Here's a question: How do doctors know when we tell them about our pain that it's time to prescribe painkillers as opposed to changing around our RA meds? I have pain usually in some joint all the time, usually knees but it could be a toe, finger, shoulder etc. I don't like to tell my RD (stupid I know) because I hate the side effects from the meds. I finally got my hair to start growing back since the Arava hit! I don't want painkillers because I have this perception of them making people sort of "zonked out" and I have kids that I have to take care of.
There are many factors that docs take into consideration re: pain meds. What meds are you using for your RA, how long have you been taking them, when was the last adjustment, have you taken pain pills before, are the joints inflammed, swollen, how many are painful, how has you pain been prior to your request. Most docs don't hesitate to prescribe a mild pain med for RA patients. Some docs don't care and will write a script based on your request only and other docs make you jump through hoops.
When I went from Tramadol, Ultram to Lortabs I didn't ask, all my RD did was take one look at my face and eyes and how I was moving and he offered a stronger pain med. Pain shows first in my face.
There's no pat answer for your questions and once again it's as individual and as personal as the disease and the people that have it.
I told my doctor I was going to Europe for two weeks and I was concerned about pain while on the trip. She perscribed me Vicodin. When I got back she asked if I used it, I told her yes but she didn't offer to give me anymore.