Abstract

Practical guidelines for the management of joint pain

Joint pain is the most common and important clinical symptom of musculoskeletal diseases. The current definition of pain, as published by the International Association for the Study of Pain (IASP) in 2020, states that pain is “an unpleasant sensory and emotional experience associated with, or resembling that associated with, actual or potential tissue damage”. In clinical practice pain can be considered as an additional vital sign which can be measured using a one-dimensional Numerical Rating Scale (NRS) for pain or Visual Analogue Scale (VAS). This paper presents the characteristics of inflammatory, osteoarthritic and nociplastic pain in chronic musculoskeletal diseases as well as pharmacological and non-pharmacological treatment strategies. Topical non-steroidal anti-inflammatory drugs (NSAIDs), including diclofenac, are recommended by international and national guidelines as an early treatment option for the symptomatic management of osteoarthritis and they can be used ahead of oral NSAIDs due to their superior safety profile.

Piśmiennictwo

1. Raja SN, Carr DB, Cohen M, et al. The revised International Association for the Study of Pain definition of pain: concepts, challenges, and compromises. Pain 2020;161(9):1976-82

2. Morone NE, Weiner DK. Pain as the fifth vital sign: exposing the vital need for pain education. Clin Ther 2013;35(11):1728-32

3. Jensen MP, Karoly P, Braver S. The measurement of clinical pain intensity: a comparison of six methods. Pain 1986;27:117-26

4. Van Steenbergen HW, Aletaha D, Beaart-van de Voorde LJ, et al. EULAR definition of arthralgia suspicious for progression to rheumatoid arthritis. Ann Rheum Dis 2017;76(3):491-6

5. Aletaha D, Neogi T, Silman AJ, et al. 2010 rheumatoid arthritis classification criteria: an American College of Rheumatology/European League Against Rheumatism collaborative initiative. Arthritis Rheum 2010;62:2569-81

6. Magnusson K, Turkiewicz A, Englund M. Nature vs nurture in knee osteoarthritis – the importance of age, sex and body mass index. Osteoarthritis Cartilage 2019;27:586-92

7. Trouvin AP, Perrot S. New concepts of pain. Best Pract Res Clin Rheumatol 2019;33(3):101415. doi: 10.1016/j.berh.2019.04.007

8. Kocot-Kępska M, Dobrogowski J, Przeklasa-Muszyńska A. Funkcjonalne zespoły bólowe. W: Dobrogowski J, Wordliczek J, Woroń J (red.). Leczenie bólu w praktyce lekarza POZ. Poznań: Wydawnictwa Medyczne Termedia, 2019:71-6

9. Wolfe F, Smythe HA, Yunus MB, et al. The American College of Rheumatology 1990 Criteria for the Classification of Fibromyalgia. Report of the Multicenter Criteria Committee. Arthritis Rheum 1990;33:160-72

10. Wolfe F, Clauw DJ, Fitzcharles MA, et al. 2016 Revisions to the 2010/2011 fibromyalgia diagnostic criteria. Semin Arthritis Rheum 2016;46(3):319-29

11. Bennett RM, Jones J, Turk DC, et al. An internet survey of 2 596 people with fibromyalgia. BMC Musculoskelet Disord 2007;8:27

12. Wolfe F, Ross K, Anderson J, et al. Aspects of fibromyalgia in the general population: sex, pain threshold, and fibromyalgia symptoms. J Rheumatol 1995;22:151-6

13. Smolen JS, Landewé RBM, Bijlsma JWJ, et al. EULAR recommendations for the management of rheumatoid arthritis with synthetic and biological disease-modifying antirheumatic drugs: 2019 update. Ann Rheum Dis 2020;79:685-799

14. Uivaraseanu B, Vesa CM, Tit DM, et al. Therapeutic approaches in the management of knee osteoarthritis (Review). Exp Ther Med 2022;23(5):328. doi: 10.3892/etm.2022.11257

15. Bruyere O, Cooper C, Pelletier J, et al. An algorithm recommendation for the management of knee osteoarthritis in Europe and internationally: A report from a task force of the European Society for Clinical and Economic Aspects of Osteoporosis and Osteoarthritis (ESCEO). Seminars in Arthritis and Rheumatism 2014;44(3):253-63

16. McAlindon TE, Bannuru RR, Sullivan MC, et. al. OARSI guidelines for the non-surgical management of knee osteoarthritis. Osteoarthritis Cartilage 2014;22(3):363-88

17. Da Costa BR, Reichenbach S, Keller N, et al. Effectiveness of non-steroidal anti-inflammatory drugs for the treatment of pain in knee and hip osteoarthritis: A network meta-analysis. Lancet 2017;390:e21-e33. doi: 10.1016/S0140-6736(17)31744-0

18. Atzeni F, Masala IF, Sarzi-Puttini P. A Review of Chronic Musculoskeletal Pain: Central and Peripheral Effects of Diclofenac. Pain Ther 2018;7(2):163-77

19. Fransen M, McConnell S, Harmer AR, et al. Exercise for osteoarthritis of the knee. Cochrane Database Syst Rev 2015;1(Cd004376). doi: 10.1002/14651858

20. Messier SP, Gutekunst DJ, Davis C, et al. Weight loss reduces knee-joint loads in overweight and obese older adults with knee osteoarthritis. Arthritis Rheum 2005;52:2026-32

21. Rannou F, Pelletier JP, Martel-Pelletier J. Efficacy and safety of topical NSAIDs in the management of osteoarthritis: Evidence from real-life setting trials and surveys. Semin Arthritis Rheum 2016;45(4 Suppl):S18-21. doi: 10.1016/j.semarthrit.2015.11.007

22. Efe T, Sagnak E, Roessler PP, et al. Penetration of topical diclofenac sodium 4% spray gel into the synovial tissue and synovial fluid of the knee: a randomised clinical trial. Knee Surg Sports Traumatol Arthrosc 2014;22:345-50

23. Derry S, Conaghan P, Da Silva JA, et al. Topical NSAIDs for chronic musculoskeletal pain in adults. Cochrane Database Syst Rev 2016;22;4(4):CD007400. doi: 10.1002/14651858.CD007400.pub3

24. Wolff DG, Christophersen C, Brown SM, et al. Topical nonsteroidal anti-inflammatory drugs in the treatment of knee osteoarthritis: a systematic review and meta-analysis. Phys Sportsmed 2021;49(4):381-91

Do góry