Pain Management in Rheumatoid Arthritis using the Biopsychosocial Model

The current biopsychosocial model approach to manage pain in rheumatoid arthritis seeks to address the reality that pain has a biological, psychological, and social aspect. In addition to the objective physical pain felt by the patient, there is a subjective component involving the experience of the patient and a social aspect that relates to their experience of pain within society. Looking at pain through the lens of this model makes it far likelier that the chronic pain patient can experience relief. This model looks beyond analgesic (pain killers) use alone to focus on goal setting, challenging negative thoughts, self- management, and non -pharmacological ways to improve pain. It expands the scope of pain management to include acupuncture, massage, hydrotherapy, splints, proper shoes, assistive devices, orthotics, knee sleeves, protection, positioning, motivational interviewing, education, rest, graded activity, and exercise.

It is recommended to exercise 150 minutes per week for all Canadians and the patient with rheumatic disease is no exception; only the type of exercise may need to be modified. Patients living with arthritis need to learn the difference between hurt and harm. It may be best to start with the least anxiety provoking activity, or to start with exercising a non-affected area of the body. There will often be some hurt before there is benefit.

Utilizing the expertise of a physiotherapist who has experience with RA is an excellent place to start! The Arthritis Society also has physiotherapy resources available. Charlton Health has compiled an excellent resource list, which will be featured on a future blog. Don’t hesitate to ask us for a copy.

Janice Maretzki is a pharmacist at Charlton Health who recently attended the Canadian Rheumatology Association meeting in Montreal.

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