How Do You Treat Chronic Pain in PsA?

A multimodal approach to pain control is an important part of living with chronic pain. Medication options include pills, patches, creams and injections (nerve blocks). Non-medication treatment options include physical therapy, cognitive therapy, and alternative approaches such as acupuncture or nerve stimulation. Evaluating and selecting appropriate pain management may require working with an interdisciplinary team to achieve best results.

Non-opioid medications

Some medications, such as nonsteroidal anti-inflammatory drugs (NSAIDs) like ibuprofen, are available over-the-counter without a prescription. Other NSAIDs, such as ones that inhibit cyclooxygenase II (COX II), require a prescription. Even though ibuprofen can be purchased without a prescription it is not without side effects or risk, and you should be sure to discuss its use with your healthcare provider. Some medications that are typically prescribed for mental health conditions, such as depression, can be effective in reducing pain, as are some medications used to treat seizures.

Opioid medications

For severe pain, your provider may prescribe a medication in a class of medications called opioids, or narcotics. These medications are often highly effective and offer rapid relief, however long-term or over-use of these medications can create significant problems for patients including tolerance (requiring bigger doses to achieve the same level of pain relief), physical dependence (experiencing symptoms of withdrawal such as nausea, sweating, diarrhea, high blood pressure and generalized pain when stopping the medication), and addiction (compulsively using the medication despite physical or social/emotional harm associated with the use of the mediation).

Before starting an opioid medication, your health care provider may do an assessment or screening for family and personal history of risk factors for addiction. Additionally, to reduce the risk of these serious problems occurring, your health care provider will work closely with you to monitor your use of these medications and may discontinue them if there are any concerns for misuse. Some states require patients on these medications to be included in a central database that providers are required to check before prescribing controlled substances to avoid unintentional over-prescribing or diversion of these medications.

Opioid medications can cause constipation and nausea, so in addition to staying hydrated, your provider may recommend medications to assist with this. Additionally, these medications should never be taken with alcohol, and if you take other medications that make you drowsy be sure to discuss this with your healthcare provider.

Medical marijuana

Several states have legalized medical marijuana and some states have additionally de-criminalized recreational marijuana use. Though there is anecdotal evidence of the pain-relieving properties of tetrahydrocannabinol (THC), there are currently no high-level research studies supporting the long-term use of marijuana for chronic pain. There is, however, strong evidence that excessive marijuana use, especially for young adults and teens, can be harmful to physical and mental health. Even though some states have de-criminalized marijuana use and permit medical marijuana, it is still a federal crime for a healthcare provider to prescribe this substance and patients must obtain the medication through the permissible channels. Additionally, possessing marijuana in a state where it is illegal could result in legal charges even if the person is carrying the appropriate documentation from his or her home state. Testing positive for marijuana, even in legalized states, can result in “driving under the influence” charges if impaired driving is observed and employers with a “no drug” policy may terminate (or not hire) individuals who test positive for marijuana.

Pain specialty treatment centers

Not all pain is created equal, and what relieves muscular pain is not necessarily the same as what relieves rheumatic pain. Increasingly, patients with chronic pain are involving pain management specialists in their treatment teams. These providers are often located in pain clinics where an interdisciplinary team works to provide holistic options for maximum pain relief with minimum side effects. They may recommend physical interventions, such as nerve blocks, biofeedback training, or physical therapy. Other treatments, such as counseling or use of cognitive therapy, may be used to decrease the psychological distress of chronic pain, which in turn can reduce the perception of pain. Depending on your unique circumstances, a pain management specialist may provide short-term consultation to your rheumatologist or may be involved on an ongoing basis.

The decision about if and how to treat pain is an important one. While all medications used to treat pain have risks of side effects, leaving pain untreated also carries risks including increased rates of depression and having a significant and negative impact on your quality of life. There are many approaches to pain management, and your health care team will work with you to identify which medications and non-medication approaches will be most effective and meaningful for you.

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