Abstract
BackgroundMany people attending rheumatology clinics use analgesics and non-steroidal anti-inflammatories for persistent musculoskeletal pain. Guidelines for pain management recommend regular and pre-emptive use of analgesics to reduce the impact of pain. Clinical experience indicates that analgesics are often not used in this way. Studies exploring use of analgesics in arthritis have historically measured adherence to such medication. Here we examine patterns of analgesic use and their relationships to pain, self-efficacy and demographic factors.MethodsConsecutive patients were approached in a hospital rheumatology out-patient clinic. Pattern of analgesic use was assessed by response to statements such as 'I always take my tablets every day.' Pain and self-efficacy (SE) were measured using the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) and Arthritis Self-Efficacy Scale (ASES). Influence of factors on pain level and regularity of analgesic use were investigated using linear regression. Differences in pain between those agreeing and disagreeing with statements regarding analgesic use were assessed using t-tests.Results218 patients (85% of attendees) completed the study. Six (2.8%) patients reported no current pain, 26 (12.3%) slight, 100 (47.4%) moderate, 62 (29.4%) severe and 17 (8.1%) extreme pain. In multiple linear regression self efficacy and regularity of analgesic use were significant (p < 0.01) with lower self efficacy and more regular use of analgesics associated with more pain.Low SE was associated with greater pain: 40 (41.7%) people with low SE reported severe pain versus 22 (18.3%) people with high SE, p < 0.001. Patients in greater pain were significantly more likely to take analgesics regularly; 13 (77%) of those in extreme pain reported always taking their analgesics every day, versus 9 (35%) in slight pain. Many patients, including 46% of those in severe pain, adjusted analgesic use to current pain level. In simple linear regression, pain was the only variable significantly associated with regularity of analgesic use: higher levels of pain corresponded to more regular analgesic use (p = 0.003).ConclusionOur study confirms that there is a strong inverse relationship between self-efficacy and pain severity. Analgesics are often used irregularly by people with arthritis, including some reporting severe pain.
Highlights
Many people attending rheumatology clinics use analgesics and non-steroidal antiinflammatories for persistent musculoskeletal pain
Predictors of regularity of analgesic use In simple linear regression, pain was the only variable significantly associated with regularity of analgesic use: a greater pain score corresponded to more regular analgesic use
In multiple linear regression where age, gender, duration of arthritis, ethnicity, regularity of analgesic use and self-efficacy were entered simultaneously, lower self efficacy and regular use of analgesics remained significantly associated with more pain
Summary
Many people attending rheumatology clinics use analgesics and non-steroidal antiinflammatories for persistent musculoskeletal pain. Methods of measuring compliance have included recording proportion of medication taken [7], assaying drug levels [8], self-reported adherence [9,10,11] and recording non-adherent behaviours such as missing doses [7]. In chronic conditions such as arthritis analgesics may be prescribed to be taken 'as needed' especially where the severity of pain fluctuates, so we have chosen to investigate the pattern of patients' use of pain killers rather than their actual adherence to prescribed regimens. In this study 'patterns' refers to the way in which people take analgesics on a daily basis
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