Towards an individualised approach to pain management in inflammatory arthritis.

Abstract

Pain management in inflammatory arthritis (IA) remains challenging. The contribution of multiple mechanistic factors to the initiation and maintenance of pain, and the interplay of sensory, psychological and social factors that modulate perceptual outcomes, requires a multi-faceted approach that does not solely rely on inflammation-targeted therapies. Growing evidence points to the contribution of, and therefore the need to target, centrally mediated pain processes and/or peripheral sensitisation not associated with inflammatory burden. In this review, we examine current evidence on the mechanistic underpinnings of pain in both early and established IA, including novel insights regarding the manifestation of peripherally and centrally mediated pain. Further, we discuss evolving terminology used to describe pain types, including implications for clinical assessment and communication. Finally, we consider how treatment strategies - pharmacological and non-pharmacological - could fit into an individualised approach, exploring barriers to implementation in clinical practice, including limitations in pain assessment and practical challenges in service delivery.