Osteoarthritis Patients’ Experiences of Pharmacotherapy for Pain Management in Iran: A Qualitative Study

Abstract

Introduction:

Despite the effectiveness of pharmacotherapy for pain management in patients with osteoarthritis (OA), personal biases in the selection, administration, and continuation of pharmacotherapy challenge the proper management of symptoms and the effectiveness of the therapy. This study was conducted to carry out an in-depth examination of the experiences of patients with OA about their use of pharmacotherapy for the OA pain management and the existing challenges.

Materials and Methods:

The present qualitative study was conducted on 17 patients with OA, 5 of their family members and 8 healthcare personnel using a conventional content analysis approach. Data were collected through 35 interviews, which were unstructured at first but became semi-structured later on. Data collection continued until data saturation and analyzed simultaneously. The criteria used to determine the rigor of the study included the credibility, transferability, dependability and conformability of the data.

Results:

The analysis of the data revealed 3 main categories and 8 subcategories. The main categories including preference for non-pharmacological modalities, preference for symptomatic slow-acting drugs for osteoarthritis (SySADOAs) and preference for vitamins and minerals.

Conclusion:

Briefing the patients on the therapeutic goals, participating them in the clinical decision-making process, modifying drug administration patterns through prescribing the minimum effective dosage and substituting alternative therapies whenever possible, consistently monitoring the therapeutic responses and any unexpected complications and use of complementary treatments, makes up strategies that can help improve OA pain management.

Key words

Osteoarthritis - behavioural pharmacology - analgesic drugs - anti-inflammatory drugs - adverse drug reactions

• References

• 1 Wilson D. Efficacy of a natural mineral complex in North American adults with osteoarthritis of the knee: a randomized double-blind placebo-controlled study 2014
• 2 Suter LG, Smith SR, Katz JN et al. Projecting Lifetime Risk of Symptomatic Knee Osteoarthritis and Total Knee Replacement in Individuals Sustaining a Complete Anterior Cruciate Ligament Tear in Early Adulthood. Arthritis care & research 2016
• 3 Murphy LB, Helmick CG, Schwartz TA. et al. One in four people may develop symptomatic hip osteoarthritis in his or her lifetime. Osteoarthritis and Cartilage 2010; 18: 1372-1379
• 4 Murray CJ, Vos T, Lozano R. et al. Disability-adjusted life years (DALYs) for 291 diseases and injuries in 21 regions, 1990–2010: a systematic analysis for the Global Burden of Disease Study 2010. The lancet 2013; 380: 2197-2223
• 5 Keenan AM, Mckenna SP, Doward LC. et al. Development and validation of a needs-based quality of life instrument for osteoarthritis. Arthritis Care & Research 2008; 59: 841-848
• 6 Yusuf E. Pharmacologic and Non-Pharmacologic Treatment of Osteoarthritis. Current Treatment Options in Rheumatology 2016; 2: 111-125
• 7 Michael J, Schlüter-Brust KU, Eysel P. The epidemiology, etiology, diagnosis, and treatment of osteoarthritis of the knee. Dtsch Arztebl Int 2010; 107: 152-162
• 8 Hochberg MC, Altman RD, April KT. et al. American College of Rheumatology 2012 recommendations for the use of nonpharmacologic and pharmacologic therapies in osteoarthritis of the hand, hip, and knee. Arthritis care & research 2012; 64: 465-474
• 9 Lehne RA, Rosenthal L. Pharmacology for nursing care: Elsevier Health Sciences 2014
• 10 Rask-Andersen M, Masuram S, Schiöth HB. The druggable genome: evaluation of drug targets in clinical trials suggests major shifts in molecular class and indication. Annual review of pharmacology and toxicology 2014; 54: 9-26
• 11 Tasleem F, Azhar I, Ali SN. et al. Analgesic and anti-inflammatory activities of Piper nigrum L. Asian Pacific journal of tropical medicine 2014; 7: S461-S468
• 12 Gorsek WF. An effective amounts of vitamin a, b, c, magnesium, selenium, extract of bilberry, lutein and lycopene extracts, l-taurine, lipoic acid/a-/, quercetin, rutin and citrus flavonoids useful for prevention of age related vision defects. Google Patents 2000
• 13 Imamura T. Critical Points Regarding Chronic Musculoskeletal Pain Management Using Analgesics in Elderly Pa-tients. EC Orthopaedics 2016; 1: S1
• 14 Woolf AD. The bone and joint decade. strategies to reduce the burden of disease: the Bone and Joint Monitor Project. The Journal of Rheumatology 2003; 67: 6-9
• 15 Imamura M, Imamura ST, Kaziyama HH. et al. Impact of nervous system hyperalgesia on pain, disability, and quality of life in patients with knee osteoarthritis: a controlled analysis. Arthritis Care & Research 2008; 59: 1424-1431
• 16 Morone NE, Lynch CS, Greco CM. et al. “I felt like a new person.” The effects of mindfulness meditation on older adults with chronic pain: qualitative narrative analysis of diary entries. The Journal of Pain 2008; 9: 841-848
• 17 Bunzli S, Watkins R, Smith A. et al. Lives on hold: A qualitative synthesis exploring the experience of chronic low-back pain. The Clinical journal of pain 2013; 29: 907-916
• 18 Sale JE, Gignac M, Hawker G. How “bad” does the pain have to be? A qualitative study examining adherence to pain medication in older adults with osteoarthritis. Arthritis Care & Research 2006; 55: 272-278
• 19 Hawker G, Stewart L, French M. et al. Understanding the pain experience in hip and knee osteoarthritis–an OARSI/OMERACT initiative. Osteoarthritis and Cartilage 2008; 16: 415-422
• 20 Yu A, Devine CA, Kasdin RG. et al. Pain management among Dominican patients with advanced osteoarthritis: a qualitative study. BMC Musculoskeletal Disorders 2016; 17: 1
• 21 Holloway I, Wheeler S. Qualitative research in nursing and healthcare. John Wiley & Sons; 2013
• 22 Cutolo M, Berenbaum F, Hochberg M. et al. editors. Commentary on recent therapeutic guidelines for osteoarthritis. Seminars in arthritis and rheumatism. 2015. Elsevier;
• 23 McAlindon TE, Bannuru RR, Sullivan M. et al. OARSI guidelines for the non-surgical management of knee osteoarthritis. Osteoarthritis and cartilage 2014; 22: 363-388
• 24 Bruyère O, Cooper C, Pelletier J-P, Branco J, Brandi ML, Guillemin F. et al. editors. An algorithm recommendation for the management of knee osteoarthritis in Europe and internationally: a report from a task force of the European Society for Clinical and Economic Aspects of Osteoporosis and Osteoarthritis (ESCEO). Seminars in arthritis and rheumatism. 2014. Elsevier;
• 25 Dunbar-Jacob J, Mortimer-Stephens M. Treatment adherence in chronic disease. Journal of clinical epidemiology 2001; 54: S57-S60
• 26 Makris UE, Higashi RT, Marks EG. et al. Ageism, negative attitudes, and competing co-morbidities–why older adults may not seek care for restricting back pain: a qualitative study. BMC geriatrics 2015; 15: 1
• 27 Sharifi H, Hasanloei M, Mahmoudi J. Polypharmacy-induced drug-drug interactions; threats to patient safety. Drug research 2014; 64: 633-637
• 28 Ahmadi A, Naderi N, Daniali M. et al. Synthesis and Pharmacological Evaluation of New Chemical Entities from Ibuprofen as Novel Analgesic Candidates. Drug research 2015; 65: 457-462
• 29 Hochberg MC, Martel-Pelletier J, Monfort J et al. Combined chondroitin sulfate and glucosamine for painful knee osteoarthritis: a multicentre, randomised, double-blind, non-inferiority trial versus celecoxib. Annals of the rheumatic diseases 2015 annrheumdis-2014-206792
• 30 Reginster J-Y. Efficacy and safety of glucosamine sulfate in the management of osteoarthritis: Evidence from real-life setting trials and surveys. Osteoporosis International 2016; 27 (Suppl. 01) 65
• 31 Kucharz EJ, Kovalenko V, Szántó S. et al. A review of glucosamine for knee osteoarthritis: why patented crystalline glucosamine sulfate should be differentiated from other glucosamines to maximize clinical outcomes. Current medical research and opinion 2016; 32: 997-1004
• 32 Mantovani V, Maccari F, Volpi N. Chondroitin Sulfate and Glucosamine as Disease Modifying Anti-Osteoarthritis Dru gs (DMOADs). Current medicinal chemistry 2016; 23: 1139-1151
• 33 Pham T, Cornea A, Jenkins A. et al. Oral glucosamine in doses used to treat osteoarthritis worsens insulin resistance. The American journal of the medical sciences 2007; 333: 333-339
• 34 Meneses S, Goode A, Nelson AE et al. Clinical algorithms to aid osteoarthritis guideline dissemination. Osteoarthritis and Cartilage 2016
• 35 Smith S, Deshpande B, Collins J. et al. Comparative pain reduction of oral non-steroidal anti-inflammatory drugs and opioids for knee osteoarthritis: systematic analytic review. Osteoarthritis and Cartilage. 2016; 24: 962-972
• 36 Beaudreuil J, Bendaya S, Faucher M. et al. Clinical practice guidelines for rest orthosis, knee sleeves, and unloading knee braces in knee osteoarthritis. Joint Bone Spine 2009; 76: 629-636
• 37 Peabody FW. The care of the patient. Jama 2015; 313: 1868
• 38 Benjamin I, Griggs RC, Wing EJ et al. Andreoli and Carpenter’s Cecil essentials of medicine: Elsevier Health Sciences. 2015
• 39 MBasedow M, Runciman WB, March L. et al. Australians with osteoarthritis; the use of and beliefs about complementary and alternative medicines. Complementary therapies in clinical practice 2014; 20: 237-242
• 40 Magaña-Villa M, Rocha-Gonzalez HI, del Valle-Laisequilla CF. et al. B-vitamin mixture improves the analgesic effect of diclofenac in patients with osteoarthritis: a double blind study. Drug research 2013; 63: 289-292
• 41 Tabrizi JS, Amini A, Zeinalhajlu AA. Consequences of Population Aging in Iran with Emphasis on its Increasing Challenges on the Health System (Literature Review). Deciction of Health 2015; 6: 54-64
• 42 Imani A, Dastgiri S, Azizi Zeinalhajlu A. Population Aging and Burden of Diseases (A Review). j Deciction of, Health 2015; 6: 54-60