Why should we study pain in rheumatic and musculoskeletal diseases?
- Pain arising as a symptom of musculoskeletal disease is a formidable worldwide problem for which safe and effective pharmacological treatments are generally unavailable.
- There is a clear need for identifying new drugs that target distinct, novel mechanisms for producing pain relief.
- It is anticipated that a better understanding of the molecular and cellular basis of MSK pain will help to discover new therapeutic targets for analgesic drug development.
Pain is a key symptom in all rheumatic and musculoskeletal diseases
- Osteoarthritis (OA) and low back pain (LBP) are by far the major causes of pain worldwide, and this is expected to worsen as the world’s population ages. Despite the availability of a variety of analgesics, OA pain is often inadequately controlled. Its management relies on standard pharmacological (acetaminophen, NSAIDs, opiates, centrally acting drugs) and nonpharmacological (physiotherapy, cognitive behavioral therapy) interventions. For many patients, however, treatments do not provide adequate pain relief, and the chronic use of analgesic drugs can be associated with debilitating side effects, including addiction – as has recently become acutely evident in light of the ongoing opiate crisis.
- In rheumatoid arthritis (RA), pain is the primary symptom along with stiffness and fatigue, and it has been well documented that pain often persists even when the inflammation is controlled.
- Spondylarthritis (SpA) and psoriatic arthritis (PsA) are characterized by pain, the mechanisms of which are ill understood and can be caused by inflammation and structural bone remodeling. Even with the availability of disease modifying drugs, including biologics, pain remains a problem for these patients.
- Many hereditary connective tissue diseases are characterized by chronic pain. The Ehlers-Danlos Syndromes (EDS) are a group of rare heritable disorders resulting from defects in in genes encoding structural components of the extracellular matrix, in particular fibril-forming collagens types I, III, V, or molecules involved in the maturation, folding, secretion or supramolecular organization of these collagens. The syndromic presentation of joint hypermobility, skin hyperextensibility, abnormal scar formation and easy bruising is key to the diagnosis, but intractable pain is often the primary reason for these patients to seek medical help.
It is unknown how mechanisms underlying pain may overlap or differ between different types of arthritis and MSK diseases.
Multidisciplinary research into the mechanisms underlying chronic pain associated with arthritis and other musculoskeletal diseases is considered an urgent need throughout the world.
We are inviting basic and clinical researchers in the field of musculoskeletal and rheumatic diseases as well as pain researchers and neuroscientists to engage with the Center, in order to bridge the gap between these fields.