Pain Treatment in Arthritis-Related Pain: Beyond NSAIDs

Abstract

Managing pain from chronic conditions, such as, but not limited to, osteoarthritis and rheumatoid arthritis, requires the clinician to balance the need for effective analgesia against safety risks associated with analgesic agents. Osteoarthritis and rheumatoid arthritis pain is incompletely understood but involves both nociceptive and non-nociceptive mechanisms, including neuropathic mechanisms. Prevailing guidelines for arthritis-related pain do not differentiate between nociceptive and non-nociceptive pain, sometimes leading to recommendations that do not fully address the nature of pain. NSAIDs are effective in treating the nociceptive arthritis-related pain. However, safety concerns of NSAIDs may cause clinicians to undertreat arthritis-related pain. In this context, combination therapy may be more appropriate to manage the different pain mechanisms involved. A panel convened in November 2010 found that among the currently recommended analgesic products for arthritis-related pain, fixed-low-dose combination products hold promise for pain control because such products allow lower doses of individual agents resulting in decreased toxicity and acceptable efficacy due to synergy between the individual drugs. Better evidence and recommendations are required to improve treatment of chronic arthritis-related pain.

Transdermal Drug Delivery System of Aceclofenac for Rheumatoid Arthritis and the Effect of Permeation Enhancers: In vitro and in vivo Characterization

“…J. Pharmacol., 11 (5): 456-462, 2015 Van Laar et al, 2012). To improve the quality of life of arthritic patients managing moderate to severe chronic pain remains challenging for various reasons (Perrot, 2009).…”

Aceclofenac in rheumatology: The golden mean

“…Он включает в себя и локальное вос-паление, сопровождающееся выбро-сом цитокинов, простагландинов (ПГ) и других биологически активных ве-ществ, и мышечный спазм, и повреж-дение элементов связочного аппарата, и биомеханические нарушения, а так-же дисфункцию болевой системы (пе-риферическая и центральная сенсити-зация, «истощение» антиноцицептив-ных механизмов и др.) [ вовоспалительного и жаропонижающего действия, обеспе-чивающим эффективное купирование основных симпто-мов, связанных с патологией органов опорно-двигательно-го аппарата [1,2,4,12]. Фармакологические эффекты НПВП в наибольшей сте-пени определяются их способностью блокировать фермент циклооксигеназу (ЦОГ) 2, который образуется в очагах ткане-вого повреждения и отвечает за активный синтез ПГ, важней-ших медиаторов боли и воспаления.…”

The Additivity Antinociceptive Interactions Between Diclofenac and the Derris Scandens Extract Drug in Mice.

“…Among the currently recommended analgesic products for arthritis-related pain, fixed-lowdose combination products hold promise for pain control because such products allow lower doses of individual agents resulting in decreased toxicity and acceptable efficacy due to the synergy between the individual drugs. Better evidence and recommendations are required to improve treatment of chronic arthritis-related pain [8].…”