Self Imposed Barriers Inhibit Pain Relief For Rheumatoid Arthritis

Main Category: Arthritis / Rheumatology
Also Included In: Pain / Anesthetics
Article Date: 19 Mar 2009 - 3:00 PDT

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Surprisingly, there is little understanding about the pain experience in rheumatoid arthritis (RA) other than measurements of pain intensity. A team of Canadian researchers addressed this knowledge gap in a study of 60 RA patients to assess their pain experiences, determine satisfaction with pain control, and explore barriers that may inhibit optimal pain management.

For the study, the RA patients were asked about potential barriers to achieving pain relief, such as fear of medication side effects, concern about addiction, fear of drug interactions, aversion to taking too many pills, and fear of masking the disease.

More than half of the patients said they have considerable pain, even though they were receiving care in a rheumatology practice. However, two-thirds said they were satisfied with their pain management and 8 in 10 believe pain can be effectively controlled. Previous studies have shown that pain thresholds are reduced in RA patients and longer duration is associated with more pain.

The McGill University researchers noted their findings concur with reports of poor pain control in patients with chronic diseases. As expected, greater pain intensity was associated with less satisfaction with pain status. Patients also said they accept pain as a consequence of having an incurable disease and rate pain behind concerns about possible deformity and disability.

The study showed that barriers to pain control may play an important role in the suboptimal management of RA pain. In response to questions about potential barriers, the patients associated analgesic drugs with negative cultural attitudes, said they are fearful about possible addiction, believe that pain relief would mask active disease and further deteriorate joint health, and think drug side effects hamper quality of life.

The authors concluded RA patients should be specifically questioned regarding their pain, and clinicians should appreciate the negative effects of pain on overall quality of life and actively explore potential barriers to effective pain management.

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