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Pain management in rheumatology research, training, and practice.

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The Pain Management Task Force of the American College of Rheumatology published a report in 2010 highlighting pain management as a fundamental aspect of clinical practice, training and research. In the interim, the consideration of pain as a focus of attention of rheumatologists and rheumatology health professionals has become even more challenging than in 2010 because of the epidemic of opiate addiction and overdose death.

The characterization of categories of pain by mechanism (e.g., inflammation, joint degeneration, abnormalities of central pain processing) can help guide treatment. However, such categorization can overlook the overlap of these processes and their interaction to create mixed pain states. Further complicating the assessment of pain, outcome measures in rheumatic disease often assess the degree of pain indirectly while concentrating on the quantification of inflammation. Non-inflammatory pain often persists despite treatment, highlighting the need for alternative analgesic therapies.

Recommended therapies include acetaminophen, nonsteroidal anti-inflammatory drugs, and stimulators of the pain inhibitory pathway. Each of these non-opioid therapies has incomplete efficacy and potential toxicities that can limit their utility.

Non-pharmacologic therapies can show efficacy that rivals or surpasses pharmacologic therapies in the control of pain and improving function in a variety of rheumatic disorders including chronic low back pain and fibromyalgia. A limitation of the use of these therapies is inadequate training and appreciation of their benefits. Furthermore, the supply of trained practitioners to provide non-pharmacological care and support patient efforts for self-management is often limited.

Together, these considerations suggest the importance of a renewed effort to implement task force recommendations.
Full text available here.
Source:  Borenstein DG, Hassett AL, Pisetsky D. Pain management in rheumatology research, training, and practice. Clin Exp Rheumatol. 2017 Sep-Oct;35 Suppl 107(5):2-7. Epub 2017 Sep 28.

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2 thoughts on “Pain management in rheumatology research, training, and practice.”

  1. erikcoley1 says:

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  2. rakiethebird says:

    This summary demonstrates one thing and one thing only about the medical research community’s interest in EFFECTIVE pain management -their abject DISINTEREST! The only CHALLENGE they have is how to justify letting their patients suffer to themselves and to their clinical colleagues when they know there are already safe and effective management regimens to alleviate pain. Their sub-challenges are how to gaslight the suffering into thinking that their pain is ALL IN THEIR HEAD or the product of hysteria and how to pander more effectively to pathologically insane politicians and the ignorant public so that their research funding is safe. They are already experts at the first sub-challenge because they have been doing it for so long, especially with their women patients whom they actually BELIEVE are hysterical anyway.The second is a little more tricky because insanity and public opinion do not follow a pattern.

    Research in this country is predicated on BIG PAYDAYS to the pharmaceutical industry. The pharmaceutical companies are fully aware that you can’t squeeze blood from a turnip and WE, the chronic pain sufferers are the turnips. Our turnip status has been profoundly increased by being cut off the pain management regimens that DO WORK to satisfy bureaucracies that respond to political propaganda fanned by a conspiracy of cruel and heartless media. WHEN YOU RENDER PEOPLE INCAPABLE OF WORKING BY CONDEMNING THEM TO INTRACTABLE BUT CONTROLLABLE PAIN, YOU ALSO TAKE AWAY THEIR MEANS OF AFFORDING ALTERNATIVE PAIN TREATMENT MODALITIES.

    The scientific community is well aware that NONE TO MOST alternative pain management strategies are COVERED by anybody’s health insurance, and especially SSD or no insurance at all, It is tantamount to saying, “let them eat cake.” As with the French Revolution, they will regret their diffidence and callous disregard of suffering, or will they? Maybe they will actually say “problem solved” as pain patients either transform themselves into criminals searching for the pain management they been denied, or they resort to suicide.

    Incarceration and suicide statistics among chronic pain patients who have been cold-turkeyed off their effective regimens are increasing at a rapid pace. I am amazed that they are collected at all. However, they are conveniently NOT COUNTED in the so-called “opioid addiction crisis” because they don’t fit the propaganda narrative. As one healthcare researcher opined to me, “legitimate chronic pain patients on controlled legal opioid-based pain management regimens must sacrifice themselves to the greater good.” But this is an egg-in-the-snake argument because at SOME POINT, society has to deal with the reality of the collateral damage created, even if it is just digging graves.

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