Comprehensive Approach to Pain Management in Inflammatory Arthritis and Osteoarthritis
Pain management in inflammatory arthritis and osteoarthritis should follow a stepped-care approach that begins with education and self-management, progresses to specific targeted interventions based on individual assessment, and escalates to multidisciplinary treatment when monotherapy fails. 1
Initial Assessment
A thorough assessment should include:
- Patient's pain characteristics (severity, type, spread, quality)
- Previous and current pain treatments and their effectiveness
- Current inflammation and joint damage as sources of pain
- Pain-related factors requiring attention:
- Pain-related disability
- Beliefs and emotions about pain
- Social influences related to pain
- Sleep problems
- Obesity
Step 1: Core Interventions for All Patients
Education and Self-Management
- Provide educational materials about the condition
- Deliver psychoeducation about pain mechanisms
- Offer access to self-management programs 1
Physical Activity and Exercise
- Recommend appropriate physical activity based on individual assessment
- For patients unable to initiate exercise independently, refer to physiotherapist for tailored exercise programs
- Address fear of movement or catastrophizing that may limit activity 1
Step 2: Targeted Interventions Based on Assessment
Orthotics and Assistive Devices
- Consider orthotics (splints, braces, insoles) if pain during activities impedes functioning
- Recommend assistive devices (canes, daily living aids) as appropriate
- Refer to occupational therapist for fitting and training 1
Psychological Interventions
- If psychological factors interfere with pain management:
- Provide basic psychological support for mild issues
- Refer to psychologist or cognitive-behavioral therapy for more severe problems
- Address depression or anxiety in collaboration with primary care physician 1
Sleep Interventions
- Provide education about sleep hygiene when sleep disturbance is reported
- For persistent sleep problems, refer to specialized sleep therapy or clinic 1
Weight Management
- For patients with obesity, explain its contribution to pain and disability
- Refer to appropriate weight management support (dietitian, community services) 1
Pharmacological Treatment
- Assess current medication use (prescribed and over-the-counter)
- Ensure safe and appropriate dosing
- Consider additional pharmacological options according to disease-specific recommendations 1
Step 3: Multidisciplinary Treatment
When multiple treatment options are indicated or monotherapy has failed, implement multidisciplinary treatment that addresses all identified factors 1
Implementation Considerations
Shared Decision-Making
- Treatment plans should be personalized based on patient needs, preferences, and priorities
- Engage patients in setting functional goals and treatment decisions 1
Monitoring Progress
- Regularly evaluate patient progress using validated outcome measures
- Adjust treatment plan based on response 1
Avoiding Common Pitfalls
Overreliance on imaging: Radiological imaging should be used only when serious pathology is suspected, when conservative care has failed, or when it would change management 1
Overuse of manual therapy: Apply manual therapy only as an adjunct to other evidence-based treatments, not as a standalone intervention 1
Neglecting psychosocial factors: Always assess and address psychological and social factors that may contribute to pain persistence 1
Failing to facilitate work continuation: Support patients in maintaining or resuming work activities as appropriate 1
Treating pain in isolation: Remember that pain management should address function and participation in daily activities, not just pain reduction 1
The evidence supporting this approach is strong, with recommendations for education, physical activity, and psychological interventions having Level 1A evidence and Grade A strength of recommendation 1. These interventions have been shown to improve both pain outcomes and functional status, which directly impacts quality of life for patients with inflammatory arthritis and osteoarthritis.