Like many other people who have rheumatoid arthritis (RA), I live with high levels of chronic pain every day.
The stigma and misperceptions that surround chronic pain are fed by other social pressures, and the war on opioids in particular. These external factors color how we are viewed, creating a filter that allows only a fractured view of what our lives are really like. Let’s take a look at two of these filters: misconceptions about the severity of RA pain, and some myths about opioids.
The myth of minor pain
RA is "just arthritis," isn't it?
This myth is fed by the perception that all 100 types of arthritis are alike, resembling a mild case of osteoarthritis. Moreover, people think that arthritis is more of an inconvenience, at most causing the "minor arthritis pain" that is so often mentioned in commercials for over-the-counter painkillers.
Nothing could be further from the truth.
RA inflammation affects many systems within the body, including internal organs, but the most well-known and visible is the effect on the joints. This is usually the primary source of pain associated with RA.
A healthy joint has cartilage acting as a cushion between the ends of bone that make up a joint (think, for instance, your upper and lower arm bones). The inflammation creates swelling within the joint and destroys that cartilage until there is no cushion. Both the pain of inflammation and fluid in the joint (active RA) and the pain of two bones grating against each other as you move (RA damage) can be excruciating.
RA pain is a monster that eats your life. RA pain is all-encompassing, wrapping you in a tight embrace that never lets go. In my book, “7 Facets: A Meditation on Pain,” I describe it like this:
"It starts in one place and then it moves, creeping through your body, leaving a thorny trail of interconnected feeling. It links painful spot to painful spot to yet another painful spot, and by the time it is done, you are a burning network of pain. Everything hurts. Every muscle, every tendon, every joint is caught in a spasm. It is a paroxysm of stinging, throbbing, all-encompassing sensation."
The myth of opioids
Opioids are addictive and should be avoided as much as possible. Right? This is the core premise of the war on opioids, but it doesn’t tell the whole story.
There is a big difference between being dependent on a medication and being addicted, but little awareness of what each means. Therefore, people often mistake physical dependence for addiction. Like many other substances, including beta blockers (used to manage high blood pressure) and caffeine, your body adapts to opioids and if stopped abruptly, it can result in withdrawal symptoms. Addiction, on the other hand, is characterized by maladaptive behavior, cravings, and harm to the individual.
The lack of understanding of these differences contributes to the myth that if you take opioids, you will inevitably become addicted. And it is a myth. One large review of studies showed that when prescribed and taken correctly, opioids lead to addiction in one quarter of one percent of cases. The key here is the words “prescribed and taken correctly.”Doctor overprescribing is a major contributor to the availability of opioids, which facilitates addiction. How? Most people — 75 percent — start misusing opioids by taking prescriptions not prescribed for them.
Despite the facts, the war on opioids is increasingly targeting pain medication, effectively becoming a war on pain management and the people who need it. Myths — not facts —form the basis for these efforts that restrain effective treatment, not facts. Opioids are a tool and only that, not an inherently evil substance.
Not all people with RA will need these medications to manage their pain. For those who do, opioids are essential to being able to participate in family activities, go to work, and be active in their community, instead of being housebound in excruciating pain. Access to pain management is a fundamental human right. A better understanding of the facts will help more people live better lives.