title: Australian and New Zealand evidence-based recommendations for pain management by pharmacotherapy in adult patients with inflammatory arthritis.
abstract: OBJECTIVE
  To develop Australian and New Zealand evidence-based recommendations for pain management by pharmacotherapy in adult patients with optimally treated inflammatory arthritis (IA).
  
  
  METHODS
  Four hundred and fifty-three rheumatologists from 17 countries including 46 rheumatologists from Australia and New Zealand participated in the 2010 3e (Evidence, Expertise, Exchange) Initiative. Using a formal voting process, rheumatologists from 15 national scientific committees 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 EULAR/ACR abstracts. Relevant studies were retrieved for data extraction and risk of bias assessment. Rheumatologists from Australia and New Zealand used the evidence to develop a set of national recommendations. These recommendations were then formulated and assessed for agreement and the potential impact on clinical practice. The Oxford Levels of Evidence and Grade of Recommendation were applied to each recommendation.
  
  
  RESULTS
  The systematic reviews identified 49 242 references, from which 167 studies which met the pre-specified inclusion criteria. Combining this evidence with expert opinion led to the development of 10 final Australian and New Zealand recommendations. The recommendations relate to pain measurement, and the use of analgesic medications in patients with and without co-morbidities and during pregnancy and lactation. The recommendations reflect the clinical practice of the majority of the participating rheumatologists (mean level of agreement 7.24-9.65).
  
  
  CONCLUSIONS
  Ten Australian and New Zealand evidence-based recommendations regarding the management of pain by pharmacotherapy in adults with optimally treated IA were developed. They are supported by a large panel of rheumatologists, thus enhancing their utility in everyday clinical practice.
authors.affiliation: Department of Rheumatology, Royal Prince Alfred Hospital, Sydney, New South Wales, Australia; Department of Medicine, University of Sydney, Sydney, New South Wales, Australia.
authors.forename: Bethan L
authors.initials: BL
authors.lastname: Richards
authors.forename: Samuel
authors.initials: S
authors.lastname: Whittle
authors.forename: Rachelle
authors.initials: R
authors.lastname: Buchbinder
authors.forename: Claire
authors.initials: C
authors.lastname: Barrett
authors.forename: Nora
authors.initials: N
authors.lastname: Lynch
authors.forename: Gabor
authors.initials: G
authors.lastname: Major
authors.forename: Geoffrey
authors.initials: G
authors.lastname: Littlejohn
authors.forename: Andrew
authors.initials: A
authors.lastname: Taylor
authors.forename: Jane
authors.initials: J
authors.lastname: Zochling
mesh_terms: D000328:Adult; D000700:Analgesics / Q000009:adverse effects / Q000627:therapeutic use*; D018771:Arthralgia / Q000175:diagnosis / Q000188:drug therapy* / Q000209:etiology; D001168:Arthritis / Q000150:complications / Q000175:diagnosis / Q000188:drug therapy*; D001315:Australia; D032921:Consensus; D003697:Delphi Technique; D019317:Evidence-Based Medicine / Q000592:standards*; D006801:Humans; D009520:New Zealand; D059408:Pain Management / Q000009:adverse effects / Q000592:standards*; D010147:Pain Measurement; D012219:Rheumatology / Q000592:standards*; D016896:Treatment Outcome
chemical_list: D000700:Analgesics
keywords: analgesics; evidence-based medicine; inflammatory arthritis