title: Multinational evidence-based recommendations for pain management by pharmacotherapy in inflammatory arthritis: integrating systematic literature research and expert opinion of a broad panel of rheumatologists in the 3e Initiative.
abstract: OBJECTIVE
  To develop evidence-based recommendations for pain management by pharmacotherapy in patients with inflammatory arthritis (IA).
  
  
  METHODS
  A total of 453 rheumatologists from 17 countries participated in the 2010 3e (Evidence, Expertise, Exchange) Initiative. Using a formal voting process, 89 rheumatologists representing all 17 countries selected 10 clinical questions regarding the use of pain medications in IA. Bibliographic fellows undertook a systematic literature review for each question, using MEDLINE, EMBASE, Cochrane CENTRAL and 2008-09 European League Against Rheumatism (EULAR)/ACR abstracts. Relevant studies were retrieved for data extraction and quality assessment. Rheumatologists from each country used this evidence to develop a set of national recommendations. Multinational recommendations were then formulated and assessed for agreement and the potential impact on clinical practice.
  
  
  RESULTS
  A total of 49,242 references were identified, from which 167 studies were included in the systematic reviews. One clinical question regarding different comorbidities was divided into two separate reviews, resulting in 11 recommendations in total. Oxford levels of evidence were applied to each recommendation. The recommendations related to the efficacy and safety of various analgesic medications, pain measurement scales and pain management in the pre-conception period, pregnancy and lactation. Finally, an algorithm for the pharmacological management of pain in IA was developed. Twenty per cent of rheumatologists reported that the algorithm would change their practice, and 75% felt the algorithm was in accordance with their current practice.
  
  
  CONCLUSIONS
  Eleven evidence-based recommendations on the management of pain by pharmacotherapy in IA were developed. They are supported by a large panel of rheumatologists from 17 countries, thus enhancing their utility in clinical practice.
authors.affiliation: Rheumatology Unit, The Queen Elizabeth Hospital, Woodville South, South Australia 5011, Adelaide, Australia. sam@whit.tl
authors.forename: Samuel L
authors.initials: SL
authors.lastname: Whittle
authors.forename: Alexandra N
authors.initials: AN
authors.lastname: Colebatch
authors.forename: Rachelle
authors.initials: R
authors.lastname: Buchbinder
authors.forename: Christopher J
authors.initials: CJ
authors.lastname: Edwards
authors.forename: Karen
authors.initials: K
authors.lastname: Adams
authors.forename: Matthias
authors.initials: M
authors.lastname: Englbrecht
authors.forename: Glen
authors.initials: G
authors.lastname: Hazlewood
authors.forename: Jonathan L
authors.initials: JL
authors.lastname: Marks
authors.forename: Helga
authors.initials: H
authors.lastname: Radner
authors.forename: Sofia
authors.initials: S
authors.lastname: Ramiro
authors.forename: Bethan L
authors.initials: BL
authors.lastname: Richards
authors.forename: Ingo H
authors.initials: IH
authors.lastname: Tarner
authors.forename: Daniel
authors.initials: D
authors.lastname: Aletaha
authors.forename: Claire
authors.initials: C
authors.lastname: Bombardier
authors.forename: Robert B
authors.initials: RB
authors.lastname: Landewé
authors.forename: Ulf
authors.initials: U
authors.lastname: Müller-Ladner
authors.forename: Johannes W J
authors.initials: JW
authors.lastname: Bijlsma
authors.forename: Jaime C
authors.initials: JC
authors.lastname: Branco
authors.forename: Vivian P
authors.initials: VP
authors.lastname: Bykerk
authors.forename: Geraldo
authors.initials: G
authors.lastname: da Rocha Castelar Pinheiro
authors.forename: Anca I
authors.initials: AI
authors.lastname: Catrina
authors.forename: Pekka
authors.initials: P
authors.lastname: Hannonen
authors.forename: Patrick
authors.initials: P
authors.lastname: Kiely
authors.forename: Burkhard
authors.initials: B
authors.lastname: Leeb
authors.forename: Elisabeth
authors.initials: E
authors.lastname: Lie
authors.forename: Píndaro
authors.initials: P
authors.lastname: Martinez-Osuna
authors.forename: Carlomaurizio
authors.initials: C
authors.lastname: Montecucco
authors.forename: Mikkel
authors.initials: M
authors.lastname: Ostergaard
authors.forename: Rene
authors.initials: R
authors.lastname: Westhovens
authors.forename: Jane
authors.initials: J
authors.lastname: Zochling
authors.forename: Désirée
authors.initials: D
authors.lastname: van der Heijde
mesh_terms: D000465:Algorithms; D000700:Analgesics / Q000009:adverse effects / Q000627:therapeutic use*; D001168:Arthritis / Q000188:drug therapy*; D019317:Evidence-Based Medicine; D005260:Female; D006801:Humans; D010146:Pain / Q000188:drug therapy*; D059408:Pain Management; D011247:Pregnancy; D016896:Treatment Outcome
chemical_list: D000700:Analgesics