During the 70th Annual Meeting of The Canadian Rheumatology Association (CRA) held at the Fairmont Chateau Frontenac in Quebec, Canada on February 4–7, 2015, a team of researchers presented results of a study showing that the majority of patients with a diagnosis of rheumatoid arthritis have symptoms of neuropathic pain, fibromyalgia and migraines, and that treatments for this group of patients should be multimodal.
In the study titled “Characterization of Patient Reported Pain Medication in Rheumatoid Arthritis Patients – Results from the Ontario Best Practices Research Initiative (OBRI),” the researchers evaluated a total of 1,816 patients with a diagnosis of rheumatoid arthritis (RA) who were prescribed with at least one drug for pain management.
Patients were enrolled in a study called the Ontario Best Practices Research Initiative (OBRI). Patients had a mean age of 57.6 years, average disease duration of 8.98 years, and a total of 78.9% of the RA patients were women.
Results revealed that in this group of patients, a total of 3,445 events were reported, across all medication classes. The largest medication classes included NSAIDs (40.8%, N = 1405), opioid analgesics (15.9%, N = 548) and non-opioid analgesics (15.5%, N = 533). The use of antidepressants (14.3%, N = 494), benzodiazepines (8.04%, N = 277) and anti-epileptics (5.57%, N = 192) were also observed.
Patients did not specify any indication for 48.5% (N = 1670) of these pain medications. From the specified indications (N = 1,775), 6 most prevalent pain disorders reported were identified – generalized pain (28.0%, N = 497), joint pain (12.1%, N = 214), migraines (4.68%, N = 83), fibromyalgia (3.83%, N = 68), back pain (3.77%, N = 67) and neuropathic pain (3.10%, N = 55). Opioid and nonopioid analgesics were highly utilized amongst these groups (56.8%) followed by NSAIDs (33.8%).
These findings indicate that in addition to inflammatory pain, many RA patients also suffer from neuropathic pain, fibromyalgia and migraines, with the researchers acknowledging the need for a multimodal clinical approach for RA pain management.
According to the researchers, the high utilization of pain medications may be linked to other comorbidities such as depression, anxiety and sleep disorder, and that more investigation is necessary to understand the potential associations between pain and comorbidities in patients with RA.