Pain in Inflammatory and Degenerative Joint Diseases
The International Association for the Study of Pain (IASP) agreed in 2020 on a revised definition of pain: “An unpleasant sensory and emotional experience associated with, or resembling that associated with, actual or potential tissue damage”. Patients with rheumatic diseases frequently report pain...
Saved in:
| Main Author: | |
|---|---|
| Format: | Article |
| Language: | English |
| Published: |
World Scientific Publishing
2024-01-01
|
| Series: | Journal of Clinical Rheumatology and Immunology |
| Online Access: | https://www.worldscientific.com/doi/10.1142/S2661341724740109 |
| Tags: |
Add Tag
No Tags, Be the first to tag this record!
|
| _version_ | 1846169837419626496 |
|---|---|
| author | Hilde Berner Hammer |
| author_facet | Hilde Berner Hammer |
| author_sort | Hilde Berner Hammer |
| collection | DOAJ |
| description | The International Association for the Study of Pain (IASP) agreed in 2020 on a revised definition of pain: “An unpleasant sensory and emotional experience associated with, or resembling that associated with, actual or potential tissue damage”. Patients with rheumatic diseases frequently report pain as a primary symptom. However, rheumatology healthcare providers often lack the training to adequately differentiate between different causes of pain, which are mandatory for optimal treatment. IASP classifies pain into 3 descriptive categories: nociceptive, neuropathic, and nociplastic pain. A recent review (Murphy AE et al, Arthritis Care & Research, 2023) gives a nice overview of these different forms of pain. Nociceptive pain derives from tissue injury, with subsequent sensation of pain by nociceptors. It is usually well-localized and can be precisely described by patients (i.e. rheumatoid arthritis, primary osteoarthritis) and there are localized pathologies that explain the pain symptoms. Neuropathic pain occurs with injury or insult to a peripheral or central nerve. There may be pressure on the nerve as in carpal tunnel syndrome, or changes in nerves caused by diabetes or other causes of nerve pathologies like mononeuritis multiplex. The pain and paresthesia typically follow the distribution of peripheral nerves in a dermatomal distribution. Nociplastic pain describes pain characterized by altered nociceptive processing (e.g., hypersensitivity), suggestive of dysregulation of CNS pain processing pathways. Nociplastic pain likely encompasses many different CNS pathways that lead to amplified processing of pain signals, decreased inhibition of pain, or both. Prototypical nociplastic pain conditions include both widespread (e.g., fibromyalgia) and localized conditions (e.g., chronic temporomandibular pain disorders and irritable bowel syndrome). Patients with inflammatory or degenerative joint diseases may have one, two or three of the presently described forms of pain, and an important objective for the rheumatologists is to understand which types of pain our patients are suffering from. About one-quarter of the patients with inflammatory rheumatic joint diseases have additional fibromyalgia causing increased scores of patient-reported outcomes like patient’s global VAS and number of tender joints, and this results in elevated composite scores independent on the degree of inflammation. Thus, rheumatologists must try to differentiate between nociceptive pain caused by inflammatory or degenerative pathologies which may be treated by different ant-inflammatory treatments, neuropathic pain which may need operative of medical treatment, or nociplastic pain which should be non-medically treated. |
| format | Article |
| id | doaj-art-e9d1f1787ede4159ab4aa717e676dc45 |
| institution | Kabale University |
| issn | 2661-3417 2661-3425 |
| language | English |
| publishDate | 2024-01-01 |
| publisher | World Scientific Publishing |
| record_format | Article |
| series | Journal of Clinical Rheumatology and Immunology |
| spelling | doaj-art-e9d1f1787ede4159ab4aa717e676dc452024-11-12T08:27:23ZengWorld Scientific PublishingJournal of Clinical Rheumatology and Immunology2661-34172661-34252024-01-0124supp01101010.1142/S2661341724740109Pain in Inflammatory and Degenerative Joint DiseasesHilde Berner Hammer0NorwayThe International Association for the Study of Pain (IASP) agreed in 2020 on a revised definition of pain: “An unpleasant sensory and emotional experience associated with, or resembling that associated with, actual or potential tissue damage”. Patients with rheumatic diseases frequently report pain as a primary symptom. However, rheumatology healthcare providers often lack the training to adequately differentiate between different causes of pain, which are mandatory for optimal treatment. IASP classifies pain into 3 descriptive categories: nociceptive, neuropathic, and nociplastic pain. A recent review (Murphy AE et al, Arthritis Care & Research, 2023) gives a nice overview of these different forms of pain. Nociceptive pain derives from tissue injury, with subsequent sensation of pain by nociceptors. It is usually well-localized and can be precisely described by patients (i.e. rheumatoid arthritis, primary osteoarthritis) and there are localized pathologies that explain the pain symptoms. Neuropathic pain occurs with injury or insult to a peripheral or central nerve. There may be pressure on the nerve as in carpal tunnel syndrome, or changes in nerves caused by diabetes or other causes of nerve pathologies like mononeuritis multiplex. The pain and paresthesia typically follow the distribution of peripheral nerves in a dermatomal distribution. Nociplastic pain describes pain characterized by altered nociceptive processing (e.g., hypersensitivity), suggestive of dysregulation of CNS pain processing pathways. Nociplastic pain likely encompasses many different CNS pathways that lead to amplified processing of pain signals, decreased inhibition of pain, or both. Prototypical nociplastic pain conditions include both widespread (e.g., fibromyalgia) and localized conditions (e.g., chronic temporomandibular pain disorders and irritable bowel syndrome). Patients with inflammatory or degenerative joint diseases may have one, two or three of the presently described forms of pain, and an important objective for the rheumatologists is to understand which types of pain our patients are suffering from. About one-quarter of the patients with inflammatory rheumatic joint diseases have additional fibromyalgia causing increased scores of patient-reported outcomes like patient’s global VAS and number of tender joints, and this results in elevated composite scores independent on the degree of inflammation. Thus, rheumatologists must try to differentiate between nociceptive pain caused by inflammatory or degenerative pathologies which may be treated by different ant-inflammatory treatments, neuropathic pain which may need operative of medical treatment, or nociplastic pain which should be non-medically treated.https://www.worldscientific.com/doi/10.1142/S2661341724740109 |
| spellingShingle | Hilde Berner Hammer Pain in Inflammatory and Degenerative Joint Diseases Journal of Clinical Rheumatology and Immunology |
| title | Pain in Inflammatory and Degenerative Joint Diseases |
| title_full | Pain in Inflammatory and Degenerative Joint Diseases |
| title_fullStr | Pain in Inflammatory and Degenerative Joint Diseases |
| title_full_unstemmed | Pain in Inflammatory and Degenerative Joint Diseases |
| title_short | Pain in Inflammatory and Degenerative Joint Diseases |
| title_sort | pain in inflammatory and degenerative joint diseases |
| url | https://www.worldscientific.com/doi/10.1142/S2661341724740109 |
| work_keys_str_mv | AT hildebernerhammer painininflammatoryanddegenerativejointdiseases |