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EULAR recommendations for the health professional’s approach to pain management in inflammatory arthritis and osteoarthritis
  1. Rinie Geenen1,
  2. Cécile L Overman1,
  3. Robin Christensen2,3,
  4. Pernilla Åsenlöf4,
  5. Susana Capela5,6,
  6. Karen L Huisinga7,
  7. Mai Elin P Husebø8,
  8. Albère J A Köke9,
  9. Zoe Paskins10,11,
  10. Irene A Pitsillidou12,
  11. Carine Savel13,
  12. Judith Austin1,
  13. Afton L Hassett14,
  14. Guy Severijns15,
  15. Michaela Stoffer-Marx16,17,
  16. Johan W S Vlaeyen18,19,
  17. César Fernández-de-las-Peñas20,
  18. Sarah J Ryan11,
  19. Stefan Bergman21
  1. 1 Department of Psychology, Utrecht University, Utrecht, The Netherlands
  2. 2 Musculoskeletal Statistics Unit, The Parker Institute, Bispebjerg and Frederiksberg Hospital, Copenhagen, Denmark
  3. 3 Department of Rheumatology, Odense University Hospital, Odense, Denmark
  4. 4 Department of Neuroscience, Uppsala University, Uppsala, Sweden
  5. 5 Rheumatology and Metabolic Bone Diseases Department, Hospital de Santa Maria, Lisbon, Portugal
  6. 6 Rheumatology Research Unit, Faculty of Medicine, Lisbon Academic Medical Centre, Instituto de Medicina Molecular, University of Lisbon, Lisbon, Portugal
  7. 7 Department of Rheumatology, Virginia Mason Medical Center, Seattle, Washington, USA
  8. 8 Norwegian National Unit for Rehabilitation for Rheumatic Patients with Special Needs, NBRR, Diakonhjemmet Hospital, Oslo, Norway
  9. 9 Department of Rehabilitation Medicine, Maastricht University, Maastricht, The Netherlands
  10. 10 Research Institute for Primary Care and Health Sciences, Keele University, Keele, UK
  11. 11 Haywood Academic Rheumatology Centre, Haywood Hospital, Stoke-on-Trent, UK
  12. 12 EULAR Patient Research Partner, Cyprus League Against Rheumatism, Nicosia, Cyprus
  13. 13 Department of Rheumatology, CHU, Clermont Ferrand, Clermont Ferrand, France
  14. 14 Department of Anesthesiology, Division of Pain Research, Chronic Pain & Fatigue Research Center, University of Michigan Medical School, Ann Harbor, Michigan, USA
  15. 15 EULAR Social Leagues Patients’ Representative, Leuven, Belgium
  16. 16 Section for Outcomes Research, Center for Medical Statistics, Informatics, and Intelligent Systems, Medical University of Vienna, Vienna, Austria
  17. 17 Department of Health Sciences, University of Applied Sciences FH Campus Wien, Vienna, Austria
  18. 18 Research group Health Psychology, University of Leuven, Leuven, Belgium
  19. 19 Behavioral Medicine Research, Faculty of Psychology and Neuroscience, Maastricht University, Maastricht, The Netherlands
  20. 20 Department Physical Therapy, Occupational Therapy, Rehabilitation and Physical Medicine, Universidad Rey Juan Carlos, Alcorcón, Spain
  21. 21 Department of Public Health and Community Medicine, Primary Health Care Unit, Institute of Medicine, The Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
  1. Correspondence to Professor Rinie Geenen, Department of Psychology, Utrecht University, Heidelberglaan 1, 3584CS, Utrecht, The Netherlands; r.geenen{at}


Pain is the predominant symptom for people with inflammatory arthritis (IA) and osteoarthritis (OA) mandating the development of evidence-based recommendations for the health professional’s approach to pain management. A multidisciplinary task force including professionals and patient representatives conducted a systematic literature review of systematic reviews to evaluate evidence regarding effects on pain of multiple treatment modalities. Overarching principles and recommendations regarding assessment and pain treatment were specified on the basis of reviewed evidence and expert opinion. From 2914 review studies initially identified, 186 met inclusion criteria. The task force emphasised the importance for the health professional to adopt a patient-centred framework within a biopsychosocial perspective, to have sufficient knowledge of IA and OA pathogenesis, and to be able to differentiate localised and generalised pain. Treatment is guided by scientific evidence and the assessment of patient needs, preferences and priorities; pain characteristics; previous and ongoing pain treatments; inflammation and joint damage; and psychological and other pain-related factors. Pain treatment options typically include education complemented by physical activity and exercise, orthotics, psychological and social interventions, sleep hygiene education, weight management, pharmacological and joint-specific treatment options, or interdisciplinary pain management. Effects on pain were most uniformly positive for physical activity and exercise interventions, and for psychological interventions. Effects on pain for educational interventions, orthotics, weight management and multidisciplinary treatment were shown for particular disease groups. Underpinned by available systematic reviews and meta-analyses, these recommendations enable health professionals to provide knowledgeable pain-management support for people with IA and OA.

  • rheumatoid arthritis
  • osteoarthritis
  • spondyloarthritis
  • psoriatic arthritis
  • patient perspective
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  • Handling editor Josef S Smolen

  • Contributors CLO was the research fellow for the project undertaking the systematic literature review. RG was the project convener and drafted the work. RC was the methodologist supervising the systematic literature review. CLO and RC rated the quality of studies. CLO and JA independently assessed the studies. All authors have contributed substantially by participating in the development of the recommendations and revising the manuscript critically for important intellectual content. All authors approved the final version for publication.

  • Funding This study was supported by the European League Against Rheumatism (EULAR), Grant reference: HPR029.

  • Competing interests None declared.

  • Patient consent Not required.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data sharing statement The data analysed in the current study are available from the corresponding author on reasonable request.

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