Inadequate pain relief and large functional loss among patients with knee osteoarthritis: evidence from a prospective multinational longitudinal study of osteoarthritis real-world therapies

Abstract

Objective. To estimate the prevalence of inadequate pain relief (IPR) among patients with symptomatic knee OA prescribed analgesic therapy and to characterize patients with IPR.Methods. Patients ≥50 years old with physician-diagnosed knee OA who had taken topical or oral pain medication for at least 14 days were recruited for this prospective non-interventional study in six European countries. Pain and function were assessed using the Brief Pain Inventory (BPI) and the WOMAC; quality of life (QoL) was assessed using the 12-item short form. IPR was defined as an average pain score of >4 out of 10 on BPI question 5.Results. Of 1187 patients enrolled, 68% were female and the mean age was 68 years (s.d. 9); 639 (54%) met the definition of IPR. Patient responses for the BPI average pain question were well correlated with responses on the WOMAC pain subscale (Spearman r = 0.64, P < 0.001). In multivariate logistic regression, patients with IPR had greater odds of being female [adjusted odds ratio (adjOR) 1.90 (95% CI 1.46, 2.48)] and having OA in both knees [adjOR 1.48 (95% CI 1.15, 1.90)], higher BMI, longer OA duration, depression or diabetes. Patients with IPR (vs non-IPR) were more likely to have worse QoL, greater function loss and greater pain interference.Conclusion. IPR is common among patients with knee OA requiring analgesics and is associated with large functional loss and impaired QoL. Patients at particular risk of IPR, as characterized in this study, may require greater attention towards their analgesic treatment options.Trial registration: https://clinicaltrials.gov/ (NCT01294696).

Comparison of Pain Score in Osteoarthritis Patients Treated With a Combination of Diacerein and Meloxicam and Meloxicam Alone

“…However, in its management, inadequate pain relief (IPR) was occurred in 54-64% of patients. Satisfaction and quality of life become worse because of IPR [6][7][8].…”

“…Among the study of OA therapy, non steroidal anti-inflammatory drugs (NSAIDs) are the most widely prescribed medication [6][7][8], but they often cause a dissatisfaction in the treatment of pain [9]. The inability of NSAIDs in overcoming the pain can be caused by the analgesic ceiling effect.…”

Are Psychological Factors Associated with Pain Worsening in Individuals with Knee Osteoarthritis? A Systematic Review

“…One of the psychological factors assessed by studies in our review was depression. Of eleven studies [14][15][16][17][18][19][20][21][22][23][24], six at least showed a significant relationship between depression and pain, but these findings corresponded to evidence level IV because they were confirmed by cross-sectional studies; the results of the two cohort studies were not consistent. Pain catastrophizing had been measured by ten studies [14,15,19,20,23,[25][26][27][28][29] in our review and was shown to be related with pain worsening in six cross-sectional studies as evidence level IV and in one prospective cohort study as evidence level II.…”

Overview review: Comparative efficacy of oral ibuprofen and paracetamol (acetaminophen) across acute and chronic pain conditions

“…In clinical practice, more often than not, pain relief is inadequate (Conaghan et al, 2014), so people are exposed to possible harms without benefit. In osteoarthritis, some, but not all, people taking standard ibuprofen doses will have adequate pain relief; most of those taking paracetamol will not.…”