Afton L. Hassett

Report of the American College of Rheumatology Pain Management Task Force

Pain is the most common symptom of patients with rheumatic disorders and can occur in both inflammatory and noninflammatory conditions. As a complex phenomenon with a strong subjective component, pain can be influenced by the nature of the underlying disease, personal predisposition (biologic and psychological), as well as environmental and psychosocial factors that impact the pain experience. In the management of patients with musculoskeletal disease, therefore, the characterization of pain (e.g., its onset, duration periodicity, and impact on functioning) is important in establishing the diagnosis and developing a comprehensive treatment plan to reduce pain and to improve quality of life. Although rheumatologists diagnose and treat pain, they do not characterize themselves as “pain physicians.” Rather, in their professional identity, many rheumatologists consider themselves more narrowly as subspecialists who treat musculoskeletal disorders that have a component of acute and chronic nonmalignant pain. Furthermore, rheumatologists have traditionally approached pain from the perspective of the proximal causes of pain such as tissue injury and inflammation, and have concentrated therapy on reducing inflammation either locally or systemically. The therapies used have been predominantly pharmacologic and include nonsteroidal antiinflammatory drugs (NSAIDs), disease-modifying agents including biologics, and corticosteroids. Although commonly recommended, nonpharmacologic psychosocial interventions such as cognitive–behavioral therapy or body-based therapies including exercise are generally considered less effective by rheumatologists despite evidence that such approaches can be highly efficacious depending on the setting or disease (1–3). For most conditions treated by rheumatologists, the etiology of pain has been conceptualized primarily in the context of events in peripheral tissue. As a result, rheumatologists have relied heavily on pharmacologic therapies directed at the immune system to control symptoms, especially in inflammatory disease. Correspondingly, for patients with major or irreversible tissue damage, whether arising in inflammatory or noninflammatory disease, surgery has been the mainstay of treatment, with pharmacologic therapy used as a transition until a definitive operation is performed. Given this approach, events in the central nervous systems contributing to the experience of pain have received less attention in treatment, with additional analgesic, psychosocial, or interventional therapies receiving neither extensive investigation nor widespread or appropriate use. This approach may limit the utilization of newer and multidisciplinary approaches to pain manMembers of the American College of Rheumatology Pain Management Task Force are as follows: David Borenstein, MD: Arthritis & Rheumatism Associates, Washington, DC; Roy Altman, MD: University of California, Los Angeles; Alfonso Bello, MD, MHS: Illinois Bone & Joint Institute, Glenview; Winn Chatham, MD: University of Alabama, Birmingham; Daniel Clauw, MD: University of Michigan, Ann Arbor; Leslie Crofford, MD: University of Kentucky, Lexington; Joseph Croft, MD: Bethesda, Maryland; Afton Hassett, PsyD: Robert Wood Johnson Medical School, New Brunswick, New Jersey; Franklin Kozin, MD: Scripps Clinic Medical Group, La Jolla, California; David Pisetsky, MD, PhD: Durham VA Hospital, Durham, North Carolina; Jan Richardson, PT, PhD, Laura Schanberg, MD: Duke University, Durham, North Carolina; Terence Starz, MD: Arthritis & Internal Medical Associates, Pittsburgh, Pennsylvania; James Witter, MD, PhD: NIH, Bethesda, Maryland. The American College of Rheumatology is an independent, professional, medical and scientific society which does not guarantee, warrant, or endorse any commercial product or service. Dr. Borenstein has received consultant fees, speaking fees, and/or honoraria (less than

Criterion contamination of depression scales in patients with rheumatoid arthritis: the need for interpretation of patient questionnaires (as all clinical measures) in the context of all information about the patient.

10,000 each) from Pfizer and King, and (more than

N-Methyl-D-Aspartate Receptor-Mediated Chronic Pain: New Approaches to Fibromyalgia Syndrome Etiology and Therapy

10,000) from Cephalon. Dr. Altman has received consultant fees, speaking fees, and/or honoraria (less than

Questionable Hospital Chart Documentation Practices by Physicians

10,000 each) from Nutramax, McKinsey, Endo, Cypress, Theralogix, Forest Laboratories, and NicOx, and (more than

Clues on the MDHAQ to identify patients with fibromyalgia and similar chronic pain conditions.

10,000 each) from Ferring and Smith & Nephew. Dr. Bello has received consultant fees, speaking fees, and/or honoraria (less than

The man-in-the-moon face: a qualitative study of body image, self-image and medication use in systemic lupus erythematosus

10,000 each) from Abbott, BMS, Amgen, Lilly, and UCB, and (more than

Contributions of societal and geographical environments to chronic Lyme disease : The psychopathogenesis and aporology of a new medically unexplained symptoms syndrome

10,000 each) from Pfizer and Horizon Therapeutics. Dr. Hassett has received consultant fees, speaking fees, and/or honoraria (less than

Commentary: ‘What's in a name? That which we call a rose by any other name would smell as sweet.’ Shakespeare W. Romeo and Juliet, II, ii(47–48)

10,000 each) from Forest Pharmaceuticals and Jazz Pharmaceuticals. Dr. Kozin has received speaking fees (less than

Does acute synovitis (pseudogout) occur in patients with chronic pyrophosphate arthropathy (pseudo-osteoarthritis)?

10,000 each) from Forest Laboratories and Pfizer. Dr. Schanberg has received consultant fees, speaking fees, and/or honoraria (less than

Pain Management in Rheumatology Research, Training, and Practice.

10,000) and a research grant from Pfizer. Address correspondence to David Borenstein, MD, 2021 K Street NW, Suite 300, Washington, DC 20006. E-mail: DBorenstein715@aol.com. Submitted for publication April 29, 2009; accepted in revised form January 14, 2010. Arthritis Care & Research Vol. 62, No. 5, May 2010, pp 590–599 DOI 10.1002/acr.20005