BSR Pain Management in People with Inflammatory Arthritis Guideline Summary - Guideline Central
Summary of Recommendations
Document Overview

Pain Management in People with Inflammatory Arthritis

British Society for Rheumatology


Publication Date: Jul 21, 2026

Page Last Updated: Jul 21, 2026

Grading of Recommendations, Assessment, Development, and Evaluation (GRADE)-Based Recommendations

Implications for:Strong Recommendation (S)Conditional Recommendation (C)
PatientsMost individuals in this situation would want the recommended course of action, and only a small proportion would not.The majority of individuals in this situation would want the suggested course of action, but many would not.
CliniciansMost individuals should receive the intervention. Adherence to this recommendation according to the guideline could be used as a quality criterion or performance indicator. Formal decision aids are not likely to be needed to help individuals make decisions consistent with their values and preferences.Recognize that different choices will be appropriate for individual patients and that you must help each patient arrive at a management decision consistent with his or her values and preferences. Decision aids may be useful in helping individuals to make decisions consistent with their values and preferences.
PolicyThe recommendation can be adopted as policy in most situations.Policymaking will require substantial debate and involvement of various stakeholders.
Certainty in the Evidence
HighHLowL
ModerateMVery LowVL

Source: Grading of Recommendations Assessment, Development and Evaluation Working Group (Schunemann HJ et al. Am J Respir Crit Care Med. 2006;174:605-14. Guyatt GH et al. BMJ 2008;336:924-6).

Document Overview

Document Title
Pain Management in People with Inflammatory Arthritis
Authoring Society

British Society for Rheumatology

Document Publication Date
Jul 21, 2026
Page Last Reviewed/Updated
Jul 21, 2026
Document Type
Guideline
Country of Publication
United Kingdom
Full Text Freely Available
Yes
Full Text Guideline
academic.oup.com/rheumatology/article/65/7/keag320/8738151
Source Citation
Scott, Ian C et al. “The 2026 British Society for Rheumatology guideline for pain management in people with inflammatory arthritis.” Rheumatology (Oxford, England) vol. 65,7 (2026): keag320. doi:10.1093/rheumatology/keag320

Supplemental Implementation Resources

Document Scope, Criteria, and Use Cases

Document Objectives
Pain is a frequent symptom in people with inflammatory arthritis (IA), which has substantial impact on their quality of life. Analyses of electronic health record data indicate that UK pain care in people with IA often involves prescribing long-term opioids and gabapentinoids, despite absent trial evidence for efficacy. Patient survey data suggest that non-pharmacological pain care with supportive trial evidence is underused. A UK-specific guideline on pain management for people with IA is required to address this. This comprehensive life-course guideline is the first British Society for Rheumatology Guideline to specifically address pain in people with IA. It provides evidence-based recommendations on how pain can be best managed in people with IA. It was developed using the methods outlined in the British Society for Rheumatology’s ‘Creating Clinical Guidelines’ protocol by a multidisciplinary Guideline Working Group, comprising healthcare professionals with expertise in paediatric and adult rheumatology and people with lived experience. By undertaking and considering the evidence from several systematic literature and umbrella reviews, 23 recommendations were developed. These address how pain should be assessed in people with IA alongside the role of the following treatments in IA pain management: DMARDs, glucocorticoids, analgesics, neuromodulators, exercise and physical activity, psychological interventions, ergonomic and orthotic interventions (excluding orthoses for foot pain), education, weight management and diet, addressing sleep problems, fatigue management, digital technologies and medical devices, complementary therapies, and support from others. An audit tool is provided to support the Guideline’s implementation, and key recommendations made for future research.
Scope
Management
Diseases/Conditions (MeSH)

D001168 - Arthritis

Keywords
Pain Management, arthritis, inflammatory arthritis
Target Patient Population
People with inflammatory arthritis (IA)
Target Provider Population
Healthcare professionals managing people with IA, people with IA and their families and carers, NHS managers and healthcare commissioners, and other stakeholders
Inclusion Criteria
Male, Female, Adolescent, Adult, Child, Older Adult
Health Care Settings
Ambulatory
Intended Users
Nurse, Nurse Practitioner, Physician, Physician Assistant

Recommendation Development Processes & Methodology

PICO Questions
  1. How often should pain assessments take place and which outcome measures should be used?
  2. Should pain assessments be in-person or remote?
  3. Which pain factors (e.g. sensitization) and pain-related factors (e.g. mood) should be considered when assessing pain?
  4. Which interpersonal consultation-based factors should be considered when assessing pain?
  5. Do immunosuppressants (systemic glucocorticoids, csDMARDs, bDMARDs and tsDMARDs) improve pain, relative to placebo or other pharmacological/non-pharmacological treatments?
  6. Do analgesics (paracetamol, oral NSAIDs, topical NSAIDs, nefopam and opioids) improve pain, relative to placebo or other pharmacological/non-pharmacological treatments?
  7. Do neuromodulators (anti-depressants, gabapentinoids, topical capsaicin and cannabinoids) improve pain, relative to placebo or other pharmacological/non-pharmacological treatments?
  8. Do exercise and physical activity improve pain, relative to placebo or other pharmacological/non-pharmacological treatments?
  9. Do psychological interventions improve pain, relative to placebo or other pharmacological/non-pharmacological treatments?
  10. Do ergonomic or orthotic interventions (excluding orthoses for foot pain, which are considered in the BSR management of foot health in people with IA guideline) improve pain, relative to placebo or other pharmacological/non-pharmacological treatments?
  11. Does education improve pain, relative to placebo or other pharmacological/non-pharmacological treatments?
  12. Do weight management and diet improve pain, relative to placebo or other pharmacological/non-pharmacological treatments?
  13. Does addressing sleep problems improve pain, relative to placebo or other pharmacological/non-pharmacological treatments?
  14. Does fatigue management improve pain, relative to placebo or other pharmacological/non-pharmacological treatments?
  15. Do digital technologies or medical devices improve pain, relative to placebo or other pharmacological/non-pharmacological treatments?
  16. Do complementary therapies improve pain, relative to placebo or other pharmacological/non-pharmacological treatments?
  17. Does support from others improve pain, relative to placebo or other pharmacological/non-pharmacological treatments?
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