151 Chronic pain treatment satisfaction in musculoskeletal disease: differences between osteoarthritis and chronic low back pain in medication switching, opioid use, and utilization of non-drug treatments Jimmy Mali1, Joaquim Nascimento2, Joanna Atkinson3, Rebecca Robinson4, Martha Port4, Valerie Bruemmer4 Emerge Ortho, Durham, NC, USA. 2Vanguard Strategy, London, United Kingdom. 3Pfizer Ltd, Tadworth, Surrey, United Kingdom. 4Eli Lilly and Company, Indianapolis, IN, USA 1
Purpose Chronic pain affects the lives of one in five people worldwide, and two of the most common chronic pain conditions are osteoarthritis (OA) and chronic low back pain (CLBP). Patients continually strive to find better therapies and treatments to manage chronic pain due to OA and CLBP. In this study we examined the differences between people with OA and CLBP in self-reported satisfaction of their chronic pain management and how these measures of satisfaction correlated with switching to different prescription medications, the use of opioid medication, and the use of non-pharmacologic therapies to treat their OA- and CLBP-related pain. Methods A total of 2,004 people with chronic pain due to OA or CLBP responded to an online survey regarding pain management and satisfaction with treatment in March 2018. Respondents were all 18 years or older and had been diagnosed with OA (hip or knee only) or CLBP for more than 12 months. They were also covered by medical insurance and had used at least one prescription or over-the-counter medication to treat their OA or CLBP pain in the past 12 months. Only subjects who experienced pain related to OA or CLBP at least one day per week and rated their pain as being 5 or higher on a pain scale of 0-10, were included in the study. Participants were offered a small, one time compensation (less than $5) to complete the survey. Of the total respondents, 47% identified themselves as experiencing chronic pain predominantly from OA while 53% stated that their chronic pain was due mostly to CLBP. People with OA and CLBP were further divided into those who had or had not, in the past 12 months, switched prescription pain medications, used opioid pain medications, and used nonpharmacologic therapies to treat their pain. Three measures were used to assess satisfaction with pain treatment; 1) pain relief, 2) pain impact on life, and 3) side effects. Study subjects were asked to use a categorical 7-point scale to rate their satisfaction with the three measures and higher scores indicated greater satisfaction for all measures. Results The 939 respondents with OA had a mean age of 65.1 years, time since first diagnosis of 9.9 years, and body mass index of 29.7; 75% were female and 55% had daily pain. The 1,065 respondents with CLBP had a mean age of 61.8 years, time since first diagnosis of 11.5 years and body mass index of 28.2; 58% were female and 48% had daily pain. Pain level (1-10) was 6.23 for OA and 6.37 for CLBP. In two of three measures of treatment satisfaction, participants with OA and CLBP reported similar levels of satisfaction with their pain management. However, people with CLBP reported lower levels of satisfaction with side effects compared to the OA group. A total of 952 respondents (48%) had used one or more prescription medicines in the past 12 months, and 43% of these prescription users had switched their medication during this time. Respondents in the OA group who had switched medication within the past 12 months reported a lower score for their satisfaction with pain relief (p=0.02) compared to those who had not switched, while people with CLBP showed no differences related to switching in all three measures of satisfaction. A total of 428 people (21%) reported having used opioids to treat their OA- or CLBP-related pain in the past 12 months and opioid users had a slightly higher pain score than non-opioid users (OA: 6.45 vs 6.32; p=0.17 and CLBP: 6.81 vs 6.23; p<0.001 on a 0-10 point numeric rating scale). Opioid users in both the OA and CLBP groups reported lower levels of satisfaction for pain impact on life and side effects of their treatments, compared to respondents who had not used opioids (p<0.001 for all comparisons).