New British Society for Rheumatology guideline: Pain management in people with inflammatory arthritis 

Clinical guidelines bring together the most up-to-date evidence and expert opinions. This allows doctors, nurses, and other healthcare professionals to quickly get information about how to support someone as effectively and safely as possible. It can also help to make sure people get the same quality of care no matter where they live, as all healthcare professionals can access the guidelines.

Importantly, they are not an instruction manual or a set of rules, but guidance. This is because pain can be quite different between different people. Care always needs to be adapted depending on how a person’s pain impacts them specifically, their medical history, and the person’s preferences.

There are lots of different guidelines for rheumatology developed by the BSR. This Pain in inflammatory arthritis guideline is one of many that have relevance to JIA. We have also supported the BSR in reviewing their csDMARDs guideline, we are on the Guideline Working Group for the ‘hot swollen joints’ guideline that is currently in progress and there is a new JIA guideline currently in development that we are also supporting.  You can find out more about the BSR guidelines here. 

The guideline was updated by a team of experts called a “guideline working group”. This included people living with inflammatory arthritis, doctors, GPs, pharmacists, and specialist nurses. Representatives from Juvenile Arthritis Research also took part in the guideline working group.

The team looked at all the latest research about pain and pain management through pharmacological and non-pharmacological interventions and the impacts of pain on sleep, mental health, and wellbeing amongst other factors. They also considered how pain is assessed including what should be measured and how.  If there was not enough research in an important area, the expert group made recommendations based on their experience.

You can read more about the guideline scope at https://www.rheumatology.org.uk/news/details/New-Guideline-Pain-Management-in-People-with-Inflammatory-Arthritis-Guideline-Scope

Pain is complex, so the guideline is detailed and thorough. There are a set of recommendations, split into sections and cover everything from pain assessment and analgesic use through to exercise, sleep, psychological interventions and self-management support.

One of the strengths is its recognition that pain is often multifactorial and requires a holistic approach rather than a purely pharmacological one, as well as strongly emphasising the importance of the multidisciplinary team.

Key messages from the guideline include:

• Pain should be assessed at every inflammatory arthritis related appointment.

• Optimising disease control is essential, but pain often has multiple drivers.

• Non-pharmacological approaches such as exercise, education and psychological support are central to effective pain management.

• Long term use of opioids and neuromodulators for inflammatory arthritis pain should be avoided, where possible.

The guideline is written mainly for doctors and other healthcare professionals, so they are written in medical language. But they are available for everyone to read, and you can read them here.

There are lots of ways you might find the guidelines helpful. The guidelines may help you to:

• Understand what you can expect from your care and how your medical team is thinking about decisions relating to pain.

• Talk to your medical team and make shared decisions. You can ask them about the guidelines and what they mean for you as an individual.

Juvenile Arthritis Research is really pleased that the guideline has been developed and published. We will also use it in our work when we are trying to make change in the healthcare system by using the guideline to help us show what people need as recommended care for managing pain in JIA. We will also signpost patients to the guideline when they need help and support in relation to pain management so that they can have informed conversations with their medical team. 

Guidelines are “best practice”, but they are not a rule that everyone must follow like a law. This means some of the recommendations will take different members of your medical team working together to make change and ensure you receive the best-practice care detailed in this guideline.