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A 49-year-old female asked:

I am on orencia, (abatacept) 20mg methotrexate, 75mg fentanyl patch, 200mg celebrex, 250mg tramadol, 75 lyrica my pain is still severe? where can i go from here?

2 doctor answers7 doctors weighed in
Dr. Paul Grin
Pain Management 37 years experience
Sympathetic Blockade: Some continuous neuropathic pains are also maintained by the sympathetic nervous system and are designated as sympathetically maintained pain (smp). Sympathetic blockade can be accomplished using either regional anesthesia (e.g. Stellate ganglion block) or systemic intravenous infusion with phentolamine. Rec.: see an interventional pain management specialist.
Dr. Robert Lowe
Dr. Robert Lowe commented
Pediatric Rheumatology 18 years experience
If you still have joint swelling, you may get some additional pain relief if your are able to optimize your RA immunomodulatory therapy(increase dose or frequency or switch to another med). If you have generalized pain "all over" you may also have fibromyalgia that will benefit from improved sleep hygiene, light daily exercise, physical therapy, and counseling. I hope you can get to feeling better
Apr 26, 2014
Dr. Paul Grin
Dr. Paul Grin commented
Pain Management 37 years experience
Provided original answer
Great advice, Dr. Robert M. Lowe! Thank you.
Apr 26, 2014
Dr. Karen Sibert
Anesthesiology 40 years experience
Cause of pain?: First, make sure the cause of your pain has been properly worked up and diagnosed. Treating the source of pain is the only way to eliminate it. If you have chronic pain and have exhausted other treatment options, see a physician anesthesiologist who specializes in chronic pain mgmt. You may be a candidate for an implanted pump, regional blocks, or other modalities. Good luck!

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