Due to changes in opioid prescribing guidelines, many people with rheumatoid arthritis (RA) who relied on opioids for chronic pain were left undertreated or with no pain management at all. If you have RA, there may be other non-opioid ways to reduce pain.
Address The Root Cause
The root cause of pain from RA is inflammation, which is not only painful in itself but can lead to joint damage and hypermobility. Part of controlling the pain associated with RA is reducing inflammation at its source by helping suppress the immune system. Generally, those newly diagnosed with RA will start on medication within a class of drugs called disease-modifying anti-rheumatic drugs (DMARDs).
These medications include methotrexate, hydroxychloroquine, sulfasalazine, and leflunomide. If these medications are not effective alone or in combination, your rheumatologist might recommend a biologic medication. Less commonly, your doctor may give you steroids to help reduce a current flare-up. Sometimes longer-term, low-doses of steroids may be necessary to control especially severe cases of RA that are not responding to medications.
Try Physical Therapy
Physical therapy (PT) can pose additional challenges to patients with RA who have inadequate pain control, because they may need pain managed before they can participate in PT. For those who can participate, PT serves several purposes. Physical therapists can identify imbalances in your body that may contribute to pain. For example, tightness in the front of your hips could be responsible for debilitating iliopsoas bursitis.
Another benefit of PT for some people is providing more stability to the joints. Frequent inflammation and damage to the soft tissue can cause joints to become hypermobile, meaning they move more than they should. In extreme cases, this hypermobility can result in partial or complete dislocations. Strengthening the muscles surrounding a specific joint can act as a brace to the joint by minimizing unnecessary movement.
Include Joint Injections
There are different types of joint injections that may be available, depending on the specific joint. The most common locations for joint injections are large joints and the SI joint. Steroid injections are often the first option to reduce or alleviate pain in a specific large joint. Injecting a combination of a local anesthetic and steroids into the joint can provide short-term and long-term pain relief. The local anesthetic may give you a few hours of relief before it wears off.
Generally, within the next day or two, you should notice the steroid working. Some people find steroid injections work for months. However, subsequent injections may not work as long as the first one. Other options for injections can include hyaluronic acid to help provide lubrication to the joint or platelet-rich plasma (PRP) that recycles your own platelets and injects them back into the joint to aid in healing.
Opioids are often the last resort for RA patients with chronic pain. Fortunately, there are multiple approaches used to manage pain that can make you more comfortable and improve your quality of life with RA. Talk to a medical clinic that offers pain management services to get started.