Most OA Patients Take Pain Meds -- But Tend to Switch Drugs

Kingsbury SR, Hensor EMA, Walsh CAE, et al. How do people with knee osteoarthritis use osteoarthritis pain medications and does this change over time? Data from the Osteoarthritis Initiative. Arthritis Research & Therapy (2013) 15:R106 doi:10.1186/ar4286  Published: 4 September 2013  (Open access)

Most people with osteoarthritis (OA) pain take analgesics  -  prescription and over-the-counter (OTC) drugs or nutraceuticals like glucosamine - regularly, but they tend to switch choices over time, according to a 3-year longitudinal study of pain medication use.

The study of almost 1,000 patients from the NIH Osteoarthritis Initiative (OAI) database may offer a glimpse of what your patients with OA are actually taking. Including primarily white patients with a mean age of 61, it shows that  almost 70% take painkillers - most commonly OTC nonsteridal anti-inflammatory drugs (NSAIDs) - for more than half the days in each month,

How many take no painkillers at all? Not quite 11% of people in this analysis reported taking no pain medications during the half-month prior to an annual followup visit. But at baseline, 68.2% said they frequently took conventional pain medications (acetaminophen, prescription or OTC NSAIDs, COX II inhibitors, or opioids) or use nutraceuticals (glucosamine, chondroitin, methylsulfonylmethane [MSM], doxycycline or S-adenosylmethionine [SAMe]).
 
Not surprisingly, those with a high body mass index (>30) were more likely to report taking pain medications.

By the third year of the study, a majority of the 806 patients remaining in the study had switched analgesics, possibly reflecting loss of efficacy. Only a third stayed with the same drug.

Among older patients (those beyond the age of 74),use of acetaminophen increased during the course of the study, while use of prescription NSAIDs dropped. During the same period, the use of OTC NSAIDs did not decline. Thus while physicians adhere to guidelines that recommend against prescribing NSAIDs to the elderly, older patients appear simply to switch to OTC alternatives.

But your older patients may not turn to supplements. People over 74 years of age (and non-whites) were less likely than others to take nutraceuticals, possibly reflecting their higher cost.

There was a substantial increase in gastroprotective drugs (mostly proton pump inhibitors) among NSAID users during the observation period, from 7.2% to 21.4%,. This may indicate increased awareness of the adverse effects of long-term NSAID use.
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