A Holistic Approach to Pain Management in the Rheumatic Diseases

Pain is the most common symptom of patients with rheumatic disease, and its characteristics can be used to diagnose disease, assess disease activity, inform treatment decisions, and determine treatment response. Pain nevertheless remains one of the most difficult symptoms to evaluate and treat. Understanding the mechanisms of pain in the rheumatic diseases can provide a framework for a holistic approach to guide treatment decisions. In this article, we provide an overview on pain generation in rheumatologic disease, with a focus on rheumatoid arthritis, osteoarthritis, and fibromyalgia, and offer a perspective on treatment. Pain in rheumatic disease can be divided into three categories: inflammation, damage, and pain processing and perception. The contribution of these mechanisms can change during the course of disease and characteristics of different causes of pain can be present at any given time. In view of the diverse mechanisms of pain in the individual patient, a personalized approach of pharmacologic and non-pharmacologic interventions can be used to address symptomatology. The division of pain into the three categories of inflammation, damage, and pain processing and perception can provide a useful construct for pain assessment and management in patients with rheumatic disease. Given its complex nature, pain can be treated using a variety of pharmacologic and non-pharmacologic interventions. For patients with inflammatory arthritis, the underlying mechanism of pain should be frequently re-assessed and a holistic approach used to manage better this important symptom.