Rheumatoid arthritis pain treatment found ineffective

Pain management is a high priority for patients with rheumatoid arthritis, but a new study shows that minimal or no benefits with muscle relaxants and neuromodulators are outweighted by the risks.

Despite recent advances in the treatment of rheumatoid arthritis, pain remains a significant problem to people with this condition. Apart from simple analgesics like paracetamol, other possible treatments that might help in treating pain include muscle relaxants such as diazepam or neuromodulators such as pregabalin or topical capsaicin.

However, in two papers published in The Cochrane Library, Australian researchers have found that patients received little pain benefit from either of these two different classes of drugs.

The researchers from Monash University, the Royal Prince Alfred Hospital and the Queen Elizabeth Hospital, arrived at their conclusion after examining existing study data.

Professor Rachelle Buchbinder from Monash University's Department of Epidemiology and Preventive Medicine said the research found there was weak evidence to support the use of these drugs in pain management for rheumatoid arthritis.

"We found that there had only been a small number of trials completed and none had investigated newer neuromodulators like pregabalin. And the trial data that we did find was generally of low quality," Professor Buchbinder said.

Rheumatoid arthritis is a disease in which the person's immune system attacks the lining of their joints resulting in stiff and painful joints. There is currently no cure for rheumatoid arthritis, so treatments are designed to control pain and stiffness and improve a patient's mobility.

Muscle relaxants can be used to treat anxiety and promote sleep, and some people believe they may help reduce pain by acting on the nerves that cause pain, however this remains contentious. Neuromodulators alter the way nerves communicate with each other, and therefore, change the overall activity level of the brain. This may result in a reduction of the pain felt by a patient.

"The worrying thing is that we found that both classes of drugs had significant side effects and the potential harms seem to outweigh any modest benefit achieved," Professor Buchbinder said.

"There is certainly a need for more high-quality research to be carried out to better assess the efficacy and safety of these medications for pain management in this patient group."

The two papers, Neuromodulators for pain management in rheumatoid arthritis and Muscle relaxants for pain management in rheumatoid arthritis can be found on The Cochrane Library website.

(Source: Monash University: The Cochrane Library)