Residency Training May Be Key to Better Pain Management in Rheumatoid Arthritis
Rheumatoid arthritis (RA) is a progressive inflammatory disease characterized by joint destruction, synovitis and autoantibody production. Evidence has found insufficient pain management a major concern amongst RA patients. Since rheumatologists are not trained to address pain concerns, they refer RA patients with pain issues to pain clinics which often have long wait times. The current project aimed to summarize and improve RA pain management strategies and protocols as well as make evidence-based recommendations to residency training curricula. Publications by the Canadian Rheumatology Association, the European League Against Rheumatism and the American College of Rheumatology were consulted for disease treatment protocols and pain management strategies. Furthermore, publications outlining the training objectives for Canadian residency programs were obtained from the Royal College of Physicians and Surgeons. In order to make evidence-based recommendations to the curricula, The Cochrane Library was searched for systematic reviews on the efficacy of different treatment modalities. Evidence indicated that pharmacological treatment for RA pain such as analgesics, anti-inflammatory drugs, opioids and anti-depressants were at the core of pain management. Additionally, a variety of non-pharmacological treatments, such as cognitive-behavioural therapy and transcutaneous electrical neural stimulation therapy, were recommended. This evidence was used to provide guidelines for effective RA pain management techniques to the rheumatology residency curriculum. Moreover, the project provides a multi-disciplinary, patient-centred approach to treatment using the biopsychosocial perspective. These guidelines aim to equip rheumatologists with resources to address their patients’ pain concerns in a timely manner.