To increase the understanding of a rheumatologist’s role in pain management and the place of pain in the rheumatology research agenda, the Executive Committee of the American College of Rheumatology (ACR) established a task force whose goal was to consider these issues both at present and in the future as the field develops. This task force conducted literature reviews and practitioner surveys, and held face-to-face and telephone meetings to gauge the impact of a greater focus on pain management on practice, training, and education. At the heart of this task force’s inquiry are the following types of questions: Are rheumatology health care providers optimally treating their patients’ pain? How can rheumatologists and allied health professionals become better informed regarding the new research and clinical opportunities for pain management? What is the approach to patients with inflammatory disease who have responded to disease-modifying antirheumatic drugs (DMARDs) and/or a biologic agent but nevertheless have ongoing pain? What is the role of psychosocial and other nonpharmacologic interventions in the management of musculoskeletal pain?
The relevance of these issues is highlighted by a recent study of European rheumatoid arthritis (RA) patients indicating that two-thirds reported inadequate pain control. Indeed, despite advances in the management of rheumatic diseases, many patients believe that their physicians focus on the treatment of the underlying musculoskeletal disease and are not concerned with relieving pain itself. Although some patients may have this impression, the ACR, in its position statement on pain management in rheumatic diseases, nevertheless affirms that effective pain and symptom management is an ethical obligation of all health care providers and organizations.
The intent of the initiative is not to remake rheumatologists as pain specialists in general, but rather to increase their skill and expertise in the management of pain as it relates to a specific group of painful disorders. The goal of this report is to summarize the salient issues in treatment, research, and training considered by the task force to establish the foundation for ACR initiatives to enhance the effectiveness of rheumatologists and rheumatology health professionals in the diagnosis and management of pain associated with rheumatic diseases to improve patient outcomes.
Catastrophizing and pain in arthritis, fibromyalgia, and other rheumatic diseases.
(Arthritis Rheum. 2006;55:325–332.)
Abstract
Objective: Pain is among the most frequently reported, bothersome, and disabling symptoms described by patients with osteoarthritis, rheumatoid arthritis, fibromyalgia, and other musculoskeletal conditions. This review describes a growing body of literature relating catastrophizing, a set of cognitive and emotional processes encompassing magnification of pain-related stimuli, feelings of helplessness, and a generally pessimistic orientation, to the experience of pain and pain-related sequelae across several rheumatic diseases.