[The therapy of pain in rheumatic joint-and spine diseases.]

The therapy of pain caused by rheumatic diseases above all must take into consideration the cause of the pain. In rheumatoid arthritis, especially in the early stages, inflammation is the primary cause of the pain. The pain decreases the inflammation subsides following the administration of non-steroidal anti-inflammatory drugs (NSAIDs), or corticosteroids, if necessary. The so-called disease modifying anti-rheumatic drugs do not influence the inflammation or consequently, the pain directly, but rather through mechanisms before the local joint process some of which are not exactly known. In later stages of the progressive joint degeneration the NSAIDs only have a limited effect regarding the inhibition of inflammation. In osteoarthrosis, in which the pain is caused by a secondary inflammation and increasingly by capsular, muscular and tendon involvement, the pain is only treated by NSAIDs in active inflammatory stages; otherwise, the treatment is physical activity and medication. In degenerative and static disorders of the spine the pain is caused predominantly by muscular bracing. Therefore, physical and especially gymnastic therapy play a major role. Whether muscle relaxants have an effect on muscle bracing is doubtful. If there is pressure on the ligaments and, in cases of vertebral dislocation with overstraining of the vertebral joints, therapy with local injections is indicated. The pain in osteoporosis is also predominantly muscular and must be treated accordingly. Above all, high doses of calcium and calcitonin are effective analgesics. Moreover, fluoride also acts as an analgesic once the osteoporosis has stabilized. In most cases fibromyalgia, which is mostly of a psychosomatic nature, cannot be influenced by medical therapy. Instead repeated attempts at treatment help to make the affliction chronic with neurotic fixation. Also, as a rule, myotonolytic and tranquilizing substances are not effective.