Self-Imposed Barriers Inhibit Pain Relief for RA

Surprisingly, there is little understanding about the pain experience in rheumatoid arthritis (RA) other than measurements of pain intensity. A team of Canadian researchers addressed this knowledge gap in a study of 60 RA patients to assess their pain experiences, determine satisfaction with pain control, and explore barriers that may inhibit optimal pain management.

For the study, the RA patients were asked about potential barriers to achieving pain relief, such as fear of medication side effects, concern about addiction, fear of drug interactions, aversion to taking too many pills, and fear of masking the disease.

More than half of the patients said they have considerable pain, even though they were receiving care in a rheumatology practice. However, two-thirds said they were satisfied with their pain management and 8 in 10 believe pain can be effectively controlled. Previous studies have shown that pain thresholds are reduced in RA patients and longer duration is associated with more pain.

The McGill University researchers noted their findings concur with reports of poor pain control in patients with chronic diseases. As expected, greater pain intensity was associated with less satisfaction with pain status. Patients also said they accept pain as a consequence of having an incurable disease and rate pain behind concerns about possible deformity and disability.

The study showed that barriers to pain control may play an important role in the suboptimal management of RA pain. In response to questions about potential barriers, the patients associated analgesic drugs with negative cultural attitudes, said they are fearful about possible addiction, believe that pain relief would mask active disease and further deteriorate joint health, and think drug side effects hamper quality of life.

The authors concluded RA patients should be specifically questioned regarding their pain, and clinicians should appreciate the negative effects of pain on overall quality of life and actively explore potential barriers to effective pain management.

When I suffered a stress fracture to my hip, I walked around on my broken hip for a little over two weeks.

He of course ordered an x-ray and an MRI. When he got the results back, he called and asked why I hadn't said something sooner about being in pain. I told him I was always in pain and I didn't want to bother him about it.........

I got a very stern lecture about not being open concerning the amount of pain I was in and that I should never assume that RA was the cause of everything I was feeling. I felt pretty stupid and I've not made that mistake again.

Lynn492009-03-19 19:12:14Lynn, I am that way now. I can't take pain meds, so I accept the pain and suffer in silence. I don't mean to sound like a S&M type, I just feel there is little my RD can do for the pain I have. I do the hot baths and heating pads and anything I can think of to relieve it.

Thanks for the article and the story you shared. I will pay way more attention and talk to my RD. Lesson learned! Lynn, I've done the same. Broke my elbow in a fall 2 years ago. Didn't realize my elbow was broken for 2 weeks, because like you we become so used to the pain

My friend Susan said to me at the time, "Well, this is the downside of having a high pain tolerance, woman."

As it was my radius (elbow) they couldn't cast it so my doctor said I would need to put it in a sling and rest it for three weeks...yeah, right...like that's going to happen when you're a single parent.

I did rest it as much as possible but I have to get Neve to school everyday by dropping her at the right and only bus stop which was 15 minutes drive away. So for three weeks I rested it only taking off the sling to drive to get Neve twice a day. And I drive a manual (shift) car.

I think because we endure to much constant, gnawing pain it becomes normalized.

Surprisingly, it did heal very well but like Lynn's doctor said, "Never assume".
I tend not to take pain meds because I think about them building up in my liver. I find that I don't really feel much better when I take them so why take the chance? My prescription meds I hoard in case I ever get REALLY bad again. I was with a different doctor when they were prescribed but it was so hard to get them from her I feel like I need to keep them in reserve. My new doctor recently gave me tramadol during my flare and I found it to be another useless drug. I fear some narcotic meds...... and won't take them...... as well as pred.... the pages of possible issues is too much for me....... so I suffer.

This statement hit home; the fact that we rate pain behind concerns about possible deformity and disability

I know I do this...... being unable to do things.. is worse than anything that hurts...

That is the way I feel too, Babs, besides not being able to tolerate the pain meds. It became a quality of life issue for me. On the one hand, pain. On the other, total inability to function due to my intolerance of the meds. For me, all the pain meds and differing doses I tried hampered my quality of life much more that most of the pain I was in.

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