Rheumatoid arthritis (RA) pain can be debilitating—significantly interfering with your quality of life, and your ability to function. It’s important to get your RA treated, but it’s also important to get your pain treated.
Two kinds of RA pain
There are two kinds of rheumatoid arthritis pain. One is the pain of active RA inflammation. There are many ways to describe this, including feeling as if your joints are on fire, as if they’re being pried apart, or as if they are disintegrating. Depending on your level of inflammation, it can be extremely intense, so intense, in fact, that some doctors have compared the pain of moderate and severe RA to the pain of bone cancer.
The second kind of RA pain relates to joint damage. RA inflammation erodes the cartilage that acts as a buffer in the joints. Without that buffer, movement of the joints is bone-on-bone. It can be excruciating.
What do rheumatologists treat?
Given that a major symptom of RA is pain, your first step for pain management is often your rheumatologist. However, this is where you can encounter a wrinkle. Many rheumatologists do not treat pain. This may seem incongruous, but there’s actually a good reason.
Rheumatologists treat arthritis. Treating the disease means treating the inflammation, attempting to suppress it to prevent the damage that can cause pain. By treating the inflammation, the pain involved in active RA goes away. Ideally, this will happen before the RA has caused any damage that might cause pain.
Secondly, there is an increasing understanding that pain is a complex condition in itself. This requires in-depth study, as well as a specialist approach. In other words, rheumatologists are specialists in treating inflammation, not in treating pain.
That said, there are certainly rheumatologists who include pain management in their practice. When you are looking for pain control, it’s always a good idea to begin the process by talking to your rheumatologist.
Other options for pain management
Many people with RA get pain management from their family doctor. A primary care physician is a generalist, knowing a little about a lot of different things. Many of the conditions they treat involve pain, ranging from a sprained or broken ankle, to chronic illnesses like RA. Therefore, they are usually fairly knowledgeable about a certain level of pain management. They can prescribe the standard strong painkillers offered to anyone with acute pain, and often also have a knowledge of pain medications beyond that.
The second option is getting a referral to a pain specialist. These are doctors who have studied pain and the treatment of pain in detail, and who are uniquely qualified to treat this condition. Some pain specialists primarily use different medications, usually opioids, to treat pain. Others use a multidisciplinary approach, using medication, but also including meditation, physical therapy, acupuncture, biofeedback, and other techniques in teaching their patients to manage pain.
Unfortunately, there aren’t as many pain specialists as there are people in need of their services, so it might be tricky to find one. There is also a political angle to getting effective pain control, as laws and regulations are making it increasingly difficult for doctors to prescribe narcotics. Unfortunately, many of the fears of addiction are not based on facts. If you do find a pain specialist who prescribes opioids to deal with the pain, you can expect to have to sign a treatment agreement and to take regular drug tests.
The right to treatment
Being in pain is very difficult. Talking about the pain is difficult. And it can be almost impossible to make others understand your pain. In fact, you may encounter a fair degree of pushback from medical professionals in your quest for effective pain control.
Don’t give up. It is your right to get your pain treated. In fact, the 13th World Congress on Pain hosted a summit in Montréal, Canada in 2010. At the conclusion of the summit, the delegates passed a declaration stating that access to pain management is a fundamental human right. This is called the Declaration of Montréal.
Although it’s important to understand the obstacles faced by doctors as they attempt to treat pain, it’s also important to remember that living in pain is unreasonable. If you encounter obstacles, persevere. Push back.
It is your right to have access to a pain management.
What is your experience with getting your pain treated?
See More Helpful Articles:
Lene writes the award-winning blog The Seated View. She’s the author ofYour Life with Rheumatoid Arthritis: Tools for Managing Treatment, Side Effects and Pain and 7 Facets: A Meditation on Pain.
Lene Andersen is the Community Leader for HealthCentral’s RA Community. Lene (pronounced Lena) is an award-winning writer, health and disability advocate, and photographer living in Toronto. She’s written several books, including Your Life with Rheumatoid Arthritis: Tools for Managing Treatment, Side Effects and Pain, and 7 Facets: A Meditation on Pain, as well as the award-winning blog, The Seated View. Follow Lene on Twitter @TheSeatedView and on Facebook. Watch her story on HealthCentral.