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

Jun 6, 2016

In Part 2 of a two-part interview, Lars Arendt-Nielsen and Serge Perrot discussed their book, Pain in the Joints.


Q: Please tell us about your book and how it accompanies the 2016 IASP Global Year theme.

Arendt-Nielsen: Pain in the Joints consists of 17 chapters written by highly esteemed researchers within this field. It aims to provide a comprehensive overview of joint pain problems, ways to assess joint pain, mechanisms involved, and treatment options. It will address the general concepts of the diagnostic and therapeutic challenges.

The goal is to provide better understanding and management of joint pain, and it will be translated into Japanese as a courtesy to our Japanese hosts at the World Congress in Yokohama. It complements the Global Year Fact Sheets, which now number 21 in 14 languages.

Perrot: The book differs from the Fact Sheets because the Fact Sheets are very concise and are not written by the same authors. In some cases, they cover the same topics but not in same way, so the book has a more scientific approach. It has many more references and is more directed at professionals and pain specialists than the Fact Sheets, which are for general physicians and professionals in lots of specialties and for patients as well.

Q: Why is this book important, especially right now?

Arendt-Nielsen: Because joint pain is a substantially growing and complex problem that affects millions of people worldwide and is a major socioeconomic burden.

Musculoskeletal pain, including joint pain, is the major cause of chronic pain. Chronic pain due to joint problems is assumed to further increase in the future due to demographic and lifestyle changes. Joint pain is complex, far-reaching, and related to many different local and systemic diseases.

A key feature of many joint pain problems is the lack of association between joint damage and the pain intensity felt by the patient, and hence other mechanisms (such as sensitization) may play a role.

Another key feature is the importance of exercise and movement in joint pain pathophysiology, but also in its management. Despite wide-ranging conditions and symptoms, different types of joint pain may share similar underlying mechanisms, manifestations, and potential treatments.

A translational pain research approach is important in this area and is reflected in the book. Furthermore, it’s linked up with the Global Year initiatives worldwide, which will give it much visibility via these initiatives. There is a great synergy among all the activities planned for the Global Year.

Q: How does the book differ from books already available on the topic of joint pain?

Arendt-Nielsen: The book is original, and no other recent books are entirely devoted to joint pain. Furthermore, we have leading pain researchers—many of them IASP members—as authors within the book, so in this way, it will be state-of-the-art.

Q: Who is its primary audience?  

Arendt-Nielsen: The book will not only be of interest to pain scientists but also will be useful for clinicians involved in perioperative care and the management of chronic pain. It will interest basic scientists, too, since it covers the translational aspects from neurophysiology to genetics, investigating the pathophysiology of ongoing nociception, pain persistence, and chronic pain development.

The book also should resonate with practitioners in clinical disciplines who are not normally readers of IASP books such as orthopaedic surgeons and rheumatologists. The book will be generally relevant not only to pain specialists, rheumatologists, anaesthesiologists, and surgeons managing surgical patients, but also to general practitioners, internists, neurologists, psychologists, and psychiatrists.

Q: What percentage of patients can be helped through greater awareness of treatment options for joint pain?

Perrot: That’s difficult to know, because it depends on the patient’s aim. If he wants to be as he was at age 20, that’s difficult, but if patients realize we can help them cope with pain, increase the mobility to function, then probably most patients can be helped. But completely cured? Not many. Helped? Probably many. 

Q: Can you provide an example from your book of an innovation in the joint pain field that everyone should be aware of?

Arendt-Nielsen: That at the end of the day surgery may not be the answer to joint pain. This is an important take-home message: Pain may not go away by surgery, and additional surgery for surgical procedures may actually end up generating more pain.

But the problem is that we have different health-care systems in different countries. In the United States, the problem is that treatment is very much driven by insurance companies, but in other countries, it’s driven more by the national health-care system, which do not have the financial incentives to do more surgeries. If you’re in a private setting, there may be an incentive to do more surgery, so it depends a bit on the system you’re working in.

Q: Is that discouraging for patients?

Arendt-Nielsen: As it is now, many patients continue to push their health-care professionals, saying that they need to have additional surgery because they think you can cut away the pain. The problem is you cannot cut away the pain, so there is an educational issue here. We try to educucate not only health-care professionals during the Global Year but also try to educate patients that if they do have pain after surgery, there may be nothing wrong technically, but you’ll still have pain.

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