Abstract
Rheumatoid arthritis (RA) is often associated with pain affecting functionary. Diseasemodifying antirheumatic drugs (DMARDs) and anti-inflammatory treatments may influence pain only to a certain degree, and additional pain treatment may be required. Interventional pain treatment and the use of opioids in musculoskeletal disease has been established in some areas. Although there are no controlled trials available in RA, it is mostly accepted that opioids control pain from RA and they are being increasingly used. Many RA patients continue to experience pain their current treatment with nonopioid analgesics. The use of strong opioids has always been controversial, although increasingly more clinicians feel that opioids are well tolerated and effective and should be made available when nonopioids have failed to control pain. The conditions under consideration clinically fall into two mechanisms, inflammaion and other, the latter taken to include mechanical and neuropathic. A neuropathic mechanism should be considered where there are no signs of nociceptive pathology, specifically inflammation, in the region of pain complaint but where there is allodynia or hyperalgesia to mechanical stimuli. The need for improved pain control in RA is heightened by the insidious and chronic nature of this disease. It is recommended that all clinicians regularly monitor pain levels in their patients and the use strong opioids and the interventional methods as a further step in the treatment of pain from RA.
