“It’s become clear in this day and age of more abuse that only one physician should be prescribing opioids,” says Dr. Borenstein, former chair of the American College of Rheumatology’s Pain Management Task Force. Communication among physicians is crucial to keep tabs on what medications—opioid or otherwise—a patient is using, he says.
It’s also crucial to determine which patients truly would benefit from opioids, Dr. Borenstein says. For example, opioids would “just be a Band-Aid” for someone with swollen, inflammatory joints, he says.
In certain states, such as California, medical marijuana is becoming part of the treatment mix, albeit not an area where many rheumatologists are venturing, Dr. Troum says. Although he tells curious patients that he thinks medical marijuana can be useful for certain conditions, he also lets them know he does not prescribe it, and he refers them to a pain management specialist. “I could have a line out the door, but I’m busy enough. Maybe there are others [in rheumatology] with an interest in it,” he says.
Looking Toward Advances
There have been certain advances in pain medicine that rheumatologists should be aware of, specialists says. One of these is radiofrequency ablation, which is a treatment option for patients with chronic knee pain. “The procedure typically provides greater than 50% less pain for anywhere between six and 18 months,” Dr. Smith says. “Patients undergoing this procedure are able to enjoy an improved quality of life, because they are able to return to church, group activities, chores, etcetera,” Dr. Smith says. This same procedure can be used for the hip, sacroiliac joints and the spine.
“In trained hands and in selective patients, radiofrequency ablation can deliver reliable improvement of facet/joint spine pain,” Dr. Ramos says.
Another area advancing pain treatments is the use of stem cells to treat avascular necrosis of the hip and other areas, Dr. Ramos says.
Other advances that benefit rheumatologic patients and may be promising in the future include long-acting opiates, especially in the form of patches, and platelet-rich plasma treatment and other restorative injectables, which are all being used more frequently in the osteoarthritis population, but need to be studied more in the systemic inflammatory population, Dr. Kahn says.
Vanessa Caceres is a medical writer in Bradenton, Fla.
