Pain management in inflammatory arthritis and osteoarthritis

Organisation: Position: Deadline Date: Location:

The European League Against Rheumatism has released recommendations for health professionals to use in approaching pain management in inflammatory arthritis (IA) and osteoarthritis (OA).

Dr Rinie Geenen, from Utrecht University in the Netherlands, and colleagues on a multidisciplinary task force including professionals and patient representatives conducted a systematic literature review to assess evidence regarding effects on pain of multiple treatment modalities. The authors included 186 reviews in their analysis.

The task force emphasised the importance for the health professional of adopting a patient-centred framework within a bio-psychosocial perspective, having sufficient knowledge of IA and OA pathogenesis, and being able to differentiate localised and generalised pain.

Pain treatment usually includes education, which can be complemented with physical activity and exercise; orthotics; psychological and social interventions; sleep hygiene education; weight management; pharmacological and joint-specific treatment options; or interdisciplinary pain management. Pain was consistently positively affected by physical activity and exercise interventions as well as psychological interventions.

"Underpinned by available systematic reviews and meta-analyses, these recommendations enable health professionals to provide knowledgeable pain-management support for people with IA and OA," the authors write.

Abstract
Pain is the predominant symptom for people with inflammatory arthritis (IA) and osteoarthritis (OA) mandating the development of evidence-based recommendations for the health professional’s approach to pain management. A multidisciplinary task force including professionals and patient representatives conducted a systematic literature review of systematic reviews to evaluate evidence regarding effects on pain of multiple treatment modalities. Overarching principles and recommendations regarding assessment and pain treatment were specified on the basis of reviewed evidence and expert opinion. From 2914 review studies initially identified, 186 met inclusion criteria. The task force emphasised the importance for the health professional to adopt a patient-centred framework within a biopsychosocial perspective, to have sufficient knowledge of IA and OA pathogenesis, and to be able to differentiate localised and generalised pain. Treatment is guided by scientific evidence and the assessment of patient needs, preferences and priorities; pain characteristics; previous and ongoing pain treatments; inflammation and joint damage; and psychological and other pain-related factors. Pain treatment options typically include education complemented by physical activity and exercise, orthotics, psychological and social interventions, sleep hygiene education, weight management, pharmacological and joint-specific treatment options, or interdisciplinary pain management. Effects on pain were most uniformly positive for physical activity and exercise interventions, and for psychological interventions. Effects on pain for educational interventions, orthotics, weight management and multidisciplinary treatment were shown for particular disease groups. Underpinned by available systematic reviews and meta-analyses, these recommendations enable health professionals to provide knowledgeable pain-management support for people with IA and OA.

Authors
Rinie Geenen, Cécile L Overman, Robin Christensen, Pernilla Åsenlöf, Susana Capela, Karen L Huisinga, Mai Elin P Husebø, Albère JA Köke, Zoe Paskins, Irene A Pitsillidou, Carine Savel, Judith Austin, Afton L Hassett, Guy Severijns, Michaela Stoffer-Marx, Johan W S Vlaeyen, César Fernández-de-las-Peñas, Sarah J Ryan, Stefan Bergman

EMPR material BMJ abstract

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