Critical Knowledge Gap in Managing Chronic Pain Among Patients with AxSpA
Researchers addressed unmet needs in the treatment of chronic pain for patients living with axial spondyloarthritis.
Critical knowledge gaps exist in identifying chronic pain, determining populations most respondent to therapies, understanding treatment mechanisms, and more when it comes to treating chronic pain in patients with axial spondyloarthritis (axSpA), according to data published in the Journal of Rheumatology.1
“Chronic pain is common among patients with axSpA and psoriatic arthritis (PsA) and contributes to substantial decrements in quality of life and physical function,” wrote authors of the study. “Approximately 10% to 20% of patients with axSpA and/or PsA meet the criteria for fibromyalgia (FM), and opiates are still commonly used to treat chronic pain in axSpA (36%) and PsA (24%).”
Based on knowledge prior to the study, axSpA impacts approximately 1% of the US population.2 With it being a disease associated with the spine, chronic pain—usually in the lower back—is a common symptom that patients continuously struggle with. Previous research has suggested common use of opioids and opiates to treat pain in patients with axSpA, but recent recommendations have looked to nonsteroidal anti-inflammatory drugs (NSAIDs) as the top-line treatment option for axSpA, according to the Arthritis Foundation.3
According to Mayo Clinic Proceedings, axSpA impacts approximately 1% of the US population. | image credit: Daria / stock.adobe.com
Further research is necessary to better understand the mechanisms of pain as a whole, and the same goes for understanding pain amongst patients with axSpA. With conflicting recommendations for the treatment of pain in this patient population, researchers attempted to shine a light on the lack of knowledge and unmet needs within managing axSpA.
“In this review, we discuss the prevalence of chronic pain and FM in patients with axSpA and examine the existing knowledge on the pathophysiology of chronic pain in SpA, osteoarthritis (OA), and rheumatoid arthritis (RA),” they continued.1 “Finally, we discuss the specific unmet needs that must be addressed to improve long-term outcomes in axSpA, specifically those that will improve chronic pain in this patient population.”
READ MORE: FDA Approves Actemra Biosimilar Tocilizumab-Anoh
Researchers hoped that investigating pain mechanisms in other conditions could help inform them on treating pain specifically for patients with axSpA. In their attempt to unveil a wider scope of pain in patients with axSpA, researchers explored various topics regarding pain and arthritis. More specifically, they investigated the pathophysiology of pain as well as the unmet needs in RA and pain treatment for SpA.
In their search for unmet needs in RA treatment, researchers asked a series of questions through their review. With RA being a rheumatic disease, interventions usually involve disease-modifying antirheumatic drugs (DMARDs). This led them to their first question regarding unmet RA needs, which was “How can patients who are unlikely to respond to DMARDs be identified?”
Aside from the identification of patient populations with RA pain and various treatment responses to DMARDs, researchers also explored alternate options to improve RA pain. “These results underscore the importance of carefully phenotyping patients and considering different pain phenotypes (eg, inflammatory vs noninflammatory pain) when making treatment decisions,” they wrote.1 With treatment options being a theme, one of the key areas of unmet need within RA is identifying factors that lead to chronic pain and cannot be treated by DMARDs.
“Targeted immunomodulatory therapies, such as biologics targeting TNF and the IL-23/IL-17 axis, have transformed the treatment landscape for SpA. However, many people continue to experience distressing chronic pain. The discordance between inflammation and pain is a major hindrance in the development of efficacious and safe analgesic therapies and reflects our incomplete understanding of the biology of pain in inflammatory arthritis,” continued the authors.
While there are certainly similarities between RA and axSpA, research is lacking in the SpA space, leading researchers to find noticeable gaps in the mechanisms of pain in patients with axSpA. Researchers believe conducting human and animal trials will further the knowledge gap of arthritic pain mechanisms and the pain responses for patients living with axSpA.
“Critical knowledge gaps exist in identifying patients whose pain will not resolve with appropriate immunomodulatory therapies; determining which patients are most likely to respond to targeted pharmacologic interventions for pain; understanding the specific mechanisms underlying nonpharmacologic treatments for pain, particularly those directed at improving sleep; and identifying the underlying pathways linking acute peripheral inflammation to CNS changes associated with chronic pain,” concluded the authors.1
READ MORE: Pain Management Resource Center
Ready to impress your pharmacy colleagues with the latest drug information, industry trends, and patient care tips? Sign up today for our free Drug Topics newsletter.
