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Chronic arthritic pain
Chronic arthritic pain is a combination of musculoskeletal pain arising from tissue destruction and mechanical changes to cartilage, bone, and soft tissues, which is associated with sleep disturbance, mood disorder, and fatigue.
Chronic arthritic pain is caused by an interplay of both nociceptive (inflammatory) and non-nociceptive (neurogenic) pain mechanisms.
Disease persistence and progression leads to sleep disturbances, fatigue, mood changes (depression and anxiety), and reduced QoL.
The following summarized guidelines for the evaluation and management of chronic arthritic pain are prepared by our editorial team based on guidelines from the Canadian Expert Group on Cannabinoids Use in Chronic Pain (CCP-CEG 2023), the European League Against Rheumatism (EULAR 2018), the Canadian Medical Association (CMA 2017), and the Center for Disease Control (CDC 2016).
Pain assessment: assess for the following as part of the initial evaluation of patients with inflammatory arthritis or OA:
patient's needs, preferences, and priorities regarding pain management and important activities, values, and goals in daily life
patient's pain characteristics, including severity, type, spread, and quality
previous and ongoing pain treatments and the perceived efficacy
current inflammation and joint damage as sources of pain, and whether these are adequately treated
pain-related factors that might need attention, including the nature and extent of pain-related disability, beliefs and emotions about pain and pain-related disability, social influences related to pain and its consequences, sleep problems, and obesity
General principles: initiate pharmacological and joint-specific pain treatment, if indicated, according to established recommendations for the disease being treated.
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Stepped care approach
Physical activity: advise physical activity and exercise if indicated. Assess whether advice to stay active, supervised physical exercise, or multidisciplinary treatment is needed. Consider referring patients unable to initiate physical activity and exercises without help to a physiotherapist for individually tailored graded physical exercise or strength training.
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General counseling: provide education to patients ensuring that all patients have easy access to educational materials with general healthy lifestyle advice, psychoeducation by the health professional, and online or face-to-face self-management interventions.
5.Follow-up and surveillance
Indications for specialist referral: consider offering a multidisciplinary intervention if monotherapy has failed or if several concurrent treatments are indicated, such as treatment of psychological distress in combination with a sedentary lifestyle.