Results of a recent study indicated that when a patient is able to temper their underlying disease, it can improve their experience of centrally sensitized pain despite not obtaining low disease activity.
In an interview with HCPLive, Philip Mease, MD, clinical professor at the University of Washington School of Medicine and Director of Rheumatology Research at the Swedish Medical Center in Seattle, discussed his Rheumatology Winter Clinical Symposium (RWCS) presentation, “State of the Art: Pain (simple title, complex issue).”
Results from a recent French study of over 500 patients treated with a tumor necrosis factor inhibitor (TNF) showed that although patients with fibromyalgia were less able to achieve low disease activity, significantly fewer patients reported fibromyalgia symptoms at 3 months. This indicates that when a patient is able to temper the underlying disease or condition, it can improve their experience of centrally sensitized pain despite not obtaining low disease activity.
Another study conducted in Stockholm examined pre-surgical patients with osteoarthritis and hyperalgesia, a condition that mimics symptoms of fibromyalgia. Post-surgery, hyperalgesia significantly improved when compared with the original cohort. Mease explained that, when the peripheral reason for pain was remediated, changes in the brain, as noted by Functional magnetic resonance imaging (fMRI), returned to a normal state.
He also noted therapeutic approaches highlighting immunomodulatory drug treatment for the primary rheumatic disease, both pharmacological and nonpharmacological. These included biologic disease-modifying antirheumatic drugs (bDMARDs), targeted synthetic DMARDs (tsDMARDs), and acetaminophen. Certain medications also reduce central sensitization, such as duloxetine and amitriptyline. Nonpharmacological treatments include acupuncture, biofeedback therapy, physical therapy, and mindfulness training. He stressed that clinicians should avoid narcotics whenever possible.
Ultimately, treating pain is “weaving together a village of support people ranging from a psychologist or other therapist to querying the patient about what their support structure is at home,” Mease emphasized. “What is their family support structure? What is their friendship support structure? What is their minister’s support structure? Unfortunately, in today's society many people lack those kinds of supports.”