The Rheumatologist
COVID-19 News
  • 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
      • Systemic Lupus Erythematosus Resource Center
      • Rheumatoid Arthritis Resource Center
      • Gout Resource Center
      • 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 / Trying to Parse True Meaning of Pain Can Be Challenging for Rheumatologists

Trying to Parse True Meaning of Pain Can Be Challenging for Rheumatologists

March 15, 2016 • By Simon M. Helfgott, MD

  • Tweet
  • Email
Print-Friendly Version / Save PDF
Dmitry3D/shutterstock.com

Dmitry3D/shutterstock.com

Who, except the gods, can live time through forever without any pain? —Aeschylus

You Might Also Like
  • Chronic Osteoarthritic Pain Causes Brain Changes
  • Pain Links Fibromyalgia & RA
  • Chronic Pain Research Probes Neurologic Pain Pathways, Biomarkers
Explore This Issue
March 2016
Also By This Author
  • When Medical Workforce Grievances Lead to Strikes

Pain, swelling, stiffness. These are among the most common words overheard in conversations with our patients. How stiff are you in the morning? Have your joints swelled? Can you rate your level of pain using a 10-point scale?

ad goes here:advert-1
ADVERTISEMENT
SCROLL TO CONTINUE

Discussing aching joints, sore muscles and tender limbs is all in our day’s work. We are rheumatologists; we deal in misery. But trying to parse the true meaning of these terms is among the most vexing of clinical challenges.

True, most swollen joints can be readily observed or palpated, and others might be identified using diagnostic imaging studies. And although it’s a subjective term, the true relevance of stiffness often becomes apparent following a careful review of the results of some simple lab markers of inflammation.

ad goes here:advert-2
ADVERTISEMENT
SCROLL TO CONTINUE

Sometimes, pain plays by the rules and arrives with a retinue of helpful clues; an abdominal pain accompanied by a fever and an elevated white blood cell count demands swift surgical attention to rule out visceral rupture; a pleuritic chest pain with breathlessness often triggers immediate consideration of a pulmonary embolism; a bout of podagra awakening a slumbering patient hearkens the clinician back to Thomas Sydenham’s classic description of gout.

Sometimes, pain can be misleading. Consider the patient with shoulder pain who, in reality, is sickened by their impacted gallstone or the young child whose knee pain and refusal to walk actually signifies an injured hip.

When pain is coy, it presents bereft of any clues. We are all too familiar with these scenarios: the previously healthy, athletic patient with debilitating, widespread pain whose hope for a reprieve from their anguish clings to the spurious finding of a positive antinuclear antibody test ordered by a well-intentioned, although misinformed, clinician; or the person with intractable low back pain following some trivial trauma whose Internet search for help led them astray and into the realm of rheumatic disease. In these situations, you become the bearer of mixed news, having to elucidate how their pain is not due to a defined rheumatologic illness, while also explaining how little we actually understand about chronic pain.

ad goes here:advert-3
ADVERTISEMENT
SCROLL TO CONTINUE

Pain can also be a well-entrenched symptom in many rheumatologic diseases. Consider how some of our patients with an inflammatory arthritis, such as rheumatoid arthritis (RA), start developing vexing pain symptoms. In a typical scenario, their RA is controlled with scant evidence for active synovitis. But then one day, they start to notice pain. Considerable pain. Sometimes the misery is felt in the soft tissues; other times it attacks previously unaffected joints. You examine your patient carefully, seeking any glimpse of the trusted trio of inflammation—swelling, redness and warmth. But there are no sightings. Despite cautious trials of analgesics, corticosteroids and, perhaps, even further immune modulation therapy, there is scant improvement. What is going on? What is driving this new pain?

Pages: 1 2 3 4 5 6 | Single Page

Filed Under: Opinion, Rheuminations Tagged With: Diagnosis, Pain, patient care, rheumatologist, rheumatology, stiffness, swellingIssue: March 2016

You Might Also Like:
  • Chronic Osteoarthritic Pain Causes Brain Changes
  • Pain Links Fibromyalgia & RA
  • Chronic Pain Research Probes Neurologic Pain Pathways, Biomarkers
  • Rheumatologists, Physical Therapists Partner to Offer Patients Pain Relief, Improved Quality of Life

American College of Rheumatology

Visit the official website for the American College of Rheumatology.

Visit the ACR »

Meeting Abstracts

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

Visit the Abstracts site »

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 »

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

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

Copyright © 2006–2022 American College of Rheumatology. All rights reserved.

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