Pathophysiology and principles of pain management in rheumatic diseases.

Pain is a major presenting symptom in patients with rheumatic diseases. It is difficult, however, to define pain precisely because there are both objective and subjective components to the experience of pain. Thus, patients with the same degree of tissue inflammation may experience different levels of pain. The variation in individual pain experience often presents us with a diagnostic and therapeutic dilemma. Pain management, therefore, must be based on a solid understanding of the pathophysiology of pain and on a careful review of the risks, benefits, cost, and efficacy of available treatments.