Patients with osteoarthritis are not being offered medication to protect their stomach

Two new surveys have revealed that patients with osteoarthritis (OA) are not being offered medication to protect their stomach when they are prescribed a non-steroidal anti-inflammatory (NSAID) painkiller, and that they are frequently only offered medication after they have complained of heartburn and dyspepsia. Opinion Health surveyed 2332 GPs in November 2010 and 1000 patients with OA in November/December 2010 via bespoke internet-based surveys.

The guidelines on OA issued by the National Institute of Health and Clinical Excellence (NICE), the independent organisation responsible for providing guidance on health issues, recommend that GPs should prescribe medication to protect patients whenever they prescribe an NSAID. However GPs reported that nearly half of their patients on NSAIDs are not offered stomach protection. This is important as it may leave patients at risk of potential serious and life-threatening stomach and intestinal complications such as perforation, ulcers and bleeding.

Part of the problem is the lack of awareness of the potential side effects of NSAID painkillers. The surveys show that:

• 43% of patients did not have the possible side effects of NSAID's explained to them.
• 34% of patients say that the information/educational material given to them by a GP or nurse has been poor or very poor.
• 55% of GPs say that they have too little time to provide information.
• 34% patients are not at all concerned about side effects as long as the pain of their OA is under contro.l
• Of those prescribed stomach protective medication, only 56% remember to take it regularly.

The surveys also showed that 47% of OA patients are in pain every day and 50% believe their pain is worsening. Despite this, patients seem reluctant to seek help, with over a fifth waiting two years to consult their GP. Patients report that their pain causes distress and that OA limits their daily activities. The effects of OA reported by patients, other than pain, include stiffness, fatigue, disability, depression, anxiety and sleep disorders.

Despite being the most common form of arthritis, affecting some 8.5 million people in the UK and costing the NHS up to £70 million a year, OAt is often considered an unimportant degenerative disease. But with OA predicted to be the fourth leading cause of disability by 2020, improving outcomes for patients with OA is something that needs to be taken seriously.

Dr Chris Barker, Primary Care Specialist in Pain Medicine, commented: “For a GP, the challenge in OA is helping patients achieve pain control and functional improvement, while also managing the risk of side effects."

Professor Richard Langford, President of the British Pain Society, says, “NSAIDs are a mainstay of OA treatment but their long-term use can be limited by concerns around their tolerability and patients may be at risk of gastrointestinal complications.”

The survey also shows that:

• Over a quarter - 26% - of OA patients are not satisfied with their treatment.
• Less than 10% said that their OA had improved, compared to a year ago.
• A third of GPs believe that achieving adequate pain control is the most challenging aspect of OA management.

A number of new drugs are available that now offer GPs a choice in the management of symptomatic pain caused by OA and patients should discuss this element of their treatment with their GP.