The Rheumatologist
COVID-19 NewsACR Convergence
  • Connect with us:
  • Facebook
  • Twitter
  • LinkedIn
  • YouTube
  • Feed
  • Home
  • Conditions
    • Rheumatoid Arthritis
    • SLE (Lupus)
    • Crystal Arthritis
      • Gout Resource Center
    • Spondyloarthritis
    • Osteoarthritis
    • Soft Tissue Pain
    • Scleroderma
    • Vasculitis
    • Systemic Inflammatory Syndromes
    • Guidelines
  • Resource Centers
    • Axial Spondyloarthritis Resource Center
    • Gout Resource Center
    • Psoriatic Arthritis Resource Center
    • Rheumatoid Arthritis Resource Center
    • Systemic Lupus Erythematosus Resource Center
  • Drug Updates
    • Biologics & Biosimilars
    • DMARDs & Immunosuppressives
    • Topical Drugs
    • Analgesics
    • Safety
    • Pharma Co. News
  • Professional Topics
    • Ethics
    • Legal
    • Legislation & Advocacy
    • Career Development
      • Certification
      • Education & Training
    • Awards
    • Profiles
    • President’s Perspective
    • Rheuminations
    • Interprofessional Perspective
  • Practice Management
    • Billing/Coding
    • Quality Assurance/Improvement
    • Workforce
    • Facility
    • Patient Perspective
    • Electronic Health Records
    • Apps
    • Information Technology
    • From the College
    • Multimedia
      • Audio
      • Video
  • Resources
    • Issue Archives
    • ACR Convergence
      • Gout Resource Center
      • Axial Spondyloarthritis Resource Center
      • Psoriatic Arthritis
      • Abstracts
      • Meeting Reports
      • ACR Convergence Home
    • American College of Rheumatology
    • ACR ExamRheum
    • Research Reviews
    • ACR Journals
      • Arthritis & Rheumatology
      • Arthritis Care & Research
      • ACR Open Rheumatology
    • Rheumatology Image Library
    • Treatment Guidelines
    • Rheumatology Research Foundation
    • Events
  • About Us
    • Mission/Vision
    • Meet the Authors
    • Meet the Editors
    • Contribute to The Rheumatologist
    • Subscription
    • Contact
  • Advertise
  • Search
You are here: Home / Articles / Tips for Treating Pain, Depression in Patients with Rheumatic Disease Offered at the ACR/ARHP’s 2013 Annual Meeting

Tips for Treating Pain, Depression in Patients with Rheumatic Disease Offered at the ACR/ARHP’s 2013 Annual Meeting

April 2, 2014 • By Susan Bernstein

  • Tweet
  • Email
Print-Friendly Version / Save PDF

You Might Also Like
  • Causes of Alopecia Can Vary Among Patients with Systemic Disease Say Experts at the 2013 ACR/ARHP Annual Meeting
  • 2013 ACR/ARHP Annual Meeting: Research Provides Insight into Preclinical Rheumatic Disease
  • Switches That Regulate Gene Expression Offer Better Understanding of Rheumatic Disease Say Experts at the 2013 ACR/ARHP Annual Meeting
Explore This Issue
April 2014
Also By This Author
  • Big Data May Shift Reference Ranges for Some Lab Tests
Overcoming Barriers

ad goes here:advert-1
ADVERTISEMENT
SCROLL TO CONTINUE

SAN DIEGO—Pain and depression are important to assess and treat in patients with rheumatic diseases. Painful joints may signal underlying disease activity. Pain and depression may impair a patient’s quality of life and physical function, and prompt treatment adjustments. Patients are often at higher risk for poor disease outcomes if their symptoms are not treated properly.

At the 2013 ACR/ARHP Annual Meeting, two experts offered suggestions to clinicians on treating rheumatic diseases in the elderly with dementia or cognitive impairment, and in patients with severe psychiatric disorders. (Editor’s note: This session, ARHP: Rheumatic Disease and Pain Management in Special Needs Populations, was recorded and is available via ACR Session­Select at www.rheumatology.org.)

ad goes here:advert-2
ADVERTISEMENT
SCROLL TO CONTINUE

Difficulty in Reporting Pain

Pain is common among patients older than 70; dementia and cognitive impairment are also prevalent in this population, creating barriers in patients’ abilities to express or report pain, said Devyani Misra, MD, a rheumatologist at Boston University School of Medicine. Dementia causes impairment in thinking, remembering and reasoning, and dementia patients may also have behavioral problems, Dr. Misra added.

“Pain is probably under-reported and under-recognized in this group, and because it is under-reported and under-recognized, it is undertreated,” said Dr. Misra. Significantly fewer elderly hospital patients with dementia or cognitive impairment receive opioids for their pain, she added. Undertreatment of pain leads to physical problems (e.g., impaired sleep, limited function), and psychosocial problems (e.g., depression).

Dr. Misra said that elders with dementia or cognitive impairment have difficulty with their memory or recall of pain.

ad goes here:advert-3
ADVERTISEMENT
SCROLL TO CONTINUE

Standard approaches to pain assessment include the McGill Pain Questionnaire, the Visual Analog Scale and the Wong-Baker FACES Pain Rating Scale, which uses images of facial expressions of pain to rate intensity. However, self-­reporting pain scales are problematic to use in this patient population because of their cognitive impairment. Observational scales may be more useful, according to Dr. Misra.

Two scales have shown favorable results in measuring pain among these patients. Doloplus-2 is a 10-item observational pain scale measuring such factors as somatic complaints, protection of sore areas and mobility. The Pain Assessment Checklist for Seniors with Limited Ability to Communicate comes in both a 24- or 60-item checklist form, and also measures various observations, such as facial expressions of pain and changes in personality or mood. Although these tools are helpful, more accurate measurement tools are greatly needed, Dr. Misra said.

Pharmacologic interventions for managing pain in the elderly population include acetaminophen for mild-to-moderate pain, and opioids for moderate-to-severe pain or when there is evidence of diminished quality of life, Dr. Misra said. Constipation and sedation are potential adverse effects of sustained use of opioids. Corticosteroid injections or topical analgesics may be useful for localized pain. Anticonvulsants and antidepressants are other options, but anti­cholinergics are not recommended for elderly patients with dementia or cognitive impairment, she noted.

Pages: 1 2 3 | Single Page

Filed Under: Conditions, Meeting Reports, Rheumatoid Arthritis Tagged With: ACR/ARHP Annual Meeting, Association of Rheumatology Professionals (ARP), Depression, diagnostic tools, drug, Fibromyalgia, Pain, patient care, psychological disorder, Rheumatic Disease, Rheumatoid arthritis, rheumatologistIssue: April 2014

You Might Also Like:
  • Causes of Alopecia Can Vary Among Patients with Systemic Disease Say Experts at the 2013 ACR/ARHP Annual Meeting
  • 2013 ACR/ARHP Annual Meeting: Research Provides Insight into Preclinical Rheumatic Disease
  • Switches That Regulate Gene Expression Offer Better Understanding of Rheumatic Disease Say Experts at the 2013 ACR/ARHP Annual Meeting
  • 2013 ACR/ARHP Annual Meeting: Inflammatory Eye Disease Management Can Benefit from Collaboration between Rheumatologists and Ophthalmologists

American College of Rheumatology

Visit the official website for the American College of Rheumatology.

Visit the ACR »

Simple Tasks

Learn more about the ACR’s public awareness campaign and how you can get involved. Help increase visibility of rheumatic diseases and decrease the number of people left untreated.

Visit the Simple Tasks site »

Meeting Abstracts

Browse and search abstracts from the ACR Convergence and ACR/ARP Annual Meetings going back to 2012.

Visit the Abstracts site »

The Rheumatologist newsmagazine reports on issues and trends in the management and treatment of rheumatic diseases. The Rheumatologist reaches 11,500 rheumatologists, internists, orthopedic surgeons, nurse practitioners, physician assistants, nurses, and other healthcare professionals who practice, research, or teach in the field of rheumatology.

About Us / Contact Us / Advertise / Privacy Policy / Terms of Use / Cookie Preferences

  • Connect with us:
  • Facebook
  • Twitter
  • LinkedIn
  • YouTube
  • Feed

Copyright © 2006–2023 American College of Rheumatology. All rights reserved.

ISSN 1931-3268 (print)
ISSN 1931-3209 (online)