Pain Management for Inflammatory Arthritis and Osteoarthritis: A Quiz

August 2, 2018

NSAIDs, opioids, glucocorticoid injections, CBT, relaxation training, sleep interventions . . . what’s effective, what’s not? Answers here.

Reference1. Geenen R, Overman CL, Christensen R, et al. EULAR recommendations for the health professional’s approach to pain management in inflammatory arthritis and osteoarthritis. Ann Rheum Dis. 2018;77:797-807.

Recently, the European League Against Rheumatism (EULAR) released recommendations for the management of pain from inflammatory arthritis (IA) and osteoarthritis (OA).¹ See if you know what’s new.

Question 1: Other than pathological processes, such as inflammation and tissue damage, which factors contribute to pain from osteoarthritis?

ANSWER: “Besides pathological processes such as inflammation and tissue damage, multiple individual factors influence pain, for example, illness beliefs, mood, avoidance behaviour, obesity, sleep disturbance, and the pattern of rest and activity throughout the day.”¹

Question 2: What are the major outcomes for rheumatic care endorsed by the European League Against Rheumatism (EULAR) task force?

ANSWER: “The task force unanimously endorsed that in rheumatic care, besides pain severity, physical functioning and psychological functioning are major outcomes of any management intervention by health professionals, in agreement with other expert groups.”¹

Question 3: Which intervention has the least evidence of effects on pain in osteoarthritis?

CBT, cognitive behavioral therapy; IA, inflammatory arthritis; OA, osteoarthritis; RA, rheumatoid arthritis.

ANSWER: “Psychological and social interventions showed a uniform positive effect on pain for CBT in RA and OA (general), psychosocial and coping interventions in OA (general), biofeedback in RA and relaxation interventions in OA (general, hip/knee)….There was no meta-analysis that evaluated effects of sleep interventions on pain in IA or OA but small effects of sleep interventions on pain were observed in meta-analyses in people with varied chronic medical conditions.”¹

Question 4: According to the EULAR recommendations, the evidence for pharmacologic management of pain related to inflammatory arthritis and osteoarthritis supports the use of which agents?

EULAR, European League Against Rheumatism; IA, inflammatory arthritis; OA, osteoarthritis.

ANSWER: “Pharmacological treatment is a core ingredient of pain management in IA and OA. It includes analgesics (eg, paracetamol, codeine and other opiate-like drugs); oral or topical non-steroidal anti-inflammatory drugs (NSAIDs); intra-articular injections, for example, with glucocorticoids; and occasionally also agents for neuropathic pain.”¹

Question 5: Assessment of pain was recommended to include which parameters?

ANSWER: “…assess pain severity using a numerical or visual analogue pain rating scale, and the onset, duration, location and spread (pain manikin), quality, interference, triggers and progression of pain. Furthermore, appraise the type of pain (localised or generalised) and whether referral is needed to a pain specialist to evaluate the type of pain, current treatment or current medication (safe use, interactions with other medication, side effects).”

Question 6: True or false? Physical activity and exercise interventions were found to be more universally effective for pain management of inflammatory arthritis and osteoarthritis than other measures such as weight management, sleep hygiene education, or use of orthotics.

ANSWER: “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.”¹