Dr Lon Lampa of Sweden presented data from a Swedish population-based case control study and EIRA, linked to the Swedish Rheumatology Quality Register (N=1594). 35% of patients had pain remaining after 12 months of treatment despite satisfactory inflammation control. Higher HAQ, tender joint count and patient global assessment at baseline significantly increased the risk for having persistent pain at 12months, whereas higher baseline CRP, ESR and swollen joint count decreased the risk for persistent pain at 12 months. Persistent pain was defined as having a score greater than 20 on a visual analog scale together with a CRP of less than 10.
Having pain at 12 months was associated with a strongly increased risk of developing widespread pain, sleep problems and fatigue after 3 years. The percentage of patients with no reported pain at 12 months had a 6% risk of widespread pain after 3 years vs. a 15% risk if there was pain at 12 months.
The reason for widespread pain is not known but could result from a combination of factors. Chronic pain that is untreated commonly involves exaggerated pain messaging, leading to an increased sensitivity to pain. Can the results from this analysis be generalized to all types of chronic pain, or is the presence of initial inflammation having an impact on the incidence of widespread pain? It appears prudent to address unresolved pain in the presence of low inflammation to prevent progression to widespread pain.
Often there is a disconnect between rheumatology and pain clinics and this is a need that should be addressed. It is important to keep in mind that poor sleep also increases pain perception and cardiovascular disease risk, so early assessment of sleep has many implications.
Once again this underscores the need for a team-based, holistic approach to patient care.
Carolyn Whiskin, BSc. Phm is currently the director of pharmacy programs for the Charlton Centre for Specialized Treatments in Hamilton, Ontario. She also practices pharmacy at Brant Arts Dispensary in Burlington, Ontario and is the pharmacist representative to the Ontario Rheumatology Association’s Model of Care committee.View Full Bio