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Some arthritis patients try to do without pain medications (analgesic painkillers) because they fear becoming addicted. Are these patients doing more harm than good by avoiding pain medications? When is it appropriate for pain medications to be prescribed as part of the treatment plan for arthritis patients? Are pain medications appropriate as a long-term treatment or maintenance treatment, or should they only be used short-term?

A.

Pain Is Often Poorly Managed

Most patients with rheumatic conditions experience pain or discomfort as a part of their condition. Recognition of patients pain is an important aspect of patient care and is considered by the Joint Commission on Accreditation of Healthcare Organizations as the fifth vital sign. (Editor note: the other four vital signs are blood pressure, core temperature, pulse, and respiration)

Despite the fact that chronic pain adversely affects the quality of life of patients, it is often poorly managed.

Guide to Arthritis Pain

The Pain Relief Quiz

The Pain Quiz: Acute Vs Chronic Pain

Why Does Pain Tolerance Or Pain Perception Vary?

Measures To Control Pain

Non-pharmacologic Measures

Non-pharmacologic measures to control pain include practitioner-administered treatments such as:

meditation and relaxation

hypnosis

massage

acupuncture

exercise

Pharmacologic Measures

Pharmacologic treatments include:

topical preparations

herbal remedies

dietary supplements

anti-depressants

muscle relaxants

anti-convulsants

NSAIDs (non-steroidal anti-inflammatory drugs)

acetaminophen (Tylenol)

narcotic (opioid) analgesics (painkillers)

Opioids

Due to their effectiveness, the use of opioids is a common therapy to treat musculoskeletal pain. Their use has doubled over the past 20 years to treat musculoskeletal pain. They can be quite useful to help control the pain of periodic flares.

Some patients will find that they can be taken during the day and not cause drowsiness while others will need to limit their use to evenings.

Despite their benefits, there is potential downside to the use of opioids. There are no randomized, controlled studies looking at the benefit/risk of long-term use of opioids in patients with chronic musculoskeletal conditions. As a result, the risk of addiction or tolerance to these medications in these patients is not known.

There has been a tendency to use stronger opioids such as hydrocodone (Vicodin, Lortab) and morphine (MS Contin, Avinza) although tramadol (Ultram) is a weak synthetic opioid that has gained widespread use.

The Facts Of Pain Medications (Analgesics)

What Are Analgesics?

Preventing Abuse Of Pain Medications

Side Effects

In addition, like many medications, side effects exist in addition to drowsiness and include nausea, constipation, and cognitive impairment. Many may cause withdrawl symptoms such as dizziness, anxiety, as well as other physical symptoms if stopped suddenly.

Opiate Withdrawal

Fecal Impaction

Opioid Intoxication

In general, I recommend most patients try to first control their chronic pain with non-pharmacologic therapies or pharmacologic therapies without addictive properties.

Related Resources - Pain Medications

Pain Medications (Analgesics)

Pain Relief

Pain Medications Abuse & Misuse

The Facts Of Pain Medications

Answer provided by Scott J. Zashin, M.D., clinical assistant professor at University of Texas Southwestern Medical School, Division of Rheumatology, in Dallas, Texas. Dr. Zashin is also an attending physician at Presbyterian Hospitals of Dallas and Plano. He is a fellow of the American College of Physicians and the American College of Rheumatology and a member of the American Medical Association. Dr. Zashin is author of Arthritis Without Pain - The Miracle Of Anti-TNF Blockers. The book is a must-have for anyone on one of the biologic drugs (Enbrel, Remicade, Humira) or considering the biologic drugs. Read our review of the book.

Reference:
Fitzcharles et al, Arth and Rheum Vol 52 no 12, Dec 2005

Last update 1/02/06