If you were to ask the average person what it means to have rheumatoid arthritis or RA, they would probably think first of deformed joints and pain. Modern therapies have greatly reduced the amount of joint damage for the vast majority of patients, but pain is still an issue. Some medications take considerable time to work and pain control is important early on as well as during flares.



Of course, the best treatment for pain is eliminating the cause of it. In the case of RA, this means controlling the disease and the underlying inflammation. Doing this reduces pain and reduces damage that leads to chronic pain. For about 90% of RA patients, good control of RA symptoms means good pain relief as well. However, that still leaves the newly diagnosed and the unfortunate 10% in need of analgesics and other pain control measures.

Acute pain is usually treated with traditional analgesics including opiates like those found in codeine, hydrocodone and morphine to name a few. Less severe pain may be treated with over the counter medications and also by the use of NSAIDs or non-steroidal anti-inflammatory drugs. These are the drugs like ibuprofen, naproxen, diclofenac, piroxicam, Celebrex and the like. These have the advantage of treating the inflammation itself as well as relieving pain and may be used as part of the protocol of treatment. They have the disadvantage of irritation of the digestive system and even blood loss or ulcers as a result.

Ordinary acetaminophen can be used for mild pain in RA and other conditions. While it is easier on the stomach, it does not treat inflammation itself. It might be chosen, for example, in a pregnant patient for whom other drugs might be inappropriate.

Steroidal drugs also can ease pain by controlling inflammation. Prednisone and other steroids can be given by mouth and are sometimes injected directly into an affected joint to treat inflammation directly. Such injections may also have a local anesthetic included and provide extra pain relief. Local anesthetics are also used to inject "trigger points" in select patients but are more common in other rheumatic illnesses such as fibromyalgia.

Since RA pain may become chronic, complementary and alternative therapies may also be added. Physical therapy and occupational therapy can help a patient to be more comfortable and may use assistive devices such as TENS units to control pain without drugs. Some physicians employ herbal remedies and nutritional supplements such as fish oils to help control pain. Others may refer patients for chiropractic treatments or acupuncture.

When pain is a large part of an RA patient's case, a visit to a pain specialist is usually set up to get the best pain control with the best quality of life. Pain is a relative for some RA patients but it can be managed with the right combination of therapies for virtually everyone.