New Guidelines Issued for Treating Arthritis Pain

The American Pain Society has released its new guidelines for treating arthritis pain, including the use of the widely controversial pain killer oxycontin in cases of severe pain.

With emphasize on diagnosis and nutrition, exercise and education, the guide is the first multidisciplinary, evidence-based clinical guideline for treatment of arthritic pain.

Its authors hope the information will help physicians and their patients better understand - and learn to manage - acute and chronic pain.

Some of the Guideline recommendations include:

• A comprehensive assessment of pain before treatment begins.
• Acetaminophen for mild to moderate pain.
• Cox-2 inhibitors, like Vioxx and Celebrex, for moderate to severe pain.
• Oxycodone and morphine when Cox-2 inhibitors do not provide substantial relief from severe pain.

The Guideline also stresses that patients should eat a balanced diet, and encourage those with a body mass index of more than 30 percent to follow a weight-loss program.

Physical and occupational therapy also is recommended to increase range of motion, strength, flexibility and endurance.

"Since arthritis is a chronic and progressive disease, clinicians must be sure that regular exercise or physical therapy are important components of a comprehensive management program," said Ada Jacox, PhD, RN, and chair of the Society's Clinical Guideline Development Committee. "Staying active is a critical component for managing this disease."

In addition, the Society recommends family education -- including pain-coping skills and cognitive-behavioral therapy for children suffering from juvenile chronic arthritis.

Although the authors suggest surgical treatment when drug therapy is ineffective and function is severely impaired, they also stress the importance of surgery before onset of severe deformity and advanced muscular deterioration.

"Arthritis is one of the most expensive and debilitating diseases in the U.S., and the Guideline recognizes that this condition can adversely impact earning potential, function and lifestyle," said Arthur Lipman, Pharm.D., co-chair of the Guideline Committee. "Therefore, accurate assessment and management of pain requires differentiation of the types and cause of pain and an understanding of the patient's willingness to adhere to therapy and remain active."

Other sources:American Pain Society