Current use of analgesics for rheumatological pain

Rheumatological pain is the most frequent pain doctors have to deal with. Faced with a patient experiencing pain, the clinician must work towards global management of the patient, including the prescription of analgesics. The results of a European survey amongst 722 general practitioners, rheumatologists, orthopaedic surgeons and internal specialists showed that about half of all patients treated for moderate-to-severe pain suffered from musculoskeletal pain. Despite this high treatment frequency, the management of rheumatological pain was generally perceived as problematic by the respondents. The drugs prescribed to treat rheumatological pain differed from country to country, but NSAIDs were generally the most-prescribed substances. Important reasons given for selecting analgesics included efficacy and tolerability, but also tolerance and addiction potential. NSAIDs are common first-line drugs, but their adverse reactions and interactions have led to paracetamol being recommended more often in this role. However, it has been recently demonstrated that the efficacy of paracetamol is often inadequate. On the other hand, the reduced risk of GI toxicity of the new COX-2 selective inhibitors could assure them a major role in mild-to-moderate rheumatological pain treatment. When any of these drugs are no longer effective, or when a patient cannot tolerate their adverse reactions, weak opioids should be considered. Tramadol is one such drug, which is gaining popularity for the treatment of moderate-to-severe rheumatological pain. Finally, strong opioids should be used in selected patients when all other options have been exhausted.