Pain Treatment in Arthritis-Related Pain: Beyond NSAIDs

Mart van de Laar*, 1, Joseph V Pergolizzi, Jr2, Hans-Ulrich Mellinghoff 3, Ignacio Morón Merchante 4, Srinivas Nalamachu 5, Joanne O'Brien 6, Serge Perrot 7, Robert B Raffa 8
1 Arthritis Center Twente (MST & UT), Enschede, The Netherlands
2 Johns Hopkins University, Baltimore, Maryland, USA; Association of Chronic Pain Patients, Houston, Texas, USA
3 Department of Endocrinology, Diabetology and Osteology, Kantonsspital St. Gallen, Switzerland
4 Centro de Salud Universitario Goya, Madrid, Spain
5 Kansas University Medical Center, Kansas City, Kansas, USA and International Clinic Research, Leawood, Kansas, USA
6 Department of Pain Management, Beaumont Hospital, Beaumont, Dublin, Ireland
7 Service de Médecine Interne et Consultation de la Douleur, Hôpital Dieu, Paris, France
8 Department of Pharmaceutical Sciences, Temple University School of Pharmacy, Philadelphia PA, USA

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© van de Laar et al.; Licensee Bentham Open.

open-access license: This is an open access article licensed under the terms of the Creative Commons Attribution Non-Commercial License ( which permits unrestricted, non-commercial use, distribution and reproduction in any medium, provided the work is properly cited.

* Address correspondence to this author at the Reumacentrum Twente (MST & UT), postbus 50.000, 7500KA ENSCHEDE, The Netherlands; Tel: +31-53-4872450; Fax: +31-53-4873106; E-mail:


Managing pain from chronic conditions, such as, but not limited to, osteoarthritis and rheumatoid arthritis, requires the clinician to balance the need for effective analgesia against safety risks associated with analgesic agents. Osteoarthritis and rheumatoid arthritis pain is incompletely understood but involves both nociceptive and non-nociceptive mechanisms, including neuropathic mechanisms. Prevailing guidelines for arthritis-related pain do not differentiate between nociceptive and non-nociceptive pain, sometimes leading to recommendations that do not fully address the nature of pain. NSAIDs are effective in treating the nociceptive arthritis-related pain. However, safety concerns of NSAIDs may cause clinicians to undertreat arthritis-related pain. In this context, combination therapy may be more appropriate to manage the different pain mechanisms involved. A panel convened in November 2010 found that among the currently recommended analgesic products for arthritis-related pain, fixed-low-dose combination products hold promise for pain control because such products allow lower doses of individual agents resulting in decreased toxicity and acceptable efficacy due to synergy between the individual drugs. Better evidence and recommendations are required to improve treatment of chronic arthritis-related pain.

Keywords: Osteoarthritis, rheumatoid arthritis, analgesia, fixed-dose combination products, NSAID, paracetamol, tramadol..