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Stories for Reprint
Doctors and Patients at Odds over Arthritis Pain Management
By Petya Eckler, MARRTC Staff
Two recent studies are showing the ongoing divide between physicians and patients when it comes to arthritis pain management. A British study of people with chronic knee pain showed that participants often got treatments that went against their personal preferences. Medication was prescribed far more frequently than physical therapy or exercise, although many patients preferred non-drug treatments. Yet, a Canadian study released earlier this year suggested that although patients are reluctant to take pain medications, the drugs can actually improve their daily lives.
In a study that's yet to be published, researchers from King's College in London interviewed 418 people with chronic knee pain about their previous pain management, preferences for pain management and whether they would accept a total knee replacement surgery if offered.
Of all the participants, 82 percent had previously been on either non-steroidal anti-inflammatory drugs (NSAIDs) or pain killers, and 12 percent had had surgery. Less than half (40 percent) had also had physiotherapy, which included exercise. When asked what type of pain management they preferred, however, only 3 percent preferred drugs and 4 percent wanted surgery. The rest of those who expressed an opinion wanted physiotherapy, acupuncture, osteopathy or to avoid medication or surgery.
"Most participants were getting what they did not necessarily want [drugs], and few had information about available treatments to enable them to make an informed choice about management options," said Helene Mitchell, main author of the study, who's currently a lecturer in psychology at De Montfort University in Leicester, UK.
"Patients with chronic knee pain often have other co-morbidities [health conditions] to manage, such as high blood pressure and diabetes, and have concerns about NSAIDs and analgesics interfering with other prescribed medications," she said. "Any treatment that carries a low risk or does not interfere with other interventions would be popular."
Even when given a choice, almost half (40 percent) of participants were unable to make one about their treatment when asked by the researchers. Mitchell speculates that is because of insufficient information.
"There is no reason to believe that they [those 40 percent] were not typical of the general population with knee pain, and this translates to a large number of people without a clear idea of the sort of treatment they want or knowledge of what is available to them," Mitchell said. "Better provision of information would allow more patients to make an informed choice about their treatment, and bring us closer to shared decision-making between patients and doctors."
In terms of total knee replacement surgery, 85 percent said they wouldn't accept it if it were offered and their reasons were that the pain wasn't severe enough, they wanted to avoid surgery or had previous bad experiences with it.
"Asking patients about their preferences, in terms of what they do or don't want to receive, may help to increase adherence to treatment," Mitchell concludes.
Non-adherence to medication is an ongoing problem among people with chronic disease and a study from the April issue of the journal Arthritis & Rheumatism showed the consequences of skipping drugs. In it, Canadian researchers interviewed in depth 19 adults between the ages of 67 and 92 with disabling hip or knee osteoarthritis about their taking of pain medication. The researchers found that participants took pain medicines in lower doses and less often than prescribed and they would usually take medication only when they felt it was absolutely necessary. As a result, most participants had significant ongoing pain and also restricted their activities. Some of the reasons for skipping the pain drugs were fear of addiction and reluctance to add additional pills to their regimen.
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