New guidelines released for arthritis pain

June 1, 2002

Pharmaceutical Representative

The Glenview, IL-based American Pain Society has released its new clinical guidelines for treating acute and chronic pain associated with arthritis.

The Glenview, IL-based American Pain Society has released its new clinical guidelines for treating acute and chronic pain associated with arthritis, which strongly emphasize that arthritis pain is best treated through a combination of ongoing pain assessment, medication, proper nutrition, exercise, and patient and family education.

"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 APS President Michael 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 their patients' pain."

New recommendations

Among the major recommendations in the APS Arthritis Pain Management Guideline:
• All treatment for arthritis should begin with a comprehensive assessment of pain and function.

• For mild-to-moderate arthritis pain, acetaminophen is the drug of choice for its mild side effects, over-the-counter availability and low cost.

• For moderate-to-severe pain from both osteoarthritis and rheumatoid arthritis, COX-2 nonsteroidal anti-inflammatory drugs, such as New York-based Pfizer Inc. and Peapack, NJ-based Pharmacia Corp.'s Celebrex™ (celecoxib) and Whitehouse Station, NJ-based Merck & Co. Inc.'s Vioxx® (rofecoxib tablets), are the drugs of choice for their pain-relieving potency and absence of gastrointestinal side effects. Use of nonselective 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 nonspecific NSAIDs and a medication to moderate GI distress.

• Opioid medications, such as oxycodone and morphine, are recommended for treating severe arthritis pain for which COX-2 drugs and nonspecific NSAIDs do not provide substantial relief.

• 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 so severely impaired as to prevent minimal physical activity. Surgery is recommended before the onset of severe deformity and advanced muscular deterioration.

Juvenile chronic arthritis

For patients with juvenile chronic arthritis, the guideline recommends:

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

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

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

• Cognitive-behavioral therapy should be used to help reduce pain and psychological disability and to enhance pain-coping skills.

• Clinicians should take appropriate measures to minimize pain and anxiety associated with diagnostic and therapeutic procedures for JCA.

• 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 guideline also specifies that arthritis patients should maintain their weight and keep active. "Since arthritis is a chronic and progressive disease, clinicians must be sure that regular exercise or physical therapy is an important component of a comprehensive management program," said Ada K. Jacox, chair of the APS clinical guideline development committee. "Staying active is a critical component for managing this disease." PR

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