title: [Portuguese recommendations for pain management by pharmocotherapy in inflammatory arthritis].
abstract: OBJECTIVE
  To develop Portuguese evidence-based recommendations for pain management by pharmocotherapy in inflammatory arthritis.
  
  
  METHODS
  The Portuguese project was integrated in the multinational 3E Initiative (Evidence, Expertise, Exchange) 2010 where a total of 453 rheumatologists from 17 countries have participated. The clinical questions concerning pain were formulated and the Portuguese group added 2 more questions. A systematic literature search was performed in Medline, Embase, Cochrane Library and 2008-2009 EULAR and ACR abstracts. The selected articles were systematically reviewed and the evidence was defined according to the Oxford Levels of Evidence. In each country a group of experts joined to discuss their national recommendations. In Portugal, the national meeting was held in October 2010, where 33 rheumatologists discussed and voted by Delphi method the national recommendations. Finally, the agreement among the rheumatologists and the potential impact on their clinical practice was assessed.
  
  
  RESULTS
  Thirteen national recommendations were formulated: pain measure scores; analgesic combination therapy; pharmacotherapy in preconception, pregnancy and lactation periods; pharmacotherapy according to comorbilities; safety of NSAIDs and/or paracetamol with methotrexate combination therapy; efficacy and safety of continuous/on-demand NSAIDs; opioids, paracetamol, corticosteroids, antidepressants, neuromodulators and muscle relaxants role and effectiveness; risk factors for the development of chronic pain and the role of topic analgesics.
  
  
  CONCLUSIONS
  The portuguese recommendations for the pain management by pharmacotherapy in inflammatory arthritis were formulated according to the best evidence and supported by a panel of 63 rheumatologists. The differences between the national and international recommendations are reported in this article.
authors.affiliation: Serviço de Reumatologia do Centro Hospitalar de Lisboa Ocidental, EPE - Hospital de Egas Moniz, Lisboa, Portugal.
authors.forename: Inês
authors.initials: I
authors.lastname: Silva
authors.forename: Ana F
authors.initials: AF
authors.lastname: Mourão
authors.forename: Sofia
authors.initials: S
authors.lastname: Ramiro
authors.forename: Ana
authors.initials: A
authors.lastname: Rodrigues
authors.forename: Cláudia
authors.initials: C
authors.lastname: Miguel
authors.forename: Luzia
authors.initials: L
authors.lastname: Sampaio
authors.forename: Augusto
authors.initials: A
authors.lastname: Faustino
authors.forename: Carlos
authors.initials: C
authors.lastname: Vaz
authors.forename: Helena
authors.initials: H
authors.lastname: Canhão
authors.forename: Margarida
authors.initials: M
authors.lastname: Cruz
authors.forename: Adriano
authors.initials: A
authors.lastname: Neto
authors.forename: Ana R
authors.initials: AR
authors.lastname: Cravo
authors.forename: Ana
authors.initials: A
authors.lastname: Ribeiro
authors.forename: Armando
authors.initials: A
authors.lastname: Brandão
authors.forename: Daniela
authors.initials: D
authors.lastname: Peixoto
authors.forename: Dina
authors.initials: D
authors.lastname: Medeiros
authors.forename: Fernando A
authors.initials: FA
authors.lastname: Santos
authors.forename: Filipa
authors.initials: F
authors.lastname: Teixeira
authors.forename: Inês
authors.initials: I
authors.lastname: Gonçalves
authors.forename: José P
authors.initials: JP
authors.lastname: Silva
authors.forename: José M
authors.initials: JM
authors.lastname: Gomes
authors.forename: Luís
authors.initials: L
authors.lastname: Maurício
authors.forename: Eugénia
authors.initials: E
authors.lastname: Simões
authors.forename: Maria J
authors.initials: MJ
authors.lastname: Salvador
authors.forename: Margarida
authors.initials: M
authors.lastname: Silva
authors.forename: Patrícia
authors.initials: P
authors.lastname: Nero
authors.forename: Raquel
authors.initials: R
authors.lastname: Roque
authors.forename: Rita
authors.initials: R
authors.lastname: Barros
authors.forename: Rui
authors.initials: R
authors.lastname: André
authors.forename: Sandra
authors.initials: S
authors.lastname: Falcão
authors.forename: Sara
authors.initials: S
authors.lastname: Serra
authors.forename: Viviana
authors.initials: V
authors.lastname: Tavares
authors.forename: Jaime C
authors.initials: JC
authors.lastname: Branco
mesh_terms: D000465:Algorithms; D001168:Arthritis / Q000150:complications*; D006801:Humans; D010146:Pain / Q000188:drug therapy* / Q000209:etiology*; D059408:Pain Management / Q000592:standards*; D011174:Portugal