Pain: Understanding and challenges for the rheumatologist

Patients who consult a rheumatologist almostuniversally report experiencing pain. Rheumatologists,in turn, use the particular characteristics of the painreport to help toward making a specific musculoskeletaldiagnosis. Although the documentation of the symptomof pain has always been an important component of therheumatologists’ assessment, the specific managementof pain may take second place to the management of theunderlying rheumatic disease process.The appreciation of pain is now an integral partof patient care and has recently been identified by theJoint Commission on Accreditation of Healthcare Or-ganizations as the fifth vital sign (1). Pain impacts theoverall well-being of patients with rheumatic disease (2).Chronic pain negatively affects the physical and psy-chological status as well as overall quality of life ofpatients, both in adults and in children (3–6). Never-theless, pain in chronic disease is often poorly man-aged (7,8).In the last decade, we have seen an extraordinaryadvance in the unraveling of pain mechanisms at themolecular level. Pain is a complex factor, since not onlyis it dependent on the underlying pathologic process, butalso is influenced by a multiplicity of factors such as thepsychological status, past pain experience, cultural back-ground, environment, and genetics of the individual. It istherefore timely to examine pain mechanisms and themanagement of pain as it pertains to rheumatologypractice.