Confusion Over Safety Of NSAIDs For Pain Relief Leads Patients To Suffer In Silence

Confusion and concern about the benefits and safety hazards of painkilling drug treatments is leading many people with chronic musculoskeletal pain to try and manage their pain without any medication at all, a new global survey suggests.


The Arthritis Action Group (AAG), an organisation of physicians and researchers, surveyed perceptions of 1204 people with chronic musculoskeletal pain, many of whom suffer from arthritis, and 604 primary care physicians (PCPs), in six countries - UK, Germany, Italy, France, Mexico and Australia.


Presenting the "Insights into Pain Relief" survey results in Amsterdam during the annual EULAR rheumatology meeting, AAG Chairman Professor Anthony Woolf said the findings helped explain why so many people were still enduring pain without seeking medical advice or were putting up with inadequate pain relief. "Something needs to be done to change attitudes because pain greatly impairs quality of life", he said.


More than a million people in Europe have chronic pain with 4 out of 5 experiencing it constantly, he noted. One in four finds it puts a major strain on relationships, 60 per cent are unable to work and one in five lose their jobs. Poor pain management causes 500million working days to be lost each year in Europe at a cost of ?34 billion.


Confused


Almost two thirds of people surveyed (64%) said they were confused about what to take for pain relief because of conflicting information on drug safety that has emerged following the withdrawal of Vioxx (rofecoxib), a COX-2 selective non-steroidal anti-inflammatory drug (NSAID) . Around 4 out of 5 (78%) said they didn't know enough about the risks and benefits of medicines, whether prescribed or bought over-the-counter. Almost half (47%) said they weren't using any painkiller medication at all for a number of reasons. Some were concerned about side effects, often after reading worrying news stories about painkillers, some had been advised to stop medication by their PCP and some thought they could manage without them.


In many cases patients keep their concerns to themselves. Less than half had discussed with their doctor whether or not their treatment was working or providing benefits. Even fewer - only 30 per cent - had discussed potential risks or side effects and about the same proportion had discussed how to use painkillers effectively with regard to dosing and how often they are taken.


The survey also revealed a mismatch between doctors' and patients' perceptions. Whilst up to 48 per cent of patients are concerned about potential side effects of OTC painkillers, the same was true of only 14 per cent of physicians. One in four physicians found it difficult to communicate the risks and benefits of different pain medications. And nine out of 10 reported time constraints preventing them from giving advice.


Recent large meta-analyses of clinical trials have suggested standard doses of COX-2 and non-selective NSAIDs carry the same level of risk of increasing susceptibility to cardiovascular events. COX-2 selective NSAIDs however are less likely than traditional NSAIDs to cause ulcers in the upper or lower gastro-intestinal tract. Large randomised clinical trials, in progress or about to begin, will confirm this.


New ways of explaining simply the relative risks and benefits of treatment are required, said Dr Andrew Moore, Director of Research at the Pain Research Unit, Oxford University. A visual means, such as the Paling Risk Perception Scale, showing patients the magnitude of risks of experiencing serious side effects from medication alongside risks of a similar magnitude eg, being involved in an automobile accident, might help patients put risks and benefits into context, he suggested.


Currently, more than 30 million patients use NSAIDs every day. " All treatments contain some risk of adverse as well as beneficial effects and it is important for doctors and patients to discuss suitable treatments to ensure patients receive optimal care", he concluded.



By Olwen Glynn Owen

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View drug information on Vioxx.