RA Living: Is Your Pain Adequately Controlled?

Vanessa Collins Health Guide
  • If you have moderate to severe RA, you are no stranger to pain.  You also know how difficult it can be to find a doctor who will help you manage that pain.


    There are a lot of options available for pain management, but fewer and fewer doctors willing to prescribe pain medications.  Part of the reason for this is the abuse of prescription drugs we all hear about on the nightly news.


    The DEA, or Drug Enforcement Administration, is “cracking down” on prescription pain medications, and closely monitoring doctors who prescribe them.  I have talked to people in the health care field about this issue.  They all tell me there is a lot of paperwork involved in this monitoring process.

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    Basically, prescribing pain medications has become a big headache for doctors.  All this paperwork takes away from the time doctors have to spend with their patients, and they don’t like that.  Perfectly understandable, if you think about it.


    Another problem people in chronic pain experience is an attitude from uneducated medical professionals.  They do not seem to know the difference between addiction and dependence, and they too quickly make a judgment.  They call us “drug seekers”.


    The first rheumatologist I saw thought I was a drug seeker.  I asked him about a medication for pain.  He promptly turned his back on me and left the room.  The next thing I knew, his nurse was in the room, and started talking to me as if I were an addict.


    I was absolutely humiliated.  I walked out of that office and didn’t see another rheumatologist for several years.  That was a mistake on my part, but I didn’t know what else to do.  I didn’t have a definitive RA diagnosis then.  I am sero-negative, and I felt so alone.  I was drowning in pain and now one seemed to understand.


    During this time, I was seeing a Nurse Practitioner as my primary care physician.  When my orthopedic doctor prescribed Tramadol for pain, this same nurse practitioner told me not to take it.  I still remember her standing there, looking at me critically, and saying, “It won’t make you feel good.”


    Feel good?  I was so far from feeling good.  I just wanted something to take the edge off the pain.  Tramadol is a synthetic opioid medication.  I did take the Tramadol, and it did help my pain for awhile. In the meantime, I found a doctor to be my Primary Care Physician, and said goodbye to my clueless Nurse Practitioner.


    Rheumatologists and primary care doctors will prescribe some pain medications, but if you need something stronger than they are willing to prescribe, you may find yourself referred to a pain management clinic. This can actually be a good thing, but not all pain management doctors are equal.


     I have several friends who do have good relationships with their pain management doctors.  That is the good news.


    The bad news is that there are some pain management doctors who are in the field to simply make money…a lot of money.  My best friend is a retired RN. She has moderate to severe sero-negative RA, and she was referred to a pain management clinic.


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    She never felt comfortable with the doctor she was seeing at the clinic.  He prescribed Dilaudid (Hydromorphone Hydrochloride) on her first visit.  She didn’t think she needed that much pain control.  This pain management doctor also insisted she have drug testing done at every visit.  Those tests cost $500.00 each.


    Before she knew it, my friend had a huge medical bill.  She just could not afford to keep going to this particular pain management clinic.  In addition to that, she did not  believe she needed Dilaudid to control her pain.  She needed something that was not so strong.


    My friend left the pain management clinic, and found an internist who is now her primary care physician.  He prescribed the Butrans patch for her pain, and it is working well.  She also has medications for break-through pain.


    Isn’t that all we want?  We just need medication to ease the pain and allow us to function in this world.  I don’t think that is too much to ask.


    Personally, I am happy that my primary care physician has taken on this role for me.  She writes the scripts for all of my pan medications, and she asked me if she could help in that way.  I didn’t even have to ask.


    I am lucky in that my primary care doctor treats a lot of RA and MS patients.  She understands the pain of chronic disease, and she is willing to help.  I did not have to go to a pain management clinic.


    If you, like many others I talk to in the RA community, do not have adequate pain control, please seek out a doctor to help you.  You may be able to find a primary care doctor willing to prescribe the pain medications you need.  If not, you can always ask for a referral to a pain management clinic.


    Please remember that there is a difference between drug dependence and drug addiction.  People who are dependent on pain medications do not “crave” drugs, and do not take them inappropriately.  For more on this subject, please click here.    


Published On: March 19, 2014