The complexity of pain in inflammatory arthropathies beyond pain intensity and impact: An OMERACT initiative

Khot, Sharmila ORCID: https://orcid.org/0000-0003-4677-5680, Cowern, Mary, Djurtoft, Chris, Christensen, Robin, Mease, Philip, Simon, Lee S and Choy, Ernest ORCID: https://orcid.org/0000-0003-4459-8609 2026. The complexity of pain in inflammatory arthropathies beyond pain intensity and impact: An OMERACT initiative. Seminars in Arthritis and Rheumatism , 152962. 10.1016/j.semarthrit.2026.152962

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Abstract

Introduction People with IA may suffer from pain of differing aetiologies and subtypes including nociceptive joint pain, neuropathic pain of carpal tunnel syndrome or nociplastic pain from concomitant fibromyalgia. Lack of precise measurement tools to identify nociplastic pain influences as a contextual factor potentially all outcomes in collected clinical trials as residual pain might impact various measurements in IA. The OMERACT 2025 pain SIG discussed, developing a scoping review from protocol, to identify an instrument to measure nociplastic pain in IA and a contextualised domain definition for nociplastic pain in IA. Stakeholder opinions were sought regarding pain in IA and the importance of identifying an instrument to measure nociplastic pain in IA. Methods A total of twenty-four participants attending the OMERACT 2025 pain SIG session included a mix of patients, clinicians, researchers, methodologists, and industry representatives. Patient research partner (PRP), MC spoke about the impact of pain including different pain subtypes in IA. She recapped the results of OMERACT 2023 poll where participants, including PRPs, agreed that assessing different pain subtypes in IA was important to improve targeted treatments for pain. SK – a pain specialist- presented evidence supporting the presence and impact of nociplastic pain in different IA’s including rheumatoid arthritis (RA), psoriatic arthritis (PsA) and axial spondylarthritis (AxSpA). Details of the scoping review protocol developed by the OMERACT Pain Working Group identifying candidate instruments for nociplastic pain assessment in IA was presented. Participants opinions were polled regarding their perspectives of the nociplastic pain definition and measurement. Results Polling showed clear agreement on advancing efforts to identify or develop an outcome measure for nociplastic pain. Most participants (86%, 19/24) endorsed beginning with a systematic review of the existing literature to identify an appropriate validated instrument. Following a pain neuroscience education session five of the six (83%) patient research partners (PRP) agreed they would be able to report the different pain types experienced in IA. Only one participant (1/24) agreed that the current IASP nociplastic pain definition is directly applicable to IA. Most participants (96%) either disagreed or were uncertain, and over half (14/24) felt the definition likely requires contextualisation for IA. Discussion There was broad agreement that, in a substantial proportion of patients with inflammatory arthritis, nociplastic pain persists despite optimal treatment, is challenging to manage in routine clinical practice, and is associated with substantial patient suffering. The OMERACT meeting underscored the need for a standardized measure of nociplastic pain in inflammatory arthritis to refine eligibility criteria and support the development of stratified approaches in future clinical trials.

Item Type:	Article
Date Type:	Published Online
Status:	In Press
Schools:	Schools > Medicine Schools > Psychology
Publisher:	Elsevier
ISSN:	0049-0172
Date of First Compliant Deposit:	17 March 2026
Last Modified:	17 Mar 2026 11:15
URI:	https://orca.cardiff.ac.uk/id/eprint/185801

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