Author(s): Costa, Daniela ; Cruz, Eduardo B. ; Lopes, David G. ; da Silva, Catarina Nunes ; Oliveira Henriques, Ana Rita ; Luis, Diogo ; Branco, Jaime ; Canhão, Helena ; Rodrigues, Ana M.
Date: 2023
Persistent ID: http://hdl.handle.net/10362/149279
Origin: Repositório Institucional da UNL
Subject(s): Non-pharmacological therapies; Osteoarthritis; Pain management; Pharmacological therapies; Rheumatology; Orthopedics and Sports Medicine
Funding Information: We thank Prof. Carla Nunes (NOVA National School of Public Health – Universidade NOVA de Lisboa) for the valuable insights and discussions in the conceptualization of this project. We thank the EpiDoc Unit and EpiReumaPt team for conceptualizing, planning, and implementing the main research project. We also acknowledge the support of CHRC (UIDP/04923/2020), granted by national funds through Fundação Ciência e Tecnologia, IP. Funding Information: This study received funding from an independent research grant (ID: 64165707) by Pfizer, and the first author received a grant from Fundação Ciência e Tecnologia, IP under the PhD grant SFRH/BD/148420/2019. The funders were not involved in study design; collection, analysis, or interpretation of data; or writing this article or the decision to submit it for publication. Publisher Copyright: © 2023, The Author(s).
Background: Pain due to knee and / or hip osteoarthritis (HKOA) is the most common symptom for seeking healthcare. Pain interferes on daily activities, social and occupational participation in people with HKOA. The goal of this study is to estimate the prevalence of unmanageable pain levels (UPL) among people with HKOA), characterize this population and identify factors associated with UPL, and compare therapeutic strategies used by people with UPL versus manageable pain levels (MPL). Methods: We analysed data from the EpiReumaPt study (n = 10,661), that included a representative sample of the Portuguese population. Among these, 1081 participants had a validated diagnosis of HKOA by a rheumatologist. Sociodemographic, lifestyle and health-related data were collected in a structured interview. Pain intensity (NPRS) data were collected in a medical appointment. Painmedication (last month), physiotherapy and surgery were considered as therapies for pain management. UPL was defined as a mean pain intensity in the previous week of ≥5 points on 11-point numeric pain rating scale. The factors associated with UPL were analyzed with logistic regression (p < 0.05, 95%CI). The effect of unmanageable pain levels was assessed by the HOOS/KOOS activities of daily living and quality of life subscales. Symptoms of anxiety and depression were assessed by the Hospital Anxiety and Depression Scale (HADS). Analysis was completed with linear and logistic regression. All analysis were weighted. Results: The estimated prevalence of UPL among people with HKOA was 68.8%. UPL was associated with being female (odds ratio (OR) = 2.36, p < 0.001), being overweight (OR = 1.84, p = 0.035) or obese (OR = 2.26, p = 0.006), and having multimorbidity (OR = 2.08, p = 0.002). People with UPL reported worse performance in activities of daily living and lower quality of life (β = − 21.28, p < 0.001 and β = − 21.19, p < 0.001, respectively) than people with MPL. People with UPL consumed more NSAIDs (22.0%, p = 0.003), opioids (4.8%, p = 0.008), paracetamol (2.7%, p = 0.033), and overall analgesics (7.3%, p = 0.013) than people with MPL. A higher proportion of people with UPL underwent physiotherapy (17.5%, p = 0.002) than people with MPL. Conclusion: Two-thirds of people with HKOA in Portugal have poor management of their pain levels. Clinical and lifestyle factors, that are highly presented in individuals with HKOA, are associated with unmanageable pain. Our results highlighting the need for further research and implementation of effective interventions to improve pain, function and quality of life in people with HKOA.
