Treating rheumatoid arthritis (RA) doesn’t begin and stop with a rheumatologist. RA is a complex systemic condition that can benefit from a team approach. A pain specialist can be a valuable addition to your team.
RA and pain
People with RA may experience pain, ranging from mild to severe. This can be caused by either active RA inflammation or the pain of damaged joints. Achieving RA remission often greatly reduces the experience of pain, but some people don’t respond to the treatments currently available. Getting effective pain control is an important factor in improving quality of life. But getting that pain treated can be a challenge.
As more effective RA medications have been developed, some rheumatologists no longer treat pain, instead focusing on inflammation.
“Treating inflammation is a very time-consuming activity,” said Robert G. Hylland, M.D., fellow of the American College of Rheumatology, and assistant clinical professor at the Michigan State University College of Osteopathic Medicine. “Adding pain management can overwhelm an already exhaustive office visit.”
Some people with RA go to their family doctor for pain treatment, but if the pain is severe or more complex, the individual may end up with a referral to a pain specialist.
“The more complex the pain issues, the more benefit the patient will likely receive from a pain specialist,” Dr. Hylland said in an email interview with HealthCentral.
What a pain specialist can do for RA
There is an increasing understanding that pain is a complex condition on its own, requiring a specialist.
“The ideal chronic pain physician should be somebody who has an understanding of the current state of the research literature in chronic pain and what that means for treatment,” explained Jan Carstoniu, M.D., anesthesiologist and director of the MindBody Pain Clinics in Toronto, Canada in a telephone interview. As well, they “should also have some understanding and training in the psychological research related to chronic pain and knowledge of pharmacology.”
There is significant stigma surrounding pain and invisible illnesses in our culture, which can make the experience of living with pain even harder. A pain specialist provides an understanding that can be very healing.
“Right off the bat, what a good pain specialist does is not question the person’s sanity, but actually try to listen to what’s going on,” Dr. Carstoniu said. In addition to a thorough physical examination, a pain specialist will take a history of your pain. “I go back to childhood at times, before (you) even had RA. That might tell me something about you and the way you look at your pain today,” Dr. Carstoniu said.
Having a conversation about the pain, both in terms of sharing your experience and your doctor talking about the dynamics of pain can be very useful.
“There is actually good evidence to suggest that explaining pain to some patients makes a difference; it reduces their pain,” Dr. Carstoniu explained.
He practices using a multidisciplinary perspective and recommends a holistic approach to treating chronic pain.
“Pain is a phenomenon of human experience with sensory, cognitive, and emotional dimensions,” he said. This means: “physical, psychological, and pharmacological interventions.”
Dr. Hylland agrees, recommending pain specialists in part because of that holistic approach.
“Pain centers often provide social and psychological support personnel to help dissect the numerous influences that create and exacerbate chronic pain.”
Living with chronic pain, whether from RA or another condition, can take over your life. Treating your disease helps, but for people with uncontrolled RA or significant joint damage, pain treatment is essential.
But it’s not as simple as just throwing some pills at the pain. It’s about learning to use your body better, learning to not be afraid, learning to cope, both physically and emotionally. Talking to someone who understands all the different tools that can chip away at the pain can be a life changer.
And that’s why a pain specialist can be such an important member of your team. They know the correct medication to give for different kinds of pain, and ideally can also include physical therapy, counselling, and other interventions to achieve a whole body and whole mind. That will help you get back to what’s important: living your life.