Pain in rheumatic diseases: how relevant is it?

Abstract

summary Pain, a complex phenomenon influenced by a series of genetic, biological, psychological and social factors, is a major component of many rheumatological conditions and the result of physiological interactions between central and peripheral nervous system signalling (1, 2). It may be acute or chronic (generally defined as lasting ≥ three months): acute pain is often primarily attributable to inflammation and/or damage to peripheral structures (i.e. nociceptive input), whereas chronic pain is more likely to be due to input from the central nervous system (CNS) (2, 3). The many different aspects of pain mean that rheumatologists and other clinicians need to have enough expertise to diagnose the type of pain correctly and treat it appropriately (3, 4). However, most rheumatologists receive little formal training concerning contemporary theories of pain processing or management, and this may affect the clinical results of any specific target therapy.

Unacceptable pain in the BARFOT inception cohort of patients with rheumatoid arthritis: a long-term study

“…Pain has been reported to predict functional capacity (27). Indeed, pain in RA has been said to be 'a more important cause of disability than structural joint damage' (26). This statement is supported by the present findings that both HAQ and SOFI were significantly associated with unacceptable pain, and is further illustrated by the fact that significant disability was closely related to unacceptable pain.…”

“…These results suggest that pain in patients with RA has different backgrounds. In addition to nociceptive pain from joint inflammation and osteoarthritis, pain may be nociplastic inducing central sensitization, as in fibromyalgia, a prevalent condition in RA (3,5,26). It should be noted that the present study was not designed to account for all possible causes of non-inflammatory pain but emphasizes the necessity to identify such causes in patients with RA in order to provide optimal management.…”

“…However, this may not be of major importance. Thus, erosions due to inflammation and JSN caused by coexisting osteoarthritis have been found to be associated, but only to a minor degree, with pain (26). bDMARDs as well as cDMARDs have been found to decrease pain in RA (5).…”

“…In addition to optimal drug treatment, psychotherapy may be appropriate for patients with anxiety and depression, as it is known to decrease pain (28)(29)(30). Moreover, reports supporting the pain-relieving effects of re-establishing or increasing physical activity levels and aerobic fitness should be considered (26).…”