Impact on the patient

Many patients with osteoarthritis (OA) suffer from inadequate relief for their OA-related chronic pain

but what is the impact of this?1 Chronic pain can have a real domino effect on the patient with OA: pain reduces movement, which lowers exercise capacity, which can lead to weight gain.2–4 It can also lower self-esteem, lower resilience and lead to social isolation and mental health difficulties.5 Together, the result can have a significant effect on a patient’s overall health – OA is associated with conditions such as cardiovascular disease and hypertension, diabetes mellitus, metabolic syndrome, obesity and depression.6

The loss of function experienced by many patients with OA pain can therefore seriously impact patients’ daily lives.7 Pain can often prevent patients from normal daily activity that matters to them, or even prevent them from working8 – significantly reducing self-confidence, wellbeing and quality of life.8 Many people living with OA also fear experiencing more pain and further joint damage in the future; this fear means that some patients avoid effective rehabilitation strategies such as regular exercise and physical activity – even though these are critical to maintain daily function.9 Consistently avoiding movement can worsen the domino effect of the OA, leading to even more pain and disability.10

Chronic pain can restrict patients’ daily function and cause a domino effect.11,12

domino-cycle.png

If OA pain is more severe, the impact on patients is particularly high – and patients with inadequate pain relief have a reduced quality of life.13 Furthermore, increased severity of OA is associated with increased rates of long-term sick leave, retirement, unemployment, and correlated with higher levels of comorbidities.1

But who is most likely to suffer inadequate pain relief ? The odds of suffering inadequate pain relief are particularly high in patients who have comorbidities such as depression and diabetes, in females, or in those who have OA in both knees. Inadequate pain relief is also more likely if multiple joints are affected, and in people with a higher body mass index (BMI).13

Which patients with knee OA are most likely to suffer inadequate pain relief?13

Patient Characteristic Adjusted OR 95% CI
Baseline Diabetes Diagnosis 2.09 1.47-3.01
Female 1.90 1.46-2.48
Baseline Depression 1.89 1.41-2.54
Clinical OA diagnosis of both knees 1.48 1.15–1.90
Renal impairment/failure 1.29 0.77–2.20
Cardiovascular disease 1.18 0.86-1.62
Baseline hypertension 1.15 0.88-1.51
Greater number of years since OA diagnosis 1.04 1.02-1.06
Greater number of different classes of medication* 1.04 1.01-1.06
Above average BMI 1.03 1.01-1.06
Baseline hyperlipidemia 0.88 0.68-1.14

CI, confidence interval; NSAID, non-steroidal anti-inflammatory drug; OR, odds ratio

*NSAID, paracetamol, alternative therapy, opioid containing medication and other.

Approximately 40% of people with OA have anxiety, depression, or both, as compared with 5–17% in the general population.9,14 The association of OA with depression may be due to the chronicity of the disease, pain, repeated health care utilisation, health expenditure and functional limitation;15 equally, depression can influence the pain experience.16 OA pain can also profoundly impact sleep and sleep quality, with data to suggest those with hip/knee OA pain experience poor-quality sleep that can result in excessive tiredness.17,18

Often, the impact of OA-related pain extends to people’s work: over 4 million people with OA-related chronic pain are of working age.8,19 Notably, 1 in 3 people with OA will ultimately retire early, give up work or reduce working hours because of their condition.20

The significant impact of OA and OA-related pain therefore results in a domino effect that severely reduces quality of life. There is a clear need to reduce these knock-on health impacts of chronic pain, and to improve function and mobility for patients with OA and OA-related pain. One way we can address this need is by taking an holistic approach to assessment and management of OA, as outlined in the National Institute for Health and Care Excellence (NICE) guidelines7 – take a look at the management section of this website for more information. OA can also have a significant impact on those close to a person with OA, such as friends and family, read more on the next page – Does OA have more impact than you think?

What can I do now?

Help improve patient's wellbeing by helping them manage the knock-on health impacts of their OA-related chronic pain.

1. Conaghan PG, Abraham L, Graham-Clarke P, Viktrup L, Cappelleri JC, Beck C, Bushmakin A, Williams N, Mellor J, Jackson J. Poster: Current treatment patterns among European patients with osteoarthritis: analysis of a real-world dataset. Presented at: 11th Congress of the European Pain Federation (EFIC), Valencia, Spain, September 4–7, 2019. https://www.morressier.com/article/current-treatment-patterns-among-european-patients-osteoarthritis-analysis-realworld-dataset/5d402fa68f2158d25ec131dc?. Accessed March 18, 2020. 2. Hunter DJ, McDougall JJ, Keefe FJ. The symptoms of OA and the genesis of pain. Rheum Dis Clin North Am. 2008;34(3):623-643. 3. Okifuji A, Hare BD. The association between chronic pain and obesity. J Pain Res. 2015;8:399-408. 4. NIHR. People with osteoarthritis can benefit from exercise but may harbour myths about safety. August 2018. https://discover.dc.nihr.ac.uk/content/signal-000637/people-with-osteoarthritis-can-benefit-from-exercise-but-may-harbour-myths-about-safety. Accessed March 19, 2020. 5. British Medical Association. Chronic pain: supporting safer prescribing of analgesics. March 2017. www.bma.org.uk › media › files › pdfs › analgesics-chronic-pain. Accessed March 18, 2020. 6. Booth FW, Roberts CK, Laye MJ. Lack of exercise is a major cause of chronic diseases. Compr Physiol. 2012;2(2):1143-1211. 7. NICE. Osteoarthritis: care and management. February 2014. https://www.nice.org.uk/guidance/cg177/documents/nice-updated-osteoarthritis-guideline-highlights-importance-of-exercise. Accessed March 18, 2020. 8. Arthritis Research UK. Osteoarthritis in general practice. July 2013. https://healthinnovationnetwork.com/wp-content/uploads/2017/01/Osteoarthritis_in_general_practice__July_2013__Arthritis_Research_UK_PDF_421_MB.pdf. Accessed March 18, 2020. 9. Rice D, McNair P, Huysmans E, Letzen J, Finan P. Best Evidence Rehabilitation for Chronic Pain Part 5: Osteoarthritis. Journal of Clinical Medicine. 2019;8:1769. 10. Hurley M, Dickson K, Grant R, Hallet R, Hauari H, Walsh N, Stansfield C, Oliver S. Exercise interventions and patient beliefs for people with hip, knee or hip and knee osteoarthritis: a mixed methods review. Cochrane Database of Systematic Reviews. 2018(4):CD010842. 11. Wysocka-Skurska I, Sierakowska M, Kułak W. Evaluation of quality of life in chronic, progressing rheumatic diseases based on the example of osteoarthritis and rheumatoid arthritis. Clinical Interventions in Aging. 2016;11:1741-1750. 12. Parmelee PA, Tighe CA, Dautovich ND. Sleep disturbance in osteoarthritis: linkages with pain, disability, and depressive symptoms. Arthritis Care Res. 2015;67(3):358-365. 13. Conaghan PG, Peloso PM, Everett SV, Rajagopalan S, Black CM, Mavros P, Arden NK, Phillips CJ, Rannou F, van de Laar MAFJ, Moore AR, Taylor SD. Inadequate pain relief and large functional loss among patients with knee osteoarthritis: evidence from a prospective multinational longitudinal study of osteoarthritis real world therapies. Rheumatology. 2015;54(2):270-277. 14. Axford J, Butt A, Heron C, Hammond J, Morgan J, Alavi A, Bolton J, Bland M. Prevalence of anxiety and depression in osteoarthritis: use of the hospital anxiety and depression scale as a screening tool. Clin Rheumatol. 2010;29:1277-1283. 15. Swain S, Sarmanova A, Coupland C, Doherty M, Zhang W. Comorbidities in osteoarthritis: a systematic review and meta-analysis of observational studies. Arthritis Care Res. 2019;72(7):991-1000. 16. Mayo Clinic. Pain and depression: is there a link? April 2019. https://www.mayoclinic.org/diseases-conditions/depression/expert-answers/pain-and-depression/faq-20057823. Accessed February 28, 2020. 17. Martinez R, Reddy N, Mulligan EP, Hynan LS, Wells J. Sleep quality and nocturnal pain in patients with hip osteoarthritis. Medicine. 2019;98(41):e17464. 18. Woolhead G, Gooberman-Hill R, Dieppe P, Hawker G. Night pain in hip and knee osteoarthritis: a focus group study. Arthritis Care & Research. 2010;62(70):944-949. 19. Versus Arthritis. The State of Musculoskeletal Health 2019. 2019. https://www.versusarthritis.org/media/14594/state-of-musculoskeletal-health-2019.pdf. Accessed August 3, 2020. 20. Conaghan PG, Porcheret M, Kingsbury SR, Gammon A, Soni A, Hurley M, Rayman MP, Barlow J, Hull RG, Cumming J, Llewelyn K, Moscogiuri F, Lyons F, Birrell F. Impact and therapy of osteoarthritis: the Arthritis Care OA Nation 2012 survey. Clin Rheumatol. 2015;34:1581-1588.

The significant impact of OA and OA-related pain can result in a domino effect that severely reduces quality of life.11,12

Please note that some of the following resources are not created or sponsored by Pfizer. Where this is the case, using the links will direct you to external, third-party sites.
Further reading
Does osteoarthritis have more impact than you think?
The individual suffering from osteoarthritis (OA)-related pain is not the only person affected; the domino effects of chronic pain on a patient’s function and daily life also impact on relationships with family, friends and colleagues. In particular, when family and friends take on…
Impact of osteoarthritis on wider society
The impact of osteoarthritis (OA)-related pain extends far beyond the affected individual and the people closest to them. There is a substantial socioeconomic impact of OA.1 For society in the UK, the cost of working days lost due to arthritis, including OA, will be £3.4…

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PP-INT-GBR-0210 February 2021