Recommendations issued for managing pain in patients with arthritis
medwireNews: EULAR has published recommendations for pain management in patients with inflammatory arthritis and osteoarthritis.
“Underpinned by available systematic reviews and meta-analyses, these recommendations enable health professionals to provide knowledgeable pain-management support for [these patients],” say the guideline authors, led by Rinie Geenen (Utrecht University, the Netherlands).
The multidisciplinary taskforce of 18 members – including patient representatives, physiotherapists, rheumatologists, nurses, psychologists, a primary care provider, an occupational therapist, an epidemiologist, and a research fellow – conducted a systematic review to identify 186 systematic reviews and meta-analyses evaluating the effect of various treatment strategies on pain outcomes.
Analysis of these studies indicated that physical activity and psychological interventions had the most uniformly positive impact on pain, while other strategies such as weight management, education, and orthotics had beneficial effects in specific disease groups.
On the basis of these findings, together with expert opinion, the team developed overarching principles and specific recommendations for the assessment and management of pain.
Geenen and colleagues emphasize that it is key for healthcare professionals to follow a patient-centered approach to pain management within a biopsychosocial perspective.
“Care that is respectful of and responsive to individual patient preferences, needs and values, and ensures that patient values guide clinical decisions, may improve adherence and persistence with treatment,” they write.
Caregivers should also have sufficient knowledge of disease pathogenesis to treat disease activity and prevent tissue damage, which are crucial for achieving pain control, they add, noting that it is important to differentiate between localized and general pain.
In the specific recommendations, the experts propose that pain assessment should include pain characteristics, current and prior treatment, inflammation, and psychological factors. They recommend that each patient should receive a personalized pain management plan, with treatment options including education, exercise, orthotics, psychological interventions, and pharmacologic therapies. Each recommendation was agreed upon by approximately 90% of the guideline authors.
They note that “there are several omissions” in current knowledge on pain management, particularly for patients with psoriatic arthritis, and propose a future research agenda to address these gaps.
“[A] main challenge in future research is to examine in which patient subgroups each specific treatment option causes a reduction of pain,” say the authors.
The recommendations are published in the Annals of the Rheumatic Diseases.
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