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Chronic arthritic pain

What's new

Updated 2024 APA guidelines for nonpharmacological treatment of chronic musculoskeletal pain .

Background

Overview

Definition
Chronic arthritic pain is a combination of musculoskeletal pain arising from tissue destruction and mechanical changes to cartilage, bone, and soft tissues, which is associated with sleep disturbance, mood disorder, and fatigue.
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Pathophysiology
Chronic arthritic pain is caused by an interplay of both nociceptive (inflammatory) and non-nociceptive (neurogenic) pain mechanisms.
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Disease course
Disease persistence and progression leads to sleep disturbances, fatigue, mood changes (depression and anxiety), and reduced QoL.
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Guidelines

Key sources

The following summarized guidelines for the evaluation and management of chronic arthritic pain are prepared by our editorial team based on guidelines from the American College of Physicians (ACP 2025), the American Psychological Association (APA 2024), the Canadian Expert Group on Cannabinoids Use in Chronic Pain (CCP-CEG 2023), the European League Against Rheumatism (EULAR 2018), the Canadian Medical Association (CMA ...
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Diagnostic investigations

Pain assessment: as per EULAR 2018 guidelines, assess for the following as part of the initial evaluation of patients with inflammatory arthritis or osteoarthritis:
patient's needs, preferences, and priorities regarding pain management and important activities, values, and goals in daily life
patient's pain characteristics, including severity, type, spread, and quality
previous and ongoing pain treatments and the perceived efficacy
current inflammation and joint damage as sources of pain, and whether these are adequately treated
pain-related factors that might need attention, including the nature and extent of pain-related disability, beliefs and emotions about pain and pain-related disability, social influences related to pain and its consequences, sleep problems, and obesity.
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Medical management

General principles: as per EULAR 2018 guidelines, initiate pharmacological and joint-specific pain treatment, if indicated, according to established recommendations for the disease being treated.
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  • Stepped care approach

  • Analgesic therapy

  • Cannabinoids

Nonpharmacologic interventions

Physical activity: as per EULAR 2018 guidelines, advise physical activity and exercise if indicated. Assess whether advice to stay active, supervised physical exercise, or multidisciplinary treatment is needed. Consider referring patients unable to initiate physical activity and exercises without help to a physiotherapist for individually tailored graded physical exercise or strength training.
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More topics in this section

  • Orthotics

  • Weight loss

  • Sleep interventions

  • Psychosocial interventions

Patient education

General counseling: as per EULAR 2018 guidelines, provide education to patients ensuring that all patients have easy access to educational materials with general healthy lifestyle advice, psychoeducation by the health professional, and online or face-to-face self-management interventions.
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Follow-up and surveillance

Indications for specialist referral: as per EULAR 2018 guidelines, consider offering a multidisciplinary intervention if monotherapy has failed or if several concurrent treatments are indicated, such as treatment of psychological distress in combination with a sedentary lifestyle.
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