Talking Joint Pain: A Conversation with Lars Arendt-Nielsen and Serge Perrot, Co-Chairs of the 2016 Global Year Against Pain in the Joints

Jan 11, 2016

Part 1 of a two-part interview. Read Part 2


Q: Why is the issue of joint pain so important right now?

Arendt-Nielsen: Pain in the joints is a substantially growing and complex problem that affects millions of people worldwide and is a major socioeconomic burden. Chronic pain due to such conditions is likely to increase in the future because of demographic and lifestyle changes. Joint pain is complex and far-reaching, and it is related to many different local and systemic diseases. Therefore, it is important to address this problem now, since it will not be minor in future.

Perrot: Beyond the suffering and discomfort associated with various types of joint pain, there are huge financial and other costs linked to this problem, including medical expenses, lost work days, and diminished quality and productivity in patients’ work and personal lives.

I’m a rheumatologist and pain specialist, but there are very few rheumatologists who are involved in pain management, although pain is the main symptom in rheumatoid diseases. For many years, I’ve been engaged in increasing awareness of pain in the rheumatic field and increasing the number of people who are taking care of pain in the joints in rheumatology and also in pain medicine. For me, the Global Year is very important for these two points: to merge the rheumatology field and the pain specialists.  

Q: Data show that the number of joint pain patients is growing. Why?

Arendt-Nielsen: Throughout the world, the numerous challenges surrounding joint pain are on the rise due to a number of accelerating factors and trends such as aging populations, sedentary lifestyles, and the increasing incidence of obesity.

Q: What recent innovations have you seen in the treatment of joint disorders? For instance, one of the Global Year Fact Sheets notes a consensus among practitioners of a need to stratify specific joint pain patients to individualize treatment.

Perrot: There have been some new treatments for underlying diseases like rheumatoid arthritis or spondyloarthritis. If you look at the inflammatory disorders—conditions like osteoarthritis and other inflammatory disorders—there’s no perfect treatment for that pain, for the moment, but there will be in future new treatments. For example, the class of anti-nerve growth factor (anti-NGF) monoclonal antibodies and biologics directed at NGFs. That will probably come in the next three years and will change a lot in the context of pain in the joints. Different firms are developing this new class of drugs—this is not a unique innovation since there are other ways—but this is probably the most impressive at the moment.

Arendt-Nielsen: Yes, this field is under massive development, and new drugs such as anti-NGF monoclonal antibodies are currently in clinical trials.

Q: Is 2016 a particularly important time to address joint pain as a health-care issue?

Arendt-Nielsen: It is a substantially growing and complex problem that affects millions of people worldwide. It is also a major socioeconomic burden that will not diminish. Chronic pain due to joint problems is assumed to further increase in the future due to demographic and lifestyle changes.

Perrot: It’s very important because it relates to different conditions, but the main condition is osteoarthritis. Osteoarthritis is in two populations—in the elderly and the obese—and the condition is growing among both populations. Mobility and age are the two major risk factors, which explain why pain in the joints is very important.

The other reason it’s important is because of inflammatory joint disorders. In some cases, there are specific treatments for the underlying conditions, but in others, they are not enough. We need to decide that physiological treatment, and we need also to have some symptomatic treatment for pain in the joints and the treatment of the underlying disease.

Q: Do you think most patients realize their pain can likely be reduced or even eliminated?

Arendt-Nielsen: I believe many patients hope their pain can be reduced or even eliminated, but with the pain-relief tools, treatments, and knowledge available today for joint pain, it is particularly difficult. Up to 20 percent of joint pain patients do not achieve pain relief after joint replacement. This is especially addressed in our upcoming IASP book on joint pain and in the Global Year Fact Sheets.

Q: Are most joint pain treatments expensive and long-term, or are they often simple treatments that can lead to improved relief quickly?

Arendt-Nielsen: Most of the treatments are simple pharmacological approaches, but since standard drugs may cause side effects, training and exercise are currently being promoted a lot.

Q: What do you hope the Global Year achieves specifically?

Arendt-Nielsen: This campaign will employ a series of coordinated events, activities, media-outreach efforts, publications, conferences, and other resources to draw attention to the persistent problem of joint pain. By engaging and mobilizing IASP’s members, leaders, and chapters around the world—and partnering with other influential individuals and groups outside of the association—I hope that the campaign will do the following:

  • Disseminate information on joint pain throughout the world, with particular emphasis on developing countries
  • Connect IASP-member pain researchers and clinicians to the larger global community of health-care professionals who witness the problems associated with joint pain first-hand in their daily interactions with patients
  • Increase awareness of joint pain among government officials, the news media, the general public, and patient organizations worldwide
  • Encourage government leaders, research institutions, and other key individuals and organizations to recognize and support research aimed at producing more effective and accessible treatment methods and outcomes for people with joint pain.

Perrot: Although pain in the joints is a frequent condition and symptom, the available medications and the research being conducted are very rare. There are many studies in Europe, for example, of migraine pain, but very few on pain in the joints. I’d like to increase scientific research on the topic and be involved on the other side—involving rheumatologists in pain management and assessment.

Q: Why is IASP the right organization to be leading this effort?

Perrot: Because IASP is multi-professional and has lots of specialties. IASP is really the main organization that is committed to pain, so it’s the right organization to focus worldwide attention rather than, for example, rheumatology societies that are more focused on the joint disorder than on the pain that relates to the joint.

Arendt-Nielsen: Because IASP is the leading organization within the study of pain and has the power, capabilities, tools, and connections to reach out and communicate the message to the whole world.

Q: Why is it so important for IASP chapters to get involved, and where do you think they can make the most difference?

Arendt-Nielsen: IASP’s 90 chapters will be important assets in attracting more attention, funding, research, and so forth to increase the knowledge and focus on pain research and pain relief worldwide.

Perrot: There’s a need for local chapters to be involved because if you look at different countries, joint pain is not treated by the same specialists from one country to the next. The national chapters are very important since they can closely look at local pain treatment and management.

Q: How can IASP Special Interest Groups (SIGs) get involved?

Arendt-Nielsen: The various SIGs should be heavily involved in the Global Year campaigns, since they also have a large role in reaching out to countries all over the world. The SIGs can discuss the Global year in their newsletters, topical workshops at the World Congress on Pain, satellite symposiums, and plenary lectures at meetings and conferences, and so forth.

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Read Part 2.