American Pain Society Releases New Clinical Guideline for Treatment Of Arthritis Pain

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American Pain Society Releases New Clinical Guideline for Treatment Of Arthritis

Pain

BALTIMORE, MD -- March 15, 2002 -- The American Pain Society (APS), the leading

United States professional

organization devoted to pain management, today released its new clinical

guideline for treating acute and chronic pain

associated with arthritis, a chronic disease that afflicts one in six Americans.

Introduced at a news conference at the organization's annual scientific meeting

here, the new APS guideline strongly

emphasizes that arthritis pain is best treated through a combination of ongoing

pain assessment, medication, proper

nutrition, exercise and patient and family education.

Developed by a prestigious panel of experts in arthritis pain management, the

APS Guideline for the Management of Pain

in Osteoarthritis, Rheumatoid Arthritis and Juvenile Chronic Arthritis is the

first multidisciplinary, evidence-based clinical

guideline for treatment of arthritis pain. It is intended for use by physicians,

nurses and other healthcare professionals who

treat adults and children with arthritis.

" Research shows that the under treatment of pain in adults and children can have

many serious consequences,

including physiological complications, such as muscle breakdown and weakness;

psychosocial impairments, including

anxiety and depression; and an overall decrease in quality of life, " said

Ashburn. " The APS Guideline, therefore, will help

practitioners and patients better understand acute and chronic pain brought on

by this disease and learn when to use

various treatments to manage the their patients' pain. "

" Acute arthritic pain should be approached in the same manner as other types of

pain by attempting to remove or modify

the underlying cause, giving appropriate analgesics and reducing fears that may

exacerbate pain, " said Ada K. Jacox,

PhD, RN, chair of the APS Clinical Guideline Development Committee. " Chronic

arthritis pain, however, is more complex

since it involves interactions among the biological, psychological and social

factors that influence pain and function. "

" Arthritis is one of the most expensive and debilitating diseases in the US, and

the Guideline recognizes that this condition

can adversely impact earning potential, function and lifestyle, " said Arthur

Lipman, Pharm.D., co-chair of the APS

Guideline Committee. " Therefore, accurate assessment and management of pain

requires differentiation of the types and

causes of pain and an understanding of the patients' willingness to adhere to

therapy and remain active. "

Arthritis is a generic term that refers to more than 100 conditions, the most

common is osteoarthritis (OA), a disease that

occurs with aging and affects 8 in 10 men and women older than 75. OA primarily

effects cartilage and impairs the

function of weight-bearing joints. It can result from excessive or repetitive

loading of a joint from work-related activity,

trauma, inflammation and joint pressure over time caused by chronic obesity.

Rheumatoid arthritis (RA) is the second most prevalent form of the disease. It

is a destructive and debilitating systemic

condition in which the body's immune system attacks healthy joint tissue,

causing inflammation and subsequent joint

damage. RA strikes women more frequently than men, has peak incidence between

the ages of 20 to 50 years old, and

occurs in up to 2 percent of adults.

Among the major recommendations in the APS Arthritis Pain Management Guideline

are:

1. All treatment for arthritis should begin with a comprehensive assessment of

pain and function

2. For mild arthritis pain, acetaminophen is the drug of choice for its mild

side effects, over-the-counter availability and low

cost

3. For moderate to severe pain from both osteoarthritis and rheumatoid

arthritis, COX-2 non-steroidal anti-inflammatory

drugs (NSAIDS), such as Celebrex and Vioxx, are the drugs of choice for their

pain- relieving potency and absence of

gastrointestinal side effects. Use of non-selective NSAIDs should only be

considered if the patient is non-responsive to

acetaminophen and COX-2 drugs and is not at risk for NSAID-induced GI side

effects. Due to the high cost of the COX-2

agents, some patients might benefit from taking non-specific NSAIDS and a

medication to moderate GI distress.

4. Opioid medications, such as oxycodone and morphine, are recommended for

treating severe arthritis pain for which

COX-2 drugs and non-specific NSAIDs do not provide substantial relief.

5. Unless there are medical contraindications, most people with arthritis,

including the obese and elderly, should be

referred for surgical treatment when drug therapy is ineffective and function is

severely impaired to prevent minimal

physical activity. It is advised that surgery be recommended before the onset of

severe deformity and advanced muscular

deterioration.

Juvenile chronic arthritis (JCA) is the most common chronic rheumatic condition

in children and affects some 285,000 in

North America. For patients with juvenile chronic arthritis, the Guideline

recommends:

1. Pain assessment should be ongoing in any child with JCA.

2. Analgesia should be the same for children as for adults with arthritis pain.

3. Patient and family education should be emphasized to increase self- care

skills.

4. Cognitive-behavioral therapy should be used to help reduce pain and

psychological disability and to enhance pain-

coping skills.

5. Clinicians should take appropriate measures to minimize pain and anxiety

associated with diagnostic and therapeutic

procedures for JCA.

6. Guidelines developed by the American Academy of Pediatrics should be followed

whenever sedation is required for

any procedure.

In addition to specific treatment options, the APS Guideline specifies that

arthritis patients should maintain an ideal body

weight and adhere to a balanced diet. Adults should lose weight if their BMI is

greater than 30 and follow a weight-

management program. Also, referrals should be made for physical therapy and/or

occupational therapy to evaluate and

reduce impairments in range of motion, strength, flexibility and endurance.

" Since arthritis is a chronic and progressive disease, clinicians must be sure

that regular exercise or physical therapy are

important components of a comprehensive management program, " said Dr. Jacox.

" Staying active is a critical component

for managing this disease. "

Copies of the Guideline can be obtained by writing the American Pain Society,

4700 W. Lake Avenue, Glenview, IL

60025-1485 or through the APS website, http://www.ampainsoc.org . Other APS

clinical guideline publications are

Principles of Analgesic Use in the Treatment of Acute Pain and Cancer Pain and A

Guideline for the Management of

Acute and Chronic Pain in Sickle Cell Disease.

Founded in 1978, the American Pain Society is a multidisciplinary professional

organization with more than 5,000 members

in the United States consisting of scientists, physicians, nurses, policy

experts and others who study and treat pain. APS

seeks to advance pain-related research, education, treatment and team-oriented

professional practice. In recent years,

the group has gained a reputation as the premiere scholarly scientific society

in the field of pain research and treatment. It

sponsors an annual scientific meeting and publishes the Journal of Pain, a

quarterly peer- reviewed medical journal. APS

is headquartered in Glenview, Ill.

SOURCE The American Pain Society