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Managing Osteoarthritis-associated Pain

Burden of OA-associated pain

Read time: 60 mins
Osteoarthritis (OA)-associated pain is considerable for patients and causes reduced quality of life (QoL) and a large socioeconomic burden. Current treatment for OA is pain management which can often either be ineffective or inappropriate. Traditional pain assessment methods may be suboptimal and lead to overprescription of opioids and subsequent issues with dependence.

Osteoarthritis (OA) is the most common form of arthritis, estimated to affect 302 million people worldwide1. The knees, hips and hands are the most commonly affected joints and knee and hip osteoarthritis rank highly as global causes of disability (eleventh highest) and chronic pain among older adults1–3

OA may also lead to increased risk of all-cause mortality and the incidence of OA continues to rise due to both the ageing population and increased prevalence of obesity4.

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Let’s meet our patient ‘Marie’. How does knee OA impact her daily life?

Note: this is a theoretical case for educational purposes only. Marie has had OA for a number of years and so we review her treatment and comment on how she might have been treated differently using the current guideline recommendations.

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Accurate pain assessment is the foundation of optimal management7. However, because pain is highly subjective, assessing severity can be difficult. Indeed, healthcare professionals (HCPs) and patients frequently differ in their perception of pain severity associated with a condition or extent of tissue damage8

In a study comparing patient–physician discordance in global assessment of patients with OA (n = 243) versus patients with rheumatoid arthritis (RA) (n = 216), patients with OA were more likely to be discordant with their rheumatologists than patients with RA with the most important explanatory variable for discordance being higher levels of pain9.

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An observational study in patients with knee OA suggests that inadequate pain relief (IPR) is highly prevalent. Following a year of physician-prescribed treatment, 54% of patients reported IPR (moderate to severe pain)13

This suggests that currently prescribed pain treatments for knee OA are not meeting the needs of the majority of patients13.

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There are a number of consensus and position statements that recommend against the use of opioid pain medication for the treatment of osteoarthritis (American Association of Orthopaedic Surgeons [AAOS]17; American Association of Hand and Knee Surgeons [AAHKS]18). 

Despite these recommendations, nearly 27% of patients with osteoarthritis still receive opioids and benzodiazepines, with about 36% of such individuals demonstrating at least one risk factor for prescription misuse (the most prevalent being ‘early refill’ and a history of receiving ≥3 prescriptions in the past month), according to data from a large US health care system19.

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What is the economic burden of OA? Given its high prevalence, OA incurs substantial health and societal costs, both directly (clinician visits, treatments, surgery) and indirectly (impaired work productivity and early retirement)3.

 

The costs associated with osteoarthritis can be particularly significant for the elderly, who face potential loss of independence and a requirement for daily help with living activities. While estimating costs is difficult, the United States Bone and Joint Initiative (USBJI) has highlighted the enormous economic impact of OA in their 2018 Burden of Musculoskeletal Diseases report21:

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