Pain and rheumatology : an overview of the problem

Actually pain is a very important health problem, affecting the majority of people, leading to a significant worsening of patients quality of life and being responsible for a large amount of both medical resources' expenses and indirect costs. Between the different causes of pain, rheumatic conditions are predominant; in fact diseases such as osteoarthritis (OA), rheumatoid arthritis (RA), fibromyalgia (FM) and extra-articular rheumatisms (EARs) are not only frequently observed, but are also invariably associated with pain occurrence. According to the wide range of rheumatic diseases described, pain expression is complex and not univocal, being influenced not only by the underlying disease, but also by other factors. Generally, 3 rhythms of pain presentation are described in rheumatic conditions: the "inflammatory" rhythm, characteristic of chronic arthritis, the "mechanic" one, characteristic of degenerative joint's diseases such as OA, and the "fibromyalgic" one, described in patients affected by FM; however also a true "neuropathic" pain may be present in these patients. This classification may be useful in the initial screening of the diseases potentially underlying to a painful syndrome, and in the follow-up of patients once established the diagnosis. With this paper we describe the different aspect and the burden of pain in different rheumatic diseases.