State of pain management
Pain is a familiar companion for those of us with rheumatoid arthritis. It comes in a variety of forms. Sharp. Aching. Burning. Itching. Sometimes all at once. When my pain is at its peak, I slather my joints with Voltaren (diclofenac). It is soothing and helps the itching. About 6% is absorbed into the system.
The problem with the power of pain is that it can be incapacitating. Unrelieved pain will open the door to depression when pain is not relieved and daily responsibilities remain the same. So before going down that dark, dreary road, figuring out how to manage your pain is something you will want to do.
- First, if you have RA, you will have pain. Even with a successful biologic, relief will only be 50% at best. You might recognize that you need to modify your life to accommodate the changes in your body.
- Your rheumatologist may be one of those people who feel if a patient’s inflammation markers are not elevated, they will not have RA pain. That notion has been disproven and if your Doc is stuck in that orientation, maybe it is time to change doctors. I’ve always had the pain first and the markers second.
- You recognize you need pain relief. NSAIDs are the first step. Drugs like ibuprofen and Aleve relieve inflammation and give pain relief. They work well for many people. The problem with aspirin is that it takes too high a dose to be effective and the side effects are serious.
- Pacing is also a useful tool. It is working in batches while resting in between. It is sitting to do some of your tasks that you normally stand to do. For instance I peel potatoes while sitting. I make dinner in steps.
Late in the nineties rheumatologists found tramadol to be a good alternative to NSAIDs. Tramadol is a weak synthetic opioid that is not considered to be highly addictive and is a solution for those unable to take the NSAIDs. Eventually abuse of the drug developed. Early on it was doctors and nurses who were misusing the drug. So now it is a controlled substance. A shame.
- Those people who live with chronic pain have other barriers to relief. Opioids have become discredited. Doctors are afraid to prescribe them.
- Because of the numerous side effects, NSAIDs have also been discredited for older people.
- Doctors do not like prednisone either. For those who find relief with prednisone, they might be out of luck if their doc doesn’t care for it.
The same doctors have no trouble prescribing expensive drugs that are risky to take. Drug companies will clearly tell you how dangerous their drugs are for us, but rheumatologists make good salesmen who minimize the risks.
- Today gabapentin is a drug of choice for pain relief in the medical community. Officially, gabapentin is a drug for seizures and for neurogenic pain. It calms the brain and changes the way the body perceives pain. It has been shown to reduce inflammatory mediators in mice. I find it to be helpful and docs like it for now.
- Adding acetaminophen, one tablet, regular strength, to tramadol reduces the amount of tramadol that you need.
- Low dose prednisone (8 mg) is acceptable for people who have RA that refuses to come under control. It is considered a last resort for those with uncontrolled RA although it is used early in RA as a bridge therapy. For me it is the best pain relief.
For those who need stronger pain relief, you may need to see a pain management doc. I will be happy to see the day when doctors are less paranoid about pain medication and more concerned about pain relief for their patients.