Re: RE: At what point do Rheumotologist start giving serious pain medications

[Guest guest]

I agree with this. There are doctor's who will not prescribe anti-depressants

for this reason, too!

Hopefully one of these days they will get a clue!

*~ Kami ~*

From: Cassy

Sent: Wednesday, October 20, 2010 12:27 PM

Subject: [ ] Re: At what point do Rheumotologist start giving serious

pain medications

My personal belief is that they want to remove the liability of pain meds and

put it on the shoulders of another who is in business for that reason only, and

thus willing to do what is necessary to address the pain. I really think its a

selfish move, because I have heard from many others,that say their doc does it.

Not trying to be mean about it, just stating my thoughts about it.......Cassy

[Guest guest]

Sorry for my ridiculously late reply, beth.

My opinion is that the training which rheumatologists have received

regarding pain management for their RA patients is poor. Historically,

I think all physicians were taught that pain would never kill anyone,

so they didn't have to worry too much about it. Not their problem.

Only relatively recently has pain been considered the " fifth vital

sign. "

Rheumatologists seem to have been taught to focus on preventing

deformity and maintaining physical function rather than to help

optimize the overall quality of life of their rheumatoid arthritis

patients.

Although pain is one of the most common and serious challenges RA

patients encounter, many rheumatologists seem unwilling to help RA

patients with it. And it's horrible that rheumatologists push the

problem of pain back onto the patient and expect her to solve the

problem without any assistance or advice. " Go see your GP about your

pain " doesn't count as meaningful assistance or advice.

While opioids are certainly not the only answer - there are many ways

to approach and effectively treat pain - they are sometimes quite

appropriate. As Cassy mentioned, convenience and legal liability too

often enter the equation when considering narcotics for a patient who

could benefit from their use.

I'm not aware of any American College of Rheumatology guidelines for

pain management for RA patients, but there is a glimmer of hope here:

***********************************

Arthritis Care & Research

May 2010

" Report of the American College of Rheumatology Pain Management Task Force " :

http://www.ibji.com/pdf/PMTFAMAY2010.pdf

************************************

Not an MD

On Wed, Oct 20, 2010 at 7:38 AM, beth Costa <elizcosta@...> wrote:

>

>

>

> Most Rheumy's prefer not to give serious pain meds, since that is what they

are advised to do.  If you read any books from the Arthritis Foundation they say

the same thing.  My doc told me he doesn't like to give narcotic pain meds ( he

does make a few exceptions) because they often mask the pain instead of actually

improving what causes the pain, and they therefore can sometimes miss serious

inflammation or injury.  He prefers to switch up my cocktail of meds, add a

short course of medrol or give me a short course of something like celebrex if I

have pain while he works to change the underlying meds.  Another rheumy also

told me that often the pain from RA comes from damage caused already (that

cannot be reversed) or from osteoarthritis or bursitis secondary to the RA.  He

said this is often the case when meds seem to take away fatigue and inflammation

but not pain.

>

> That being said, we need to have a quality of life, and that's maybe where a

different kind of doctor comes in (pain management?).  But I would guess that

because so many Rheumy's are saying the same thing it has to be some aspect of

their training.  , Are there any guidelines from the American College of

Rheumatology?  I'm just curious.

>

> beth in Bayport