Self-imposed barriers inhibit pain relief for rheumatoid arthritis

Many patients prevent themselves from experiencing optimal pain relief from rheumatoid arthritis (RA), according to a recent study published in the March issue of The Journal of Pain.

There is little understanding of the pain that patients experience with RA other than via measurements of pain intensity. To address this, a team of researchers from McGill University in Montreal studied 60 patients with the condition to assess their pain experiences, determine their satisfaction with pain control and explore barriers that may inhibit optimal pain management.

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

More than half of the patients said they experience considerable RA pain, even though they were receiving care in a rheumatology practice, according to a press release. However, two-thirds said they were satisfied with their pain management, and four out of every five patients said 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 researchers noted in the press release. The Canadian investigators also said 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, according to the press release.

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, according to the press release.

The researchers concluded that patients with RA 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.

Reference:
Fitzcharles M-A, DaCosta D, Ware M, Shir Y. Patient barriers to pain management may contribute to poor pain control in rheumatoid arthritis. J Pain. 10;3:300-305.