Page 233 Guide to Pain Management in Low-Resource Settings

Chapter 29

Rheumatic Pain

Fereydoun Davatchi

What is rheumatology? tenosynovitis, bursitis, etc.). Bone diseases are divid-
ed into metabolic (osteoporosis, osteomalacia), infec-
Rheumatology is a subspecialty of internal medicine tious, tumoral (benign, malignant, metastatic), and ge-
dealing with bone and joint diseases (connective tis- notypic malformations.
sue and related tissue disorders of bone, cartilage, ten-
dons, ligaments, tendon sheets, bursae, muscles, etc.).
What is the connection between
Although modern rheumatology is based on advanced rheumatology and pain?
molecular biology, immunology, and immunogenetics,
the daily practice and routine diagnosis is mainly clini- The most important symptom in rheumatology is
cal and based on symptoms and signs. In the majority pain. The pain can be inflammatory, mechanical, or
of cases, laboratory tests and imaging have a confi rma- continuous. Inflammatory pain occurs during rest
tory role, instead of being mandatory. Simple tests, such and disappears or improves gradually with activity.
as complete blood count (CBC), erythrocyte sedimen- It is accompanied by some degree of stiffness, espe-
tation rate (ESR), C-reactive protein (CRP), rheumatoid cially in the morning when the patient wakes up. Me-
factor (RF), uric acid, and urinalysis, are suffi cient in chanical pain appears with activity, increases gradu-
many cases. Sophisticated investigations are rarely man- ally, and disappears with rest. It can be accompanied
datory in routine practice. Th e same is true regarding by gelling pain, which resembles inflammatory pain,
elaborate imaging technics. but is of very short duration (a few minutes or less).

Pure continuous pain is rare; usually one can find an
How are rheumatological inflammatory or mechanical feature. Joint swelling is

diseases classifi ed? the second most important symptom in rheumatol-
ogy. It can be due to either effusion or synovial hy-
They are divided in three groups: articular, extra-ar- pertrophy. Bony enlargement of the joint (bone hy-
ticular, and bone diseases. Articular manifestations pertrophy) is the differential diagnosis. Limitation of
can be divided into six categories: inflammatory, joint movement is an indicator of joint involvement.
mechanical, metabolic, neurological, infectious, and Abnormal movement is an indicator of joint disloca-
tumoral disorders. Extra-articular manifestations tion (cartilage destruction, ligament tear, and epiphy-
are also called soft tissue rheumatism (tendonitis, seal collapse).

Guide to Pain Management in Low-Resource Settings, edited by Andreas Kopf and Nilesh B. Patel. IASP, Seattle, © 2010. No responsibility is assumed by IASP 221
for any injury and/or damage to persons or property as a matter of product liability, negligence, or from any use of any methods, products, instruction, or
ideas contained in the material herein. Because of the rapid advances in the medical sciences, the publisher recommends that there should be independent
verifi cation of diagnoses and drug dosages. Th e mention of specifi c pharmaceutical products and any medical procedure does not imply endorsement or
recommendation by the editors, authors, or IASP in favor of other medical products or procedures that are not covered in the text.