Patient self-reported functioning by pain severity and usual analgesic treatment among older adults with osteoarthritis: Analysis of the 2017 Spanish National Health Survey

Abstract

Background Osteoarthritis (OA) pain is among the leading causes of disability and social isolation worldwide. Since prevalence is high, particularly in adults aged 65 or older, it represents a significant burden for society and national health systems. The objective of this study was to determine whether patient self-reported functioning in key domains of daily living differs by pain severity and analgesic treatment among older OA patients in Spain. Methods The Spanish National Health Survey (ENSE), a large, nationally representative, cross-sectional general health survey administered by trained interviewers to 23,089 adults, was the data source. Subjects of both sexes aged 65 or older with a self-reported physician diagnosis of OA who completed the survey were analyzed. Patients were cross classified by pain severity (no/mild, moderate or severe) and analgesia (treated or untreated). Assessment of daily living included basic and instrumental activities of daily living and mental, social, and cognitive domains. Scores were re-scaled to a 0%-100% standardized metric (0%: no limitation [independence]; 100%: complete limitation [full dependence]). Results A total of 3,526 (3,389 surveys completed [96.1%]) older adults with OA were analyzed (women 73.3%; age 77.4 [standard deviation {SD}: 7.5]). Adjusted means (95% confidence interval [CI]) scores in domains of functioning showed significant association with pain severity (p < 0.001) but not treatment status, except basic and instrumental activities and social functioning, with higher scores in treated patients. Limitations in patients with untreated no/mild pain versus severe treated pain were as follows: in basic activities, 6.5% (5.0–8.0) versus 31.5% (30.1–32.9); in instrumental activities, 9.0% (7.2–10.8) versus 34.1% (32.3–35.8); in mental, 29.1% (27.9–30.3) versus 45.0% (43.9–46.2); in social, 3.0% (0.6–5.4) versus 42.2% (39.9–44.5); and, in cognitive, 10.9% (9.2–12.6) versus 23.4% (21.8–25.1). Conclusions Pain severity was a major driver of functional impairment in all the main domains of functioning analyzed in older OA patients. Regardless of pain severity, treated patients showed poorer functioning in basic, instrumental and social activities versus untreated subjects. Treated patients might have been in later disease stages, which would have affected the results. Existing analgesic treatment strategies do not meet patient needs for adequate pain management.