APS Guideline on the Treatment of Arthritis Pain

APS Guideline on the Treatment of Arthritis Pain – American Pain Society

Monica Preboth

The American Pain Society (APS) recently released a clinical guideline on the treatment of acute and chronic pain associated with arthritis. This multidisciplinary, evidence-based guideline was developed by a panel of experts in arthritis pain management and is intended for use by physicians and other health care professionals who treat adults and children who have arthritis.

The major recommendations of the APS include the following:

* All arthritis treatment should begin with a comprehensive assessment of pain and function.

* For persons with mild to moderate arthritis pain, use of acetaminophen is preferred because of its mild side effects, over-the-counter availability, and low cost.

* For persons with moderate to severe pain from osteoarthritis and rheumatoid arthritis, COX-2 nonsteroidal anti-inflammatory drugs (NSAIDs) are the best choice for their pain-relieving potency and lower incidence of gastrointestinal (GI) side effects. Use of nonselective NSAIDs should be considered only if the patient does not respond to acetaminophen and COX-2 drugs, and is not at risk for NSAID-induced GI side effects. Because of the high cost of COX-2 agents, some patients may benefit from nonspecific NSAID therapy combined with a medication to moderate GI distress.

* Opioid medications such as oxycodone and morphine are recommended for the treatment of severe arthritis pain when COX-2 drugs and nonspecific NSAIDs fail to provide adequate relief.

* In the absence of medical contraindications, most patients with arthritis should be referred for surgical treatment when drug therapy is ineffective and function is severely impaired to prevent minimal physical activity. Surgery should be recommended before the onset of severe deformity and advanced muscular deterioration.

The APS panel also makes the following recommendations for patients with juvenile chronic arthritis (JCA):

* Pain assessment should be ongoing in children with JCA.

* Use of analgesia should be the same for children and adults with arthritis pain.

* Patient and family education should be emphasized to increase self-care skills.

* Cognitive-behavioral therapy should be used to help reduce pain and psychologic disability and to enhance pain-coping skills.

* Physicians should take appropriate measures to minimize pain and anxiety associated with diagnostic and therapeutic procedures for JCA.

* Whenever sedation is required for any procedure, use of guidelines developed by the American Academy of Pediatrics is recommended.

For a copy of the guideline, write to the APS, 4700 W. Lake Ave., Glenview, IL 60025-1485, or visit the APS Web site at www.ampainsoc.org.

COPYRIGHT 2002 American Academy of Family Physicians

COPYRIGHT 2002 Gale Group