The ingredients of an effective management plan: clearly defined therapeutic goals, individualized treatment and close patient/provider communication, knowledge of all available treatment options, and a willingness to employ a team-based approach.

A ccording to the National Institute of Arthritis and Musculoskeletal and Skin Diseases (NIAMS), more than 40 million Americans are affected by at least one of the more than 100 forms of arthritis, and many have chronic pain that limits daily activity. By the year 2020, the Centers for Disease Control and Prevention predicts that as many as 60 million people will have some form of the disease.

Arthritis pain can come from a variety of sources, including inflam-mation of the synovial membrane, tendons or ligaments, as well as muscle strain, fatigue, or a combination of these factors. Swelling and damage that has occurred within the joint can also be a factor. “Arthritis pain is something that physicians from all backgrounds are likely to encounter during their clinical experience,” explains Jon D. Levine, MD. “It is not limited to physicians who specialize in rheumatic diseases or pain. Arthritis pain cases are seen every day in the primary care, ortho-pedic, and neurology settings, as well as in the emergency department.”

“Some patients with arthritis may have weakness, be unable to run, or have other problems that are associated with the disease, but they will finally seek attention when the pain sets in,” says Dr. Levine. “When these patients present, we need to establish their desired outcome and assess the potential side effects and reactions to different treatment options. We also need to consider the patient's current medication use and if the individual has other medical conditions. Age, gender, and lifestyle are also important considerations. Depending on the patient, different treatment options may have varying implications.”

Physicians should develop a management plan designed to minimize specific pain and improve joint functioning, according to Dr. Levine. “Each individual has a different threshold and tolerance for pain that is often affected by both physical and emotional factors. They may also have depression, anxiety, and hypersensitivity at the affected sites due to inflam-mation and tissue injury. These comorbidities can make it difficult for physicians to determine optimal treatments for patients with arthritis pain. It is important to determine the clinical source of our patient's pain rather than just treat the condition and expect the pain to subside. We need to establish if the pain is inflam-matory, neuro- pathic, or a generalized pain syndrome, and then understand the kinds of features that can cause exacerbation of the pain.”

Medications, heat and cold therapy, joint protection, transcutaneous electrical nerve stimulation (TENS), and massage therapy are among the short-term treatments for arthritis pain. Long-term treatments may include medications, weight reduction strategies, and exercise. In some patients, surgery may be necessary to remove inflamed joint tissue, realign the joint, or replace severely damaged joints with artificial ones. In appropriate cases, these surgical procedures can provide pain relief and improved motion in the involved joint.

According to Dr. Levine, some physicians are uncomfortable in managing their patient's pain because there is no single treatment that applies to all patients. “For this reason, we need to learn all we can about the available treatment options and become educated on the best management approaches for the individual rather than using a 'cookie-cutter' approach. Surgery may be a good option for some patients with pain, but others may be better suited to use medications or alter their lifestyle. As physicians, we need to evaluate the treatment options on a case-by-case basis.”