The Implausible Rheumatologist

A few weeks ago, Dr. R.W. posted this article about Rheumatologists’ views of complementary and alternative medicine. The results were as follows:

Of 600 rheumatologists who were sent the questionnaire, 345 responded (58%); 80 (23%) were women. Body work had the highest perceived benefit, with 70% of respondents indicating benefit. Acupuncture was perceived as beneficial by 54%. Most were willing to recommend most forms of CAM. Women had significantly higher composite benefit and recommend responses than men. Rheumatologists not born in North America were more likely to perceive benefit of select CAM therapies.

Is this surprising? No, not to me. One of the challenges of caring for people with chronic pain is that brick wall both the doctor and patient hit time after time. With the best intentions, I will deliver my evidence-based argument about how time, exercise and other conservative treatments like ice/heat and NSAIDS are best for musculoskeletal complaints like back pain. I will cite studies that dissuade use of narcotics for chronic musculoskeletal pain. I will try to convince my patients that an MRI is not needed “just to make sure” at the first twinge of pain. And yes, I can find studies to back up all these things. And when the patient hasn’t had any success with my evidence-based recommendations? Why can’t massage be beneficial? I don’t think many people in this day and age think of massage as an “out there” treatment. Yoga? Great. Meditation? Super. Anything that helps us slow down and relax. Start talking about energy treatments and I’m a little skeptical but if you think it helps you and it’s not hurting you, go for it (and I am hoping a certain Reiki practitioner isn’t reading this, you know who you are).

Chronic pain is very difficult to have and very difficult to treat. I’d like to try to keep an open mind regarding possible therapeutic options. I think, and perhaps this survey illustrates the point, that I’m not alone in this opinion. OK, I’m ready for the onslaught!

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5 responses to “The Implausible Rheumatologist

  1. Just curious, what do you think of Fish Oil supplements at a dose of 4 grams a day for rheumatoid arthritis? have you had any personal experience with your patients using this? love your blog!

    • The studies used really high doses and showed some modest benefit in pain. However, usually when discussing RA treatments we need to strongly consider DMARDS and fish oils don’t qualify as DMARDS. Therefore, supplements can be used as an adjunct but certainly not as a sole treatment.

  2. I am surprised you thought you would get an onslaught of what, criticism? You don’t say, so I am guessing.

    Patients, and I suspect almost all RA patients will try anything since the help that MDs/rheumatologists can offer is limited, dangerous, and doesn’t work in the end.

    For example, Arava, a gold standard along with MTX. Has it just been shoved off your shelf so you have to start your patients with biologics when maybe a mild RA patient can start with NSAIDS, work through the DMARDS, and then up to biologics? Seems Big Pharma doesn’t like it that way, gotta get to the $$$$ faster.

    Doctors aren’t running the show, your drug reps are. And your patients know it. So who can blame us patients for going elsewhere for help, like chiropractors and using vitamins, et.al. We don’t trust the drug reps either.

    Keep your chin up, at least you are asking questions and questioning the system.

    In remission since 7/07 on Minocin.

    • Yes, criticism. The vast majority of doctor bloggers are very anti alternative medicine. I understand why they are (its hard to recommend unproven treatments) but as I work with conditions that have limited treatment options, I need to keep an open mind about other therapeutics.

      • I think we’re anti-optimistic about holistic medical treatments, b/c outside of an occassional massage and maybe some fish oil and epson salts, none of that stuff has come close to touching our pain levels. I have nurses who did into my arms to find my rolling veins, and I don’t even flinch. I have places on my body waxed regulary and don’t even blink. THAT is the amount of pain I live with daily, that I cease to feel pain that would cause most others discomfort. Narcotics are needed for chronic pain. I’m sorry to say. I’m only 35, and it is not a life I would choose. Some days the stars align, the pain levels are good, and I leave the pain meds in the cabinet, happy to go a day without damage being done to my organs. I no that I am no more addicted to these drugs than I am to eating spinach. The pain receptors in my brain look for the pain relief these drugs provide, so there is no way I am receiving a “high” or any type of nonsense from those. If docs would recognize that pain in all forms is awful and needs to be treated as such, we with RA could live a much higher quality of life. There is a folk tale making the rounds, not sure if it is true or not, but I like to think so. It goes, a rheumatologist made the statement, “I thought I knew everything there was to know about RA, and then I got it, and realized I knew nothing. ” Please remember that. And maybe check out my blog for a better understanding of that with which we deal.

        -RA SB
        rasuperbitch.blogspot.com

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