Challenges in Providing Osteoarthritis Pain Relief

PainRelief.com Interview with:
Rebecca L Robinson
Patient Outcomes and Real-World Evidence
Eli Lilly and Company, Indianapolis, IN

PainRelief.com:  What is the background for this study?

Response: Osteoarthritis (OA) pain is unfortunately common and greatly affects patients’ quality of life. Treatment varies from patient to patient and can include nonpharmacologic therapies, over-the-counter (OTC) and prescription pain medications, as well as surgery. The combination of these treatment modalities and especially the use of acetaminophen, NSAIDs or opioids in OA patients has not been examined thoroughly. This study helps to address this gap while also demonstrating variations in treatment received by patients with different levels of pain severity. We analyzed data from the United States OA Adelphi Disease Specific Programme (DSP), which links patient and physician perspectives on the management of OA via cross-sectional surveys.

PainRelief.com: What are the main findings?

Response: Data from a total of 841 patients who self-reported Osteoarthritis pain intensity (grouped as mild, moderate, or severe based on a 0—10 Numeric Rating Scale) were linked with physician-reported patient demographics, clinical and treatment information. We found that nonpharmacologic therapy had been discussed with the majority of patients (68—80% across all pain severity subgroups). When nonpharmacologic therapies were recommended, it was primarily alongside prescription pain medication use. OTC medications were recommended to a similar proportion of patients across all subgroups (38—41%). Most patients (44—51% across all subgroups) took only one prescription drug for OA pain.  NSAIDs were the most commonly used, but prescription rates for NSAIDs did not differ by pain severity. Compared to patients with mild or moderate pain, higher proportions of patients with severe pain reported use of prescription opioids and failure of multiple prescription regimens. More than 80% of treatment regimen failures in all groups were reported as due to lack of efficacy.

PainRelief.com: What should readers take away from your report?

Response: Real-life treatment patterns for Osteoarthritis in the United States are significantly associated with current patient-reported pain. Our findings suggest that there are challenges in the treatment of painful OA, and a greater understanding of real-life treatment patterns may help explain these challenges and unmet needs for patients with OA.

PainRelief.com: What recommendations do you have for future research as a result of this work?

Response: This study was part of our effort to better understand the burden and management of osteoarthritis. We continue to use Adelphi DSP data to assess patient and physician attitudes, patient treatment patterns and outcomes associated with the use of opioids and surgery in particular. We are exploring the role of patient and physician satisfaction with medications and consistency between patient and physician beliefs about therapies, all of which may influence treatment decisions. Additionally, we recently reported that higher levels of pain were associated with increased healthcare resource utilization, including imaging for monitoring OA progression, healthcare practitioner visits (including more specialty care), hospitalizations, surgery/planned surgery and loss of independence due to functional disability. Yet rates of hospitalizations and X-ray use were still sizable even among patients with mild pain. This article can be accessed here.

Any disclosures? This study was sponsored by Pfizer and Eli Lilly and Company. The analysis was conducted independently by Adelphi Real World. Pfizer, Eli Lilly and Company and Adelphi Real World collaborated on study design and interpretation of results.

Citation:

Nalamachu SR, Robinson RL, Viktrup L, Cappelleri JC, Bushmakin AG, Tive L, Mellor J, Hatchell N, Jackson J. Multimodal Treatment Patterns for Osteoarthritis and Their Relationship to Patient-Reported Pain Severity: A Cross-Sectional Survey in the United States. J Pain Res. 2020 Dec 23;13:3415-3425. doi: 10.2147/JPR.S285124. PMID: 33380823; PMCID: PMC7767791

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