Inadequate pain relief common in knee osteoarthritis

By Lucy Piper, Senior medwireNews Reporter

Patients with knee osteoarthritis (OA) requiring analgesic therapy are often not receiving adequate pain relief, researchers report.

Of more than 1000 patients studied, they found that 54% had inadequate pain relief (IPR) after at least 2 weeks of analgesic treatment, which was associated with large functional loss and impaired quality of life (QoL).

IPR was defined as experiencing moderate-to-severe pain, corresponding to a score of at least 4 on question 5 of the Brief Pain Inventory (BPI). The researchers note that the prevalence of IPR was as high as 70% if a cutoff score of 3 or less was used.

The findings, published in Rheumatology, suggest that “currently prescribed pain treatments for knee OA are not meeting the needs of the majority of patients”, say the researcher Stephanie Taylor (Global Health Outcomes, Merck & Co., New Jersey, USA) and co-workers.

“These findings are consistent with those of prior observational studies indicating that management of OA in primary care may not conform to the recommendations in clinical practice guidelines or to the intensity of patients’ pain,” they add.

The team assessed pain and function scores on the BPI in 1187 patients aged an average of 68 years, 68% of whom were women.

The 639 patients meeting the BPI criteria for IPR showed distinct characteristics compared with those with adequate pain relief. They were more likely to be female and have longer disease duration, bilateral knee OA, greater opioid use and a higher prevalence of comorbidities such as hypertension, depression and diabetes.

“Clinicians should recognize this constellation of characteristics as constituting special risk,” say Taylor et al.

As well as having significantly greater overall pain severity, patients with IPR had much worse pain interference on the BPI than those with sufficient pain relief and experienced significantly more stiffness and poorer physical function as assessed using the Western Ontario and McMaster Universities Osteoarthritis Index.

Around half of patients in the IPR group reported their general health status to be fair or poor on the 12-item Short Form Health Survey, compared with 31% of patients with adequate pain relief.

“Practitioners should actively evaluate pain management and the effectiveness of treatment response,” urges the team.

“In discussions with patients, practitioners should ensure that patients are communicating their concerns about pain medication and have a thorough understanding of their analgesic treatment options.”

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