To the 100th anniversary of the birth of academician V.A. Nasonova. Pain control in rheumatic diseases: Past and future

Abstract

Throughout the history of rheumatology, the attitude to pain has changed significantly. In the XIX and early XX centuries, pain was considered only as one of the symptoms, the control of which is secondary to the etiotropic and pathogenetic therapy of rheumatic diseases (RD). However, already in the 30–40s years of the XX century, the treatment of pain becomes an independent task, and for this purpose a wide range of medications and non-pharmacological methods are used. Rheumatologists in Europe and the USA in those years discussed the topic of “neurogenic” and “psychogenic” pain in RD, including “fibrositis”. The works of Russian rheumatologists of 50–60s years demonstrate a different attitude to pain relief in RD: some experts considered it a necessary component of treatment; others attributed it to auxiliary methods that are significantly inferior in importance to pathogenetic therapy.In the 70s, rheumatologists have at their disposal a large arsenal of painkillers, primarily nonsteroidal anti-inflammatory drugs (NSAIDs). In parallel with the study of their therapeutic capabilities and safety, an active study of the problem of pain in RD begins. Since that time, pain relief issues have been among the main topics of the V.A. Nasonova Research Institute of Rheumatology; its employees organize their own and participate in international projects to study new analgesic drugs. Pain control is beginning to be considered among the priorities of anti-rheumatic therapy. Currently, the rheumatology community is very interested in the problem of “non-inflammatory” pain associated with autoimmune dysfunction of the nociceptive system, central sensitization and fibromyalgia – as a factor determining the insufficient response to anti-rheumatic therapy and poor quality of life of patients with RD.The V.A. Nasonova Research Institute of Rheumatology, in collaboration with neurologists and algologists, is actively involved in the study of this pathology, studying the phenotypes of pain in different RD, the role of immunological, genetic and psychoemotional factors in nociception, as well as the influence of modern anti-rheumatic therapy (genetically engineered biological drugs and JAK inhibitors) on the main manifestations of RD.