Arthritis Foundation Organizational Statement

On Pain Management

Arthritis Foundation Organization Overview

The Arthritis Foundation is fighting for all people who live with arthritis. We are boldly pursuing a cure for America’s #1 cause of disability while championing the fight to conquer arthritis with life-changing science, resources, advocacy, and community connections. By advancing scientific research, policy reform, as well as health promotion and disease management support, the Arthritis Foundation helps patients navigate the many challenges of arthritis, including managing chronic pain.

The Arthritis Foundation strives to advance and promote improved quality of life for those living with chronic pain by:

• Advocating for access to and coverage for high-quality health care;
• Providing valuable patient education and resources;
• Promoting public awareness; and
• Supporting best practices with evidence-based resources.

Pain management should be patient-centered and individualized, using integrative and traditional therapies. One size does not fit all. Every patient should have access, coverage, and awareness of effective pain management solutions that may change throughout their lifetime. The Arthritis Foundation encourages key stakeholders to make pain a priority and to seek new mechanisms to effectively manage and treat chronic pain.

Issue Background

Arthritis is very common but not well understood. Arthritis is not a single disease but an umbrella term that refers to joint pain or joint disease. There are over 100 different types of arthritis and related conditions. Pain is the #1 challenge for people living with arthritis, as arthritis patients experience levels of pain that are higher than the overall population reporting to be in pain. Additionally, arthritis is the leading cause of disability among adults in the United States, and 4 out of 5 arthritis patients experience more difficulties in their ability to function physically than the general population. Those who live with arthritis experience chronic pain differently. Further, pain is disproportionately experienced by people of color, low-income individuals, and those living in rural areas.

Nearly 60 million adults and almost 300,000 children have doctor-diagnosed arthritis, but studies suggest that these estimates of arthritis prevalence are substantially underestimated; arthritis prevalence is likely almost double these numbers. By these estimates, nearly 1 in 3 people aged 18-64 have arthritis.

Pain for individuals living with arthritis is extremely prevalent, limiting them from participating in normal activities, interfering with daily life, and reducing their quality of life. According to a 2021 Arthritis Foundation INSIGHTS report, a national survey garnering over 40,000 assessments of people living with arthritis, 100% of survey respondents reported pain over the past 7 days, with over 66% reporting a pain level of 5 or higher, indicating moderately strong pain at a level approaching distress.  The lifetime impact of chronic pain can be devastating.

Additionally, no single pain management tool typically works over the lifetime of a patient, and no single pain tool is always appropriate for that patient. Therefore, we must focus on access to care and treatments that will enhance the patient’s quality of life over their lifetime.

Arthritis Foundation Advocacy Position

The Arthritis Foundation supports federal and state legislative and regulatory initiatives that seek to enhance access to and coverage of high-quality health care for arthritis patients, including solutions for managing pain over a patient’s lifetime.

Specifically, the Arthritis Foundation recognizes the need for solutions and advocates for pain management policies that:

• Support enhanced access to and coverage of FDA-approved drugs and evidence-based best practices for appropriate use in managing arthritis pain;
• Build a broader scientific research base for the safety and efficacy of complementary and integrative therapies, non-opiate drug alternatives, and non-pharmacologic pain management therapies and tools; and
• Raise awareness of and improve access to coverage and care coordination for chronic pain management.

Arthritis Foundation Health Promotion Position

Effective pain management must be a planned outcome that integrates disease management, safe use of pharmacological pain relief, mental/behavioral health care, nondrug and complementary therapies, sleep health and self-management techniques.

The Arthritis Foundation champions the following health promotion principles that support pain management, coping strategies, and improved quality of life:

• Prioritize evidence when choosing pain relief strategies and maximize the use of non-pharmacological pain relief options;
• Consider joint surgery when pain levels cannot be well-controlled with non-pharmacological or pharmacological pain relief options;
• Encourage emerging therapies as an important part of the pain management conversation;
• Use a goal setting framework to optimize doctor/patient communication;
• Give mental health an equal footing with physical health in pain management discussions;
• Utilize care team integration to optimize pain management outcomes. The following specialties should be accessible to and fully utilized by all arthritis patients - rheumatology, orthopedics, physical therapy, occupational therapy, integrative health, psychology, sleep medicine and exercise science.

Arthritis Foundation Science Position

Treatment for the various forms of autoimmune inflammatory arthritis is individual to each patient, and therefore it is important for patients to work with their family care physician and rheumatologist to find a treatment plan that works best for them and provides the most effective pain management. Many factors, including the severity of one’s disease and duration living with the condition, come into play when discussing what may best reduce pain symptoms in the long term.

Treatment approaches for autoimmune inflammatory arthritis conditions share the same goals including the following to:

• Stop the inflammation present with the disease so that it can be put it into remission;
• Relieve pain symptoms that may accompany the disease;
• Prevent further damage to joints or organs; and
• Improve physical health and overall wellbeing.

Even more common than autoimmune inflammatory arthritis is Osteoarthritis (OA), which affects many adults, and has an inflammatory component that stems from the degenerative causes of the disease. In the area of OA, the Arthritis Foundation recommends following the 2019 guideline for management of Osteoarthritis of Hand/Hip/Knee.

Continued scientific advances for OA management are also being made with further evidence being collected in areas that include the effectiveness of steroid injections, regenerative medicine therapies, and the implementation of exercise and physical activity, among others.  The Arthritis Foundation supports patients having a comprehensive menu of treatment options that are strongly supported with evidence of safety and efficacy.

In summary, the Arthritis Foundation’s overarching scientific agenda focuses on the three major diseases: Osteoarthritis (OA), Rheumatoid Arthritis (RA), Juvenile Arthritis (JA), and other related forms of autoinflammatory arthritis diseases. We are focusing our funding and prioritizing research projects that are aligned with the pain management principles for each of the diseases above. Special emphasis is given to projects focused on communicating scientific results or are clinical research projects to quickly address the unmet medical needs of patients living with arthritis and chronic pain.

References

Arthritis Foundation. 2021. How it Hurts Report. Atlanta: Arthritis Foundation. Accessed May 15, 2021. www.arthritis.org/liveyes/insights/how-it-hurts .

Centers for Disease Control and Prevention (CDC). January 10, 2019. Arthritis in General. Accessed June 22, 2021. www.cdc.gov/arthritis/basics/faqs.htm .

Food and Drug Administration (FDA). March 5, 2021. Human Drugs . Accessed June 15, 2021. www.fda.gov/industry/regulated-products/human-drugs .

Kolaniski, Sharon L, Tuhina Neogi, Marc C. Hochberg, and et.al. 2020. "2019 American College of Rheumatology / Arthritis Foundation Guideline for the Management of Osteoarthritis of the Hand, Hip, and Knee." Arthritis & Rheumatology Vol. 72 (2): 220-233. Accessed June 30, 2021. doi: 10.1002/art.41142.