Forum for Science, Industry and Business

Sponsored by:     3M 
Search our Site:

 

Pain and its impact on the treatment of rheumatic disease

05.12.2005


New insights into pain mechanisms; Practical advice on pain management



Long treated as a side effect, pain is now widely recognized as an integral part of patient care. While the last decade has brought extraordinary advances in the unravelling of pain mechanisms at the molecular level, evaluating and alleviating pain remains an ongoing challenge for physicians, particularly rheumatologists. The December 2005 issue of Arthritis & Rheumatism offers a timely examination of pain as it pertains to rheumatology practice.

"Rheumatologists are increasingly required to address pain as a specific symptom," notes leading author Mary-Ann Fitzcharles, M.D., of Montreal General Hospital, McGill University. "Pain management is no longer simply a quick fix with a single pill, but rather an approach to the patient as a whole biopsychosocial being."


What is rheumatic pain? How is it affected by inflammation? How is it linked to a patient’s psychological state? Drawing on the latest research into this complex factor, Dr. Fitzcharles and her collaborators demystify both the process and the experience of pain for patients with rheumatoid arthritis (RA) and related diseases. Pain mechanisms are not hard wired, but constantly in a state of change. But neurotransmitters and inflammatory molecules make rheumatic pain feel chronic. Rheumatic pain, as the authors explain, is transmitted by not only the central nervous system, but also receptors in the joint tissue and cartilage. Because rheumatic pain travels through small, slow-conducting fibers, it is perceived as a pervasive aching rather than as acute, localized stabs. Inflammation also plays a role in activating pain pathways that usually lie dormant – comprising as many as one-third of the total number of pain-transmitting nerves. What’s more, molecular evidence suggests that stress and depression may increase a rheumatic patient’s production of pain-provoking inflammatory agents.

How can a rheumatologist accurately assess a patient’s pain? As Dr. Fitzcharles acknowledges, clinical evaluation of pain is difficult and subjective. In addition to using time-honored tools – namely, the visual analogue scale of pain severity and patient questionnaires – in real-life practice, the rheumatologist must take cues from the patient during the interview and examination, heeding spontaneous movement, musculoskeletal structure, and verbal complaints, as well as consider the patient’s psychosocial history and coping strategies.

Beyond the prescription of a pill, what works to relieve rheumatic pain? "There is no gold standard regarding the ideal management of chronic pain in rheumatic diseases," observes Dr. Fitzcharles. "Ideal pain management should encompass a wide range of both pharmacological and nonpharmacological interventions." The authors culminate with a comprehensive review of complementary treatment approaches, including:

  • Exercise. According to studies, regular physical activity not only maintains muscle tone and helps to improve function, but also induces the production of endogenous opioids – endorphins and other natural painkillers.
  • Herbal and dietary supplements. For example, decreased pain has been recorded among RA patients receiving supplementation with an omega-3 enriched diet for 12 months. This dietary change reduced the need for antirheumatic medication.
  • Topical applications. Used for centuries as home remedies, healing ointments have shown clinical promise for the care of rheumatic conditions. In one recent study, topical diclofenac performed as well as ingested diclofenac in relieving knee joint pain.
  • Opioid analgesics. The cornerstone of pain management in cancer, opioids are increasingly prescribed for patients with musculoskeletal pain. However, only limited data support the long-term use of opioids in patients with rheumatic pain. It is not clear, as yet, if opioids provide sufficient benefit to counterbalance the possible harmful effects.

"Rheumatologists will need to become familiar and comfortable with the use of newly developed strategies for pain management to ensure optimal treatment," Dr. Fitzcharles concludes. "Improved function and rehabilitation, and not simply palliation, should be the main goal of pain management in rheumatologic practice."

Amy Molnar | EurekAlert!
Further information:
http://www.interscience.wiley.com/journal/arthritis

More articles from Health and Medicine:

nachricht Study suggests possible new target for treating and preventing Alzheimer's
02.12.2016 | Oregon Health & Science University

nachricht The first analysis of Ewing's sarcoma methyloma opens doors to new treatments
01.12.2016 | IDIBELL-Bellvitge Biomedical Research Institute

All articles from Health and Medicine >>>

The most recent press releases about innovation >>>

Die letzten 5 Focus-News des innovations-reports im Überblick:

Im Focus: Novel silicon etching technique crafts 3-D gradient refractive index micro-optics

A multi-institutional research collaboration has created a novel approach for fabricating three-dimensional micro-optics through the shape-defined formation of porous silicon (PSi), with broad impacts in integrated optoelectronics, imaging, and photovoltaics.

Working with colleagues at Stanford and The Dow Chemical Company, researchers at the University of Illinois at Urbana-Champaign fabricated 3-D birefringent...

Im Focus: Quantum Particles Form Droplets

In experiments with magnetic atoms conducted at extremely low temperatures, scientists have demonstrated a unique phase of matter: The atoms form a new type of quantum liquid or quantum droplet state. These so called quantum droplets may preserve their form in absence of external confinement because of quantum effects. The joint team of experimental physicists from Innsbruck and theoretical physicists from Hannover report on their findings in the journal Physical Review X.

“Our Quantum droplets are in the gas phase but they still drop like a rock,” explains experimental physicist Francesca Ferlaino when talking about the...

Im Focus: MADMAX: Max Planck Institute for Physics takes up axion research

The Max Planck Institute for Physics (MPP) is opening up a new research field. A workshop from November 21 - 22, 2016 will mark the start of activities for an innovative axion experiment. Axions are still only purely hypothetical particles. Their detection could solve two fundamental problems in particle physics: What dark matter consists of and why it has not yet been possible to directly observe a CP violation for the strong interaction.

The “MADMAX” project is the MPP’s commitment to axion research. Axions are so far only a theoretical prediction and are difficult to detect: on the one hand,...

Im Focus: Molecules change shape when wet

Broadband rotational spectroscopy unravels structural reshaping of isolated molecules in the gas phase to accommodate water

In two recent publications in the Journal of Chemical Physics and in the Journal of Physical Chemistry Letters, researchers around Melanie Schnell from the Max...

Im Focus: Fraunhofer ISE Develops Highly Compact, High Frequency DC/DC Converter for Aviation

The efficiency of power electronic systems is not solely dependent on electrical efficiency but also on weight, for example, in mobile systems. When the weight of relevant components and devices in airplanes, for instance, is reduced, fuel savings can be achieved and correspondingly greenhouse gas emissions decreased. New materials and components based on gallium nitride (GaN) can help to reduce weight and increase the efficiency. With these new materials, power electronic switches can be operated at higher switching frequency, resulting in higher power density and lower material costs.

Researchers at the Fraunhofer Institute for Solar Energy Systems ISE together with partners have investigated how these materials can be used to make power...

All Focus news of the innovation-report >>>

Anzeige

Anzeige

Event News

ICTM Conference 2017: Production technology for turbomachine manufacturing of the future

16.11.2016 | Event News

Innovation Day Laser Technology – Laser Additive Manufacturing

01.11.2016 | Event News

#IC2S2: When Social Science meets Computer Science - GESIS will host the IC2S2 conference 2017

14.10.2016 | Event News

 
Latest News

UTSA study describes new minimally invasive device to treat cancer and other illnesses

02.12.2016 | Medical Engineering

Plasma-zapping process could yield trans fat-free soybean oil product

02.12.2016 | Agricultural and Forestry Science

What do Netflix, Google and planetary systems have in common?

02.12.2016 | Physics and Astronomy

VideoLinks
B2B-VideoLinks
More VideoLinks >>>