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What is pain? What are EULAR’s guidelines for pain management?

Close up of a person's face wincing in painWhat is pain?

The International Association for the Study of Pain defines pain as “an unpleasant sensory and emotional experience associated with actual or potential tissue damage, or described in terms of such damage”.

Pain is your body’s warning signal, letting you know that something is wrong in your body. When part of your body is injured or damaged, chemical signals are released that travel from nerve system cells (called neurons) to your brain where they are recognized as pain.

Most forms of pain can be divided into two general categories:

  • Acute pain – this type of pain is temporary, lasting anywhere from a few seconds to a few hours and waning as your body heals. Some examples of things that cause acute pain include broken bones, cuts, burns or an injury to a joint that is affected by arthritis.
  • Chronic pain – this type of pain is long lasting and can range from mild to severe. Often, chronic pain is associated with diseases, such as arthritis, and is not sufficiently relieved when treated because of the permanent damage to the body or nerve endings.

What causes pain?

Arthritis pain varies greatly from person to person. Even your own arthritis pain will vary from day to day. Each individual has a different threshold and tolerance for pain. This threshold can be affected by many things including: emotional and physical factors like stress, depression, anxiety and hypersensitivity at the affected areas, such as knees, hips or hands. The increased sensitivity affects how patients experience pain.

While scientists are not completely sure of why there is so much variation in how people experience their arthritis pain, we know that there are many factors that influence pain. These include:

Physical/ biological factors:

  • joint inflammation
  • damage to joint tissue caused by the disease process or wear and tear
  • muscle strain caused by overworked and overstressed muscles
  • fatigue

Emotional and social reasons

  • fears about pain
  • previous experiences with pain
  • your attitude about your disease
  • the way people around you react to your pain
  • depression
  • stress

EULAR Recommendations for Pain Management in Inflammatory Arthritis and Osteoarthritis

The most recent EULAR recommendations for pain management in inflammatory arthritis and osteoarthritis (OA) include physical activity and exercise as a part of a patient’s treatment plan. Physical activity has been shown to significantly ease joint pain and increase mobility, for this reason, exercise is increasingly being prescribed by physicians and other healthcare providers.

Below is an excerpt from Rheumatology Network summarizing the EULAR Recommendations for Pain Management in Inflammatory Arthritis and Osteoarthritis:

1. Assessment by the health professional should include the following:

  • a. Patient’s needs, preferences, and priorities regarding pain
  • b. Pain characteristics including severity, type, spread, and quality.
  • c. Previous and ongoing pain treatments and the perceived efficacy.
  • d. Current inflammation and joint damage as sources of pain, and whether these are adequately treated.
  • e. Pain-related factors that might need attention: the nature and extent of pain-related disability, beliefs and emotions about pain and pain-related disability, social influences related to pain and its consequences, sleep problems, and obesity.

2. The patient should receive a personalized management plan with the aim of reducing pain and pain-related distress and improving pain-related function and participation in daily life.

3. The patient should receive education.

4. If indicated, the patient should receive physical activity and exercise.

5. If indicated, the patient should receive orthotics.

6. If indicated, the patient should receive psychological or social interventions.

7. If indicated, the patient should receive sleep interventions.

8. If indicated, the patient should receive weight management.

9. If indicated, the patient should receive pharmacological and joint-specific pain treatment according to recent recommendations.

10. If indicated, the patient should receive multidisciplinary treatment.

Arthritis Consumer Experts also provide a good summary of short-term and long-term pain treatments here.