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Managing Osteoarthritis-associated Pain
Declaration of sponsorship Pfizer and Lilly

Personalised pain management

Declaration of sponsorship Pfizer and Lilly
Read time: 40 mins
Last updated:10th Nov 2020
Published:10th Nov 2020
Are linear pain scales suitable for use in osteoarthritis (OA)? While simple to use, these pain scales only reliably measure pain at a single point in time and may not be ideal for use in elderly patients. There are many functional assessment tools which are of great value in osteoarthritis and indeed the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) combines both pain and functional measurement. Individual goal setting is important for both HCPs and patients and forms a vital part of the individualised treatment required for OA.

Linear scales for pain such as visual analogue scales (VAS) are routinely used in clinical trials due to their simplicity and adaptability to a broad range of populations and settings1. As patients are asked to place a mark on a line at a point representing their pain severity the VAS is often treated as a scale with equality between intervals and subjected to arithmetical operations and statistics (e.g. % change in score). 

However, some patients find it difficult to judge how to rate their pain on the VAS line, describing it as “not very accurate”, “sort of random”, “almost guesswork” or having to “work it into numbers first”2.

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There have been reviews and meta-analyses of outcome measures for patients with hip or knee osteoarthritis and attempts to define an international standard4,6,7. However, this has been challenging given the varying levels of evidence available for some measures. In general though, the WOMAC questionnaire was demonstrated to be superior to all other instruments for evaluating hip and knee function7

Hip disability Osteoarthritis Outcome Score (HOOS) and the Knee Injury and Osteoarthritis Score (KOOS) and were developed as extensions of the WOMAC, and are non-proprietary comprehensive alternatives. Short forms are also available (HOOS-PS and KOOS-PS) but do not include a measure of pain and so they are often used in combination with  VAS or NRS7.

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It is very common for patients with chronic pain to feel overwhelmed and isolated because of their condition. They often use ineffective coping patterns, limit their activity and become preoccupied with the single goal of decreasing their pain.

Having pain reduction as a solitary goal puts patients at risk for frustration, depression, and decreased adherence to treatment14.

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Let’s take a look at the non-pharmacologic treatment options:

  • Weight loss through a combination of diet and exercise
  • Physical therapy
  • Bracing - a knee unloader brace was prescribed to relieve some of Marie’ s symptoms
  • Occupational therapy - helps patients by providing an individual functional assessment and joint protective strategies to be used during their activities of daily life to maintain function.
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