Pain is the most common symptom of patients with rheumatic diseases, and is the main reason why they seek medical advice. Pharmacological therapies that are currently available for the treatment of chronic musculoskeletal pain are associated with numerous limitations, including adverse effects, and addiction and tolerance issues, and patients are often left with unrelieved pain. This represents a major unmet medical, which impacts on the quality of life of millions of patients as well as on healthcare resources around the world. Nonpharmacological approaches, including educational and exercise programs, also have a role in pain management, but data from clinical trials on the use of these treatment modalities, and knowledge of how to best incorporate them into the clinical care of a patient, are limited.

Assessing, defining and managing pain can be problematic, as can understanding the complex signaling pathways and diverse mechanisms involved in this multifaceted phenomenon. This Focus issue encompasses articles on the risks of chronic opioid therapy in the management of pain in patients with rheumatic diseases, the role of the rheumatologist in managing pain relief therapies, and articles discussing nonpharmacological, self-management, psychological and targeted-surgery strategies.

An NPG library of relevant Reviews, Perspectives, Research Papers, Research Highlights, News pieces and commentaries is also provided.


Pain management: Pain by name, pain by nature

Peter E. Lipsky & Jenny Buckland


Nature Reviews Rheumatology 6, 179-180 (2010)


Adverse effects of chronic opioid therapy for chronic musculoskeletal pain

Leslie J. Crofford


Nature Reviews Rheumatology 6, 191-197 (2010)

In the absence of a safe and effective alternative treatment for chronic musculoskeletal pain, the prescription of opioid analgesics has escalated dramatically over the past decade. Their use, however, can be associated with the persistence, or even enhancement, of chronic pain, and might also induce powerful positively-reinforcing psychological effects that lead to clinical dependence, as outlined in this Review.

Psychological approaches to understanding and treating arthritis pain

Francis J. Keefe & Tamara J. Somers


Nature Reviews Rheumatology 6, 210-216 (2010)

In this Review, the authors describe the emotional, cognitive and social context variables that contribute to arthritis pain, and how they have been used to develop psychological approaches to pain management.

Self-management of chronic low back pain and osteoarthritis

Stephen May


Nature Reviews Rheumatology 6, 199-209 (2010)

Individuals with chronic back pain or osteoarthritis often do not seek healthcare because of these problems, but instead make use of a range of self-care strategies. This article explores several aspects of self-management, and includes a review of the evidence for the effectiveness of various self-management programs for these two musculoskeletal conditions.

Surgical options for patients with shoulder pain

Salma Chaudhury, Stephen E. Gwilym, Jane Moser & Andrew J. Carr


Nature Reviews Rheumatology 6, 217-226 (2010)

Surgery for painful shoulder conditions is usually only considered when conservative treatment fails. This article outlines the features of and indications for surgery in common painful conditions that affect the shoulder.


The role of the rheumatologist in managing pain therapy

David Borenstein


Nature Reviews Rheumatology 6, 227-231 (2010)

Despite the high number of patients who present to their rheumatologist with pain, this symptom remains undertreated in the clinic. In this Perspectives, David Borenstein explores reasons for the undertreatment of pain in patients with rheumatic disease, and argues that the rheumatologist's role in this regard should be brought to the forefront.


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