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Rheumatic Pain Management
Rheumatic conditions often cause chronic pain. Through The Pain Center and the Division of Rheumatology at Cedars-Sinai, people with rheumatic conditions can receive state-of-the-art treatment for chronic pain. These treatments may involve medications, rehabilitation or integrative services (e.g., acupuncture and acupressure).
Drugs to treat rheumatic diseases, such as rheumatoid arthritis, lupus, psoriatic arthritis, ankylosing spondylitis and osteoarthritis, have improved dramatically in the past several years. Today many of these drugs can help stave off or even prevent the destruction of joints that could have led to surgery.
Through rehabilitation and physical medicine services, a number of self-management programs are available to help people with rheumatic diseases manage or reduce the pain associated with these conditions.
- Topical pain relievers. Various over-the-counter creams, gels, ointments and sprays can temporarily relieve arthritis pain, reduce inflammation or both. These usually include the pain reliever trolamine salicylate (found in Aspercreme® and Sportscreme®); methyl salicylate, menthol and camphor (found in Double Ice ArthriCare®, Eucalyptamint®, Icy Hot® and Ben-Gay®); or capsaicin from the seeds of hot chili peppers (found in Zostrix® and Capzasin-P®) may relieve pain in joints close to your skin surface, such as your fingers, knees and elbows.
- Oral pain relievers, such as acetaminophen (in Tylenol®) and tramadol (in Ultram®), a centrally acting pain reliever available by prescription. These are effective for people with mild to moderate pain. Taking more than the recommended dosage of acetaminophen can cause liver damage, especially if you have three or more alcoholic drinks a day. Acetaminophen also can affect other medications you may be taking, so be sure to inform your doctor if you're taking it. Tramadol may cause nausea, constipation and drowsiness. It is also linked to seizures in persons taking certain other medications. It is best used for short-term treatment of acute flare-ups.
- COX-2 inhibitors, which are as effective for managing pain and inflammation as NSAIDs but have fewer stomach-injuring side effects. Examples of these include celecoxib (Celebrex®) and rofecoxib (Vioxx®). They are more expensive than NSAIDs and do have side effects of their own, including fluid retention, which may worsen heart failure. They may also be associated with an increased risk of heart attack, transient ischemic attack or stroke. Further review by the Food and Drug Administration is needed.
- Antidepressants. Antidepressants, especially those of the tricyclic type, can help reduce chronic pain. In addition, one in five people with a chronic disease and pain also has depression. Antidepressant medications can treat this depression and accompanying insomnia. The most common antidepressants used for arthritis treatment are amitriptyline (Elavil®, Endep®), desipramine (Norpramin®, Pertofrane®), imipramine (Tofranil®, Norfranil®) and nortriptyline (Pamelor®, Aventyl®).
Injections with local anesthetics and steroids can help alleviate back pain from rheumatic conditions.
Persistent pain should be evaluated and treated by a physician. The rheumatologist, as a nonsurgical musculoskeletal disease expert, is well suited to manage treatment of tendonitis and bursitis because of experience and knowledge about patient education, rehabilitation and drug therapy.