it's the direct effective method I've used.

Some people are content where they are, and that's a perfectly good place to be. But if you want more than acceptance, think about what you'd like your life to look like:

More activity, with less of your life revolving around pain

Everyday tasks that feel normal again

A body you don't have to think about when it does what it does

If you've been told your RA is "in remission" and you're still living around the pain, book a consultation. We'll look at how your joints move and find what's limiting them, and I'll tell you honestly whether SESM® is likely to help. You can also read how structural physiotherapy works at DeepBody Matrix.

Do I Still Need My Rheumatologist?

Yes. SESM® doesn't replace your rheumatologist or your medical follow-ups. Your doctor manages the disease. SESM® works on the joint structures the disease left behind. Please keep your appointments and your medication.

Frequently Asked Questions

Why does my RA hurt even though my disease is in remission?

Medication calms the autoimmune process but doesn't reverse everything the disease did. Studies show that people in remission or low disease activity still report pain, fatigue and difficulty with daily function. The pain can come from structural change in the joint, from sensitized pain processing, or from both.

Does residual pain mean my RA treatment isn't working?

Not necessarily. Controlling the disease and resolving the pain are two separate jobs. Tell your rheumatologist about any pain that persists, because other conditions such as fibromyalgia can overlap with RA.

What is SESM®?

SESM® (Subtle Structural Manipulation) is a trademarked, gentle, hands-on method developed by Sheryl Hooi at DeepBody Matrix in Central, Hong Kong. It works with the body's connective tissue and is applied specifically, only where warranted. It doesn't replace medical care.

Should I stop my RA medication if my pain improves?

No. Keep your medication and your medical follow-ups. SESM® addresses the joint structures the disease left behind, not the disease itself.

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About the Author

Sheryl Hooi is a Hong Kong registered physiotherapist with three decades of clinical experience and the originator of SESM® (Subtle Structural Manipulation). She is the founder of DeepBody Matrix, a private practice in Central, Hong Kong. Learn more about Sheryl.

SESM® is the method behind every session at DeepBody Matrix, across Structural Physiotherapy, In-Between Wellness and Somatic Wellness.

References

Ishida M, Kuroiwa Y, Yoshida E, et al. Modern Rheumatology. 2018. doi:10.1080/14397595.2017.1416940

Michaud K, Pope J, van de Laar M, et al. Arthritis Care & Research. 2021. doi:10.1002/acr.24369

Duffield SJ, Miller N, Zhao S, Goodson NJ. Rheumatology (Oxford). 2018. doi:10.1093/rheumatology/key112

Medapati RK, et al. Arthritis Care & Research. 2018. doi:10.1002/acr.23266

Levitsky A, Kisten Y, Lind S, et al. Journal of Manipulative and Physiological Therapeutics. 2019. doi:10.1016/j.jmpt.2018.04.007

Medina-Luque FJ, et al. Evidence-Based Complementary and Alternative Medicine. 2020. doi:10.1155/2020/1452579

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