Abstract
Osteoarthritis (OA) is the most prevalent arthritis worldwide and is characterized by chronic pain and impaired physical function. We hypothesized that heightened pain in hand OA could be reduced with duloxetine or pregabalin. In this prospective, randomized clinical study, we recruited 65 participants, aged 40–75 years, with a Numerical Rating Scale (NRS) for pain of at least 5. Participants were randomized to one of the following three groups: duloxetine, pregabalin, and placebo. The primary endpoint was the NRS pain score, and the secondary endpoints included the Australian and Canadian Hand Osteoarthritis Index (AUSCAN) pain, stiffness, and function scores and quantitative sensory testing by pain pressure algometry. After 13 weeks, compared to placebo, ANOVA found significant differences between the three groups (P=0.0078). In the intention-to-treat analysis, the pregabalin group showed improvement for NRS pain (P=0.023), AUSCAN pain (P=0.008), and AUSCAN function (P=0.009), but no difference between duloxetine and placebo (P>0.05) was observed. In the per protocol analysis, NRS pain was reduced for pregabalin (P<0.0001) and duloxetine (P=0.029) compared to placebo. We conclude that centrally acting analgesics improve pain outcomes in people with hand arthritis, offering new treatment paradigms for OA pain.
Highlights
Osteoarthritis (OA) is the most common form of arthritis worldwide, with hand pain and reduced function causing significant problems for people with hand OA.[1]
Several pharmacological agents are available for OA pain management, including acetaminophen, nonsteroidal anti-inflammatory drugs (NSAIDs), and opioids, a large proportion of patients continue to suffer from chronic pain despite using the agents described.[4,5]
A total of participants were randomized to duloxetine, a further participants were randomized to pregabalin, and 22 participants were randomized to placebo, respectively
Summary
Osteoarthritis (OA) is the most common form of arthritis worldwide, with hand pain and reduced function causing significant problems for people with hand OA.[1] Pain is a major symptom for people with OA, with 16.7% of US adults aged 45 years and older reporting pain as a predominant problem.[2] Pain and reduced function due to OA place a huge burden on patients and health care services.[2,3] several pharmacological agents are available for OA pain management, including acetaminophen, nonsteroidal anti-inflammatory drugs (NSAIDs), and opioids, a large proportion of patients continue to suffer from chronic pain despite using the agents described.[4,5] Recent trials have raised questions about current treatments, suggesting that acetaminophen has poor efficacy in controlling OA pain.[6,7] Pain management in OA is a huge problem, and novel approaches are urgently needed
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