Pain and arthritis.
N C Med J. 2007 Nov-Dec;68(6):444-6.
Winfield JB.
University of North Carolina at Chapel Hill, School of Medicine, USA.
john_winfield@med.unc.edu
PMID: 18236866
Address arthritis-associated pain as a disease entity, not as a
sensory entity. Attempt to classify chronic pain as nociceptive pain,
neuropathic pain, fibromyalgia-type pain, or psychogenic pain (very
uncommon); specific treatment approaches are required for these
different types of pain.
Overcome your negative bias against fibromyalgia and review recent discoveries that have led to classification of fibromyalgia as a biologically-based neurosensory disorder. Use the simple and
convenient ways that are available to measure pain and its
concomitants (fatigue, poor sleep, depression, anxiety, and impaired
physical functioning) both at initial evaluation and in follow-up
visits as a guide to therapy.
Do not fear use of opioids; just be careful with this class of drug.
[Note: The full text of this commentary is available for free in PDF at
http://www.ncmedicaljournal.com/nov-dec-07/winfield.pdf ]
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Too often, doctors who are unaware of the nature of fibromyalgia pain will tell the patient to "just take Advil". I took Advil in ever-increasing doses until I got an ulcer. The doctor agreed that I had an ulcer and should stop taking the Advil, but when I reminded him at the end of the appointment that he had not prescribed anything for the intense pain, he threw over his shoulder "take Advil" as he left the room. Leaving me puzzled, since he'd just told me to stop taking Advil because it had given me an ulcer???????
The fact is, fibromyalgia is non-inflammatory pain, therefore NSAIDs (anti-inflammatories) like Advil will, as I discovered, be useless. You can take them by the handful and they will not help. My pain was neurological in origin, so the first thing that helped was Tramadol. It's mild enough to be available without a prescription in Canada, yet many doctors in America shy away from offering it -- they'd rather you get an ulcer by gulping Advil or aspirin than to prescribe even a mild narcotic.
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