EULAR recommendations for the health professional’s approach to pain management in inflammatory arthritis and osteoarthritis

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.

Should patients with rheumatic diseases take pain medication in order to engage in exercise?

“…In contrast, a 2017 meta-analysis from a EULAR Taskforce conducted specifically in people with RMDs suggested that exercise associated with more uniformly positive effects on pain management [6], which is a positive finding and specific to RMDs. As such, because pain has great within-person variability, not only within a day but also between days [17], perhaps engaging people with RMDs in exercise at times when pain is experienced less, should be considered as an option prior to giving pain-relief medication in order to engage in exercise.…”

“…Even in healthy adults, the usual recommended dose of 4 g/d of acetaminophen may associate with elevated aminotransferases [24]. The most recent EULAR recommendations for managing pain in rheumatic conditions suggest usage of paracetamol, topical NSAIDs and capsaicin as first-line treatments, with the potential side-effects of NSAIDs to be taken into account when prescribing such agents [6].…”

“…Despite a significant amount of research in this area, pain still remains a challenging area of investigation, without a clear understanding of how it can be drastically and effectively managed. The lack of significant progress on how best to treat this important outcome is denoted in recent efforts, such as the 2018 European League Against Rheumatism (EULAR) recommendations on pain management in RMDs [6].…”

Pain pathogenesis in rheumatoid arthritis—what have we learned from animal models?

“…They recommended physical activity/exercise regimes and diet/weight management to help manage RA pain [59]. The effects of physical activity and exercise are increasingly being characterized in a number of pain models [62,136,146,154], but not yet RA-associated pain.…”

Efeito do vídeo game na reabilitação de pacientes com Osteoartrite de joelho

“…A média dos valores para os desfechos medidos nos dos períodos para cada grupo estão apresentados na tabela 3. Infelizmente não existem estudos com o uso do vídeo game em pacientes com OA de joelho para comparação dos resultados, mas um dos pontos principais para a melhora geral observada da dor, força muscular e função dos pacientes tratados é que o programa de fisioterapia proposto englobou as técnicas e recursos com melhores resultados propostos pelos guidelines atuais (Brosseau et al, 2011;Brosseau et al, 2017;Geenen et al 2018).…”