Complex Pain Managemen

 At our training events, our clinical team are repeatedly questioned regarding rheumatoid arthritis and osteoarthritis in the elderly, and the need to validate these as complex pain assessment and management conditions. There is always the need to validate when applying for funding, and we provide here a summary of a paper recently published in the Government's AIHW bulletin.

The facts in the document clearly stand to validate that this issue is a complex pain and lifestyle issue with many elderly. As a nurse your clinical assessments on pain and the management strategy you employ should be vigorously defended using this brief if needed.

SUMMARY

Rheumatoid arthritis is an auto-immune disease, one where the body's immune system attacks its own tissues, and thus differs from osteoarthritis which is characterised by wear-and-tear of joints.

Joints bear the brunt of auto-immunity in rheumatoid arthritis, the hallmark of the condition being painful swelling and stiffness in the joints. Rheumatoid arthritis, however, is a systemic condition, meaning that the whole body is affected. Organs and systems such as the heart, respiratory systems and digestive systems are also involved.

According to the 2007-08 National Health Survey (NHS), an estimated 428,000 Australians reported having rheumatoid arthritis. With approximately 2% of the population affected, rheumatoid arthritis is the second most common type of arthritis, after osteoarthritis.

Rheumatoid arthritis (RA) can develop at any age, but the condition is more common in those aged 55 and older. The condition is 1.6 times as common in women (2.4%) as in men (1.5%).

The way RA is managed has changed over the past 10 years:

In 2003, a new class of medicine, referred to as biologic disease-modifying anti-rheumatic drugs (bDMARD), became available for treatment in Australia, broadening the treatment options.

Hospital separations for the principal diagnosis of RA increased from 30 per 100,000 population in 2001-02 to 53 per 100,000 in 2010-11 with same-day admissions becoming more common than overnight admissions from 2005-06 onwards.

The number of times pharmacotherapy, such as corticosteroids and bDMARDs, was administered during admitted hospital care more than doubled from 2,608 in 2004-05 to 6,932 in 2010-11.

RA can be a significant cause of disability and have considerable impact on quality of life. According to the 2007-08 NHS, people with RA were:

2.9 times as likely as those without the condition to report severe or very severe pain.

1.7 times as likely as those without the condition to report high or very high levels of psychological distress

3.3 times as likely as those without the condition to report poor health status.