REVIEW - Treating the patient in pain

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J Clin Rheumatol. 2005 Apr;11(2 Suppl):S16-27, discussion S27-8.

Section 4: treating the patient in pain.

Katz WA, Rothenberg R.

University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania,

USA.

Physicians may choose from a variety of pharmacologic and nonpharmacologic

options to treat patients with painful rheumatic diseases. Osteoarthritis

(OA) is the most common type of arthritis requiring pain management. New

disease-modifying antirheumatic drugs and biologic response modifiers can

improve disease states in patients with rheumatoid arthritis (RA). After the

inflammatory component of RA is minimized with such agents, treatment goals

shift to those similar to secondary OA and other degenerative joint

diseases. Relief of pain and improvement in functional status are essential

components of effective therapy. A pure analgesic such as acetaminophen and

nonsteroidal antiinflammatory drugs, including the

cyclooxygenase-2-selective inhibitors for those at risk for gastrointestinal

side effects, may be used at the lowest effective doses. Combination therapy

for acetaminophen and an opioid may maximize pain relief and provide greater

speed and duration of action than the separate components. Use of the

atypical opioid tramadol with acetaminophen often results in an improved

side-effect profile compared with stronger opioids, with similar levels of

pain relief.Adjunctive therapy with agents such as topical analgesics,

intraarticular hyaluron, tricyclic antidepressants, anticonvulsants, muscle

relaxants, and anxiolytics may also be helpful. Nonpharmacologic therapies

such as exercise, physical therapy, and psychologic counseling may also

diminish pain and improve outcome in patients with rheumatic diseases. One

may also consider yoga, acupuncture, biofeedback, massage, relaxation

techniques, and other alternative therapies.

PMID: 16357724

http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve & db=pubmed & dopt=Abstra\

ct & list_uids=16357724

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