Arthritis and Rheumatism

Pain Management for RA

04/09/2008 04:26PM

Question:

I have severe RA. There are weeks when I can`t get out of bed for the pain. Even though I try so I would not be so stiff. I have tried many medication to help with the RA and the pain and nothing seems to work. I am taking Enbrel, Arthrotec, Prednisone, and Methotrexate for my RA and it is still out of control. About 13 years ago I had surgery and in the recovery room they gave me two lots of Morphine in the IV for the pain and that did nothing. I then was sent home with 292`s, but that did nothing. Now for my RA pain I was given Tylenol 3`s, but that does nothing. I was offered Demoral and I refused it because I hate taking medications and since the others didn`t work I didn`t think that this would either. The pain feels like there is a hot sharp knife and as I move the joints the knife is sliding back and forth. I never had a baby but I bet "natural child birth" is less painfull then what I have. The only thing that helps the smallest bit is a hot bath. It is good while I am in it but by the time I am dried off I have all the pain again. I get a bath twice a day to help with the pain. It feels like my skin is soon going to flake off from all the dryness. I get my mom to put on my socks and I scream and cry in pain. Since I tried other pain medications but not all for RA, would the Demoral might have worked? I would try it if I though that it might work. What else could I try instead of taking more medications? I don`t want to be living and pain medications for the rest of my life.

Answer:

If the cause of the pain is persistent activity of the Rheumatoid Arthritis (RA) then there are medication regimens available for people that have had an inadequate response to etanercept (Enbrel) plus methotrexate. The options may include changing the etancercept to other TNF-inhibitors versus trialing B-cell depletion therapy (rituximab) or T-cell costimulation inhibition (abatacept).
If the cause of the pain is not from persistent RA activity, then you may be better served by consulting with a physician who specializes in chronic pain management.

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Response by:

Raymond Hong, MD, MBA, FACR
Assistant Professor
Division of Rheumatology
University Hospitals
School of Medicine
Case Western Reserve University