Canadian study focuses on pain management for arthritis sufferers

Mary-Ann Fitzcharles, M.D., of Montreal General Hospital, McGill University, led a study of pain management for arthritics that incorporates diet, exercise, topical applications and opioid analgesics in its treatment of the ailment.

• Long treated as a side effect, pain is now widely recognized as an integral part of patient care.
• While the last decade has brought extraordinary advances in the unravelling of pain mechanisms at the molecular level, evaluating and alleviating pain remains an ongoing challenge for physicians, particularly rheumatologists.
• The December 2005 issue of Arthritis & Rheumatism (http://www.interscience.wiley.com/journal/arthritis) offers a timely examination of pain as it pertains to rheumatology practice.
• "Pain management is no longer simply a quick fix with a single pill, but rather an approach to the patient as a whole biopsychosocial being."
• Drawing on the latest research into this complex factor, Dr. Fitzcharles and her collaborators demystify both the process and the experience of pain for patients with rheumatoid arthritis (RA) and related diseases.
• Because rheumatic pain travels through small, slow-conducting fibers, it is perceived as a pervasive aching rather than as acute, localized stabs.
• Inflammation also plays a role in activating pain pathways that usually lie dormant -- comprising as many as one-third of the total number of pain-transmitting nerves.
• What's more, molecular evidence suggests that stress and depression may increase a rheumatic patient's production of pain-provoking inflammatory agents.
• In addition to using time-honored tools -- namely, the visual analogue scale of pain severity and patient questionnaires -- in real-life practice, the rheumatologist must take cues from the patient during the interview and examination, heeding spontaneous movement, musculoskeletal structure, and verbal complaints, as well as consider the patient's psychosocial history and coping strategies.
• Beyond the prescription of a pill, what works to relieve rheumatic pain?
• According to studies, regular physical activity not only maintains muscle tone and helps to improve function, but also induces the production of endogenous opioids -- endorphins and other natural painkillers.