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7 Articles in this Series
Introduction
Addressing Arthralgia in Children
An ACR/ARHP Preview
Axial Spondylitis: Mimics, Progression, the Need for MRI, and New Management Recommendations
How Rheumatic Diseases Can Hurt Sexual Health
Tanezumab for Hip and Knee OA; Cosentyx for Ankylosing Spondylitis; and Upadacitinib for RA
Treating Chronic Musculoskeletal Pain in Older Adults
Uncovered Inflammatory Pathways of Osteoarthritis Call for New Targets

An ACR/ARHP Preview

A preview Q&A with Rebecca Manno, MD, MHS,* reported by Angie Drakulich

Some pain-specific sessions at the upcoming ACR/AHRP 2018 will address osteoarthritis (OA) and back pain, upper extremity regional pain syndromes, and national strategies to address pain. What should a pain practitioner, or a PCP who has a large base of chronic pain patients, hope to get out of this meeting?

The safe and effective management of pain is an extremely important and complex topic for physicians, especially rheumatologists, who care for patients with chronic, painful musculoskeletal (MSK) conditions. There are new guidelines, regulations, medications, and supplements which healthcare providers need to be knowledgeable about in order to optimally treat their patients. At the annual meeting, there will be sessions which focus on the treatment, diagnosis and pathophysiology of painful rheumatic and MSK conditions. For example:

  • Dr. Carlo Martinoli will lead workshops on diagnosing neuropathic conditions, which are particularly painful and challenging to identify.
  • A key anatomy session, “Demystifying Low Back and Lateral Hip Pain,” will review sources of pain and management strategies for these MSK structures.
  • A premier symposium, “Emerging Treatments for Osteoarthritis: Targeting Pain vs Structure,” will focus on the painful aspects of this condition, giving attendees an opportunity to learn about both the physiologic mechanisms behind pain in OA, in addition to emerging therapies that specifically target OA pain.
  • “Meet the Professor” sessions led by Dr. Dan Clauw and Dr. David Borenstein will focus on the diagnosis and management of fibromyalgia and low back pain, both extremely common, painful conditions.

     

Overall, a 2018 Annual Meeting attendee can look forward to many sessions that focus on the diagnosis of painful conditions through ultrasound and physical exam, in addition to practical and novel strategies for treating both acute and chronic painful rheumatic conditions. 

In what ways do you see pain management changing in the rheumatology eld over the next decade?

As pain becomes a more universally recognized component of rheumatic disease, the rheumatologist will have a key role in developing new measurement tools and treatment strategies. However, due to the multisystem nature of rheumatic disease, a collaborative approach to pain management is absolutely necessary. Nursing, physical/occupational therapists, counselors, pharmacists and additional healthcare team members will be necessary to implement pharmacologic, behavioral, and physical treatment strategies for chronic pain patients.

For the first time at an ACR Annual Meeting, there will be an ACR/ARHP combined session focusing on exactly this issue. The symposium, “Interdisciplinary Management of Chronic Musculoskeletal Pain in Older Adults,” will highlight the management of chronic MSK pain in older adults with an emphasis on a team approach among subspecialists and healthcare professionals. This session will review non-pharmacologic strategies for managing pain, which is particularly important for older adults where polypharmacy is rampant, and the evidence behind current interdisciplinary care modules.

In your opinion, how can healthcare providers better work together to improve pain care?

The diagnosis and management of pain will be an important aspect of the Pre-Meeting sessions. The ACR Review Course, for example, will include a talk on bro- myalgia and pain syndromes by Dr. Kristine Phillips, and the musculoskeletal ultrasound course for rheumatologists will educate attendees on the diagnosis of acute and chronic MSK conditions which are common (and uncommon) generators of pain. 

In addition, Dr. Neda Gould will lead a workshop on “Mindfulness for the Physician.” Mindfulness has been recognized as an important aspect of pain management for patients. However, as healthcare providers, if we do not know how to implement these strategies into our own lives, it can be challenging to make accurate and effective recommendations for patients. The emphasis of this session is on mindfulness for healthcare providers, which will easily translate into the lives of patients. The utilization of these diagnostic and therapeutic skills for all healthcare professionals who care for patients with chronic painful conditions can be implemented in practice immediately. Each session will also clearly identify gaps in knowledge of pain management, recognizing targets for future interdisciplinary pain research and investigation. 

*Dr. Manno is the 2018 ACR/ARHP Annual Meeting MTP-Workshop Subcommittee Chair, and an assistant professor of medicine and assistant director of the Johns Hopkins Vasculitis Center Division of Rheumatology, at the JHU School of Medicine.

Next summary: Axial Spondylitis: Mimics, Progression, the Need for MRI, and New Management Recommendations
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