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

Taken together, these studies and many others suggest a pivotal behind the scenes role for immune regulation in pain processing.

Where Do We Stand?

Despite the mounting evidence linking immunity and pain pathways, there is a hesitation on the part of some rheumatologists to fully embrace pain management. This attitude is understandable given the myriad challenges facing this clinical conundrum—the subjective nature of pain; the frequent need for potent analgesia, including opioids; the accompanying litigious issues regarding the pain’s causation that may need to be addressed; and the perception that pain management is adrift from the core principles of clinical rheumatology.

This concern has been previously raised, with some rheumatologists advocating that chronic pain disorders, such as FM, be managed by other specialties, notably primary care doctors and psychiatrists.^10,11 In our June 2015 reader survey, a slim majority of respondents (56% vs. 44%) agreed with the statement that rheumatologists should be managing patients with FM. This conflict of opinion will likely persist until we gain an even deeper understanding of the relationship between pain and the immune system.

But we are rheumatologists. We are accustomed to dealing with uncertainty.

Simon M. Helfgott, MD, is associate professor of medicine in the Division of Rheumatology, Immunology and Allergy at Harvard Medical School in Boston.

Reference

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