Tuesday, 23 Apr 2019

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New EULAR Pain Guidelines

The European League Against Rheumatism (EULAR) convened a multidisciplinary task force including health professionals and patient representatives to develop evidence-based recommendations for pain management in patients with inflammatory arthritis (IA) and osteoarthritis (OA).

After a systematic literature review of the evidence regarding multi-modal pain management the task force summarized their findings as overarching principles and recommendations. 

Treatment is guided by scientific evidence and the assessment of patient needs, preferences and priorities; these recommendations were to enable health professionals to provide knowledgeable pain-management support for people with IA and OA.

Overarching principles

  • The assessment and treatment process should be guided by a patient-centred framework.
  • The health professional should understand that (any type of) pain encompasses multiple and mutually interacting biological, psychological and social factors that include but are not limited to pain severity, peripheral (inflam
  • The European League Against Rheumatism (EULAR) convened a multidisciplinary task force including health professionals and patient representatives to develop evidence-based recommendations for pain management in patients with inflammatory arthritis (IA) and osteoarthritis (OA).
  • After a systematic literature review of the evidence regarding multi-modal pain management the task force summarized their findings as overarching principles and recommendations. 
  • Treatment is guided by scientific evidence and the assessment of patient needs, preferences and priorities; these recommendations were to enable health professionals to provide knowledgeable pain-management support for people with IA and OA.
  • The health professional should have basic knowledge of the pathology, treatment and sequelae of inflammatory arthritis and osteoarthritis.
  • The health professional should be able to differentiate between localised and generalised pain and should know that these types of pain may coexist.

Recommendations for pain management in inflammatory arthritis and OA 

  1. Assessment by the health professional should include the following aspects (the assessment is brief or extensive depending on factors such as available time, whether it is a first or regular consultation, and the needs of the patient).
  2. The patient should receive a personalised management plan with the aim of reducing pain and pain-related distress and improving pain-related function and participation in daily life. This plan is guided by shared decision-making, the expressed needs of the patient, the health professional’s assessment and evidence-based treatment options. A stepped-care approach was proposed.
  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. 

(Overarching principles and recommendations regarding assessment are based on expert opinion)

 

 

Disclosures: 
The author has no conflicts of interest to disclose related to this subject

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