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Filling the Void: Managing Chronic Severe Osteoarthritis Pain

Posted on: Saturday, 8 October 2005, 03:00 CDT

By Anonymous

With the current restrictions and fears surrounding the use of some analgesics, it is vital to find appropriate drugs to manage pain and improve osteoarthritis pain and improve quality of life in the 8.5 million patients in the UK.1

With the recent concerns about cyclooxygenase-2 (COX-2) selective inhibitors, for example rofecoxib (Vioxx), the withdrawal of coproxamol, and discussion around a number of nonsteroidal anti- inflammatory drugs (NSAIDs), patients and healthcare professionals could be forgiven for thinking that paracetamol and weak opioids such as codeine, are the only treatment options left to manage osteoarthritis pain.

Because of their associated side-effects, it has not been uncommon to open a newspaper over the last six month and find headlines such as 'Top Drugs Could be Killing You'2. Does this mean that the next time you are consulting with a patient suffering from osteoarthritis pain that you have no analgesic options left to offer them?

Osteoarthritis is one of the largest causes of disability in the UK.4

Only 2.02 million adults in the UK consult their GPs4 each year, meaning that a large number of patients could be suffering in silence. These statistics show the strain this disease puts on the health service, and with the ageing UK population, the burden of osteoarthritis will continue to grow adding further pressure to an already over-stretched health provider.

Unsurprisingly, patients who suffer from osteoarthritis pain often report that their condition has a huge impact on their quality of life. Research shows that 81 % of osteoarthritis sufferers experience chronic pain or are limited in their ability to complete everyday tasks.1 Pain in Europe data, published in 2003, showed that 66% of osteoarthritis patients were less able to walk,5 while 53% of patients surveyed in the OA Nation report said that they find it difficult to even get out of bed in the morning, when their OA is bad.1 The European League Against Rheumatism (EULAR) recommendations 2003 states that 'physical disability arising from pain and loss of functional capacity reduces quality of life, and increases the risk of further morbidity and mortality'.6

Strong opioids: a viable option for managing severe osteoarthritis pain?

Recent research has shown the value of strong opioids in managing osteoarthritis or joint pain by improving function, sleep or both.7,8 Given that many elderly patients with severe osteoarthritis pain suffer from limited mobility and have disturbed sleep, opioid therapy could be considered as a treatment option in appropriate patients.

Many different strong opioids are available for the management of chronic non-malignant pain and they can be administered in a variety of ways, including transdermally and orally. Opioid treatment should be tailored to meet the individual needs of the patient.10 Controlled-release formulations and transdermal patch systems allow for the convenient management of persistent pain, and can thereby contribute to the patient's compliance and well-being.9 Recent Arthritis Care research, in which 60% of respondents were over 60 years old, showed that 24% of osteoarthritis patients would prefer their treatment to be administered once a week.10 A controlled- release transdermal route of administration may therefore be more convenient for the elderly osteoarthritis patient, with the added benefit of improved treatment compliance.

Some healthcare professionals are reluctant to prescribe strong opioids because of the fears and misconceptions surrounding their use. In an elderly patient, it may be more desirable to introduce a 'low-dose' strong opioid - one that can be titrated from a 'low dose' to an optimal dose over time.

The WHO predicts that 9.6% of men and 18.0% of women over the age of 60 have symptomatic osteoarthritis.11 The UK population is ageing and therefore the prevalence of osteoarthritis will continue to grow over time. It is an increasingly important disease and there is an urgent need to manage the pain associated with it as early and effectively as possible. Therefore, 'low-dose' strong opioids should be considered for the management of severe osteoarthritis pain in appropriate patients, particularly as the transdermal route of delivery may be a convenient option for the elderly osteoarthritic patient.

This feature was sponsored by Napp Pharmaceuticals Ltd.

References

1. Arthritis Care. OA Nation: the most comprehensive UK report of people with osteoarthritis. Arthritis Care; 2004. Available from: URL: http://oanation.arthritiscare.org.uk/

2. Dunlevy S. Top Drugs could be killing you. Daily Telegraph, 27 June 2005.

3. Qureshi Y. Study hints at painkiller link to heart failure. Manchester Evening News, 10 June 2005.

4. Arthritis Research Campaign. Arthritis: the Big Picture. Arthritis Research Campaign; 2002. Available from: URL: http:// www.arc.org.uk/about_arth/bigpic.htm

5. Napp Pharmaceuticals Ltd. Pain in Europe Survey - impact of pain on osteoarthritis. Data on file.

6. Jordan KM, Arden NK, Doherty M, et al. EULAR Recommendations 2003: an evidence based approach to the management of knee osteoarthritis: Report of a Task Force of the Standing Committee for International Clinical Studies Including Therapeutic Trials (ESCISIT). Ann Rheum Dis 2003.62:1145-1155.

7. Caldwell JR, Rapoport RJ, Davies JC, et al. Efficacy and safety of a once-daily morphine formulation in chronic, moderate-to- severe osteoarthritis pain: Results from a randomized, placebo- controlled, double-blind trial and an open-label extension trial. J Pain Symptom Manage 2002.23:278-291.

8. Roth SH, Fleischmann RM, Burch FX, et al. Around-the-clock, controlled-release oxycodone therapy for osteoarthritis-related pain: Placebo-controlled trial and long-term evaluation. Arch Intern Med 2000.160:853-860.

9. Simpson KH. Individual choice of opioids and formulations: strategies to achieve the optimum for the patient. Clin Rheumatol 2002 Suppl 1: S5-8.

10. Arthritis Care. OA patient research spotlight. Slide presentation produced by Arthritis Care. August 2005.

11. World Health Organisation. Chronic rheumatic conditions. Available from: URL: http://www.who.int/chp/topics/rheumatic/en/

Copyright Haymarket Business Publications Ltd. Sep 23, 2005

Source: GP

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