Comments on: Does Rheumatoid Arthritis Pain Really Hurt That Much?

By: Kelly Young

Kelly Young — Sat, 04 Sep 2010 23:11:53 +0000

Brenda, thank you so much for your well thought out comments. Your 3 reasons are spot on!

I think you highlight 2 important points: RA pain is often in the range with things such as post-op pain or pain of a broken bone; and 2, that it is different because it is worsening and unending instead of improving. It is also not the same for every patient. For some it goes up and down, but for others it is more constant. I think that makes it more difficult for doctors and researchers and even other patients to comprehend or “believe” in that kind of pain. We all tend to think that others are like us – I know for me it has been a hard lesson.

By: Brenda

Brenda — Sat, 04 Sep 2010 22:13:23 +0000

It is impossible to quantify a threshold of pain unless the subjects are subjected to a uniform painful stimulus. Otherwise, the “study” is just speculation.

I’ve experienced a total of 4 displaced fractures to the second largest bone in my body requiring 6 trips to the operating room for hardware placement, removal, and arthroscopy, not to mention months of PT. I have degenerative arthritis in my right ankle stemming from the first fracture and ORIF to my tibia over 20 years ago. I’ve also endured 5 other fractures (including a rib) over the years. Yet, last year a doctor had the audacity to tell me (the newly diagnosed RA patient) I had a very low threshold for pain when I complained about my joint discomfort and inability to perform daily tasks. I swiftly told him I was no wuss and that my joint pain at it’s worst was equivalent to some of the post operative pain I experienced but there were a few differences. First, I knew my leg would heal and that the pain would slowly decrease. Second, I was given Dilaudid to ease my pain. Third, there was obvious physical evidence of pain (Large screws bolted into bone) so my pain was “believable”.

I’ve found RA to be in some ways more painful because it has almost no rules. It comes anytime, anywhere, and can last days, weeks, or months. On a good day it can be minor a nuisance while on a bad day it can feel like you have been attacked by godzilla. If the pain was temporary or curable, it would be much easier to handle. Doctors often fail to realize that RA is as much of a mental battle as it is physical.

So, my best guess at why researchers have labeled RA sufferers as having a low threshold of pain? People who have endured countless days of crippling pain have probably depleted their mental reserves for dealing with pain. Without breaks or, “a light at the end of the tunnel”, coping with pain can be also be mentally excruciating!

By: Kelly Young

Kelly Young — Wed, 01 Sep 2010 15:06:10 +0000

I’ve never heard that about nsaid’s although I have heard they reduce esr w/ longterm use. Docs who can’t detect swelling? yes, well it’s hard to do from 6 feet away isn’t it? several I met like that never actually touched my joints. They imagine that RA pain is like a UFO or something: The will only believe it if they see w/ own eyes. Well, think of tendonitis or migraines or a hundred other illnesses that are treated w/out any visible evidence. Besides, the subtle swelling can be detected usually by a skilled clinician. This one always gets me going – I think it’s one of the keys to the whole problem w/ treating RA.

By: Chelsea

Chelsea — Wed, 01 Sep 2010 13:58:24 +0000

Oh, I’m sure. The concluding remarks are probably that such patients are PITA’s! On another note, I saw one abstract stating that NSAIDs may actually be causing production of MORE TNF in RAers. Maybe that’s another reason. Can’t forget that some docs just may not be very goog at detecting some swelling, which you’ve mentioned before.

By: Kelly Young

Kelly Young — Wed, 01 Sep 2010 11:59:34 +0000

A patient recently told me that his doctor told him that this topic is a hot one in some doc to doc convos.: pain w/out obvious inflammation.

By: Chelsea

Chelsea — Wed, 01 Sep 2010 03:24:37 +0000

Although it’s probably more likely bursitis (Weaver’s Bottom or Tailor’s Bottom), here’s another reason why your butt might hurt!

Dystrophic calcinosis in a patient with rheumatoid arthritis
http://www.ncbi.nlm.nih.gov/pubmed/20737189

By: Chelsea

Chelsea — Wed, 01 Sep 2010 03:15:56 +0000

At least some researchers are trying to find out if there is still pain after the inflammation subsides. See the following abstract:

Characterization of the acute and persistent pain state present in K/BxN serum transfer arthritis
http://www.ncbi.nlm.nih.gov/pubmed/20739123

By: Kelly Young

Kelly Young — Mon, 23 Aug 2010 14:53:57 +0000

I hear you Sara. I know from experience that you are right. I went through childbirth also and once I had that “back labor” from a baby who had turned breach. You are completely right – no one should be able to claim they can measure or judge pain. What good is that to do instead of treating it and looking for a cure anyway.
The saddest part is that the patients are counting on these very people to help us.

By: saragaler

saragaler — Mon, 23 Aug 2010 13:58:51 +0000

Before my RA I had a really high pain threshold and I consider myself to still have a high pain threshold. As most other people have said – I went through my first few hours of childbirth with no medication – Sam was the wrong way up so all the pain was intensified through my back and made me totally unreasonable but I got most of the way! I don’t pander to my pain and I, like all of us, will keep going despite it – How can people demean pain so much – especially when pain is personal. When I was nursing we were taught that ‘Pain is what a person says it is – it is personal’.

What makes me really angry is that pain is subjective, it can’t be seen – what makes my pain any less than anyone else with a long term illness! Going back to one of your previous posts Kelly – I’d like the person who wrote the article to take my RA for 6 months and then see how low their pain threshold is!!!

By: Kelly Young

Kelly Young — Thu, 19 Aug 2010 20:59:48 +0000

Wow. Yes, I’ve read about that happening. How brave you were to quit that way.
I’ve never tried any of those drugs & this sure makes it less likely. The pain of RA can make you feel pretty desparate, too. There’s never an end to it in sight like there is with a wound or with childbirth.