Rheumatoid arthritis

Pain management sub-optimal in RA: ARAD

Thursday, 12 Nov 2015

Clinicians should routinely ask patients with RA about their pain, even when their disease is well controlled, say researchers who found pain management was suboptimal in Australian patients despite the significant advances in treatment over the last decade.

The analysis of patients from the Australian Rheumatology Association Database (ARAD) found 95 percent of the 1548 patients who had completed a questionnaire reported having experienced pain in the preceding week (>4mm).

Overall, 37% of the patients reported mild pain (5-34mm), 39% moderate pain (35-69mm) and 19% severe pain (70-100mm).

The researchers found no difference in either the prevalence or severity of pain reported by those taking stable biological therapy versus those not taking biologics.

There was also no difference in the prevalence or severity of pain in those with early disease versus established rheumatoid arthritis.

“Whilst this study was unable to assess the aetiology of the pain reported, our data suggest that this is unlikely to be related to active disease” lead author Dr Bethan Richard from the University of Sydney told the limbic. 

The analysis also revealed that 73 percent of patients were taking an analgesic medication, with 60% saying they took paracetamol and 37% reporting using NSAIDs to control their pain.

However, one surprising and concerning finding was that 26 percent reported taking an opioid to manage their pain, said Dr Richards who presented the research this week at ACR15 in San Francisco.

“When considering the risk: benefit profile, there is little evidence to support the routine use of opioids in patients with RA and persistent pain,” she said.

The study results showed that clinicians should be asking patients about their pain as well as their use of pain medications, particularly opioids, Dr Richards said.

Pain medications should also be reviewed when patients report no improvement or worsening levels of pain.

“Persistent pain should be further investigated to elucidate the aetiology and managed in accordance with the Australian guidelines,” she added.

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