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Pain Relief in Osteoarthritis: Patients' Willingness to Risk Medication-Induced Gastrointestinal, Cardiovascular, and Cerebrovascular Complications
CHRIS G. RICHARDSON, ANDREW CHALMERS, HILARY A. LLEWELLYN-THOMAS, ALICE KLINKHOFF, ANNE CARSWELL, and JACEK A. KOPEC
ABSTRACT. Methods. Patients responded to a set of threshold technique tasks. Each task described 2 treatment options, their levels of pain relief, and the risks of side effects. The risk for the side effect under investigation was then systematically increased to reveal the maximal acceptable risk increment associated with the pain reduction. Results. Of 196 patients, 22.3% and 14.7% were unwilling to accept any additional risk of stomach bleed or heart attack/stroke for 2-point and 5-point pain reductions, respectively. Patients were willing to accept significantly more risk for a 5-point pain reduction than for a 2-point pain reduction in stomach bleed and heart attack/stroke scenarios. Patients also accepted significantly greater additional risks of stomach bleed compared to heart attack/stroke for 2-point and 5-point pain reductions. Conclusion. Most patients with OA are willing to accept some additional risk of stomach bleed and heart attack/stroke to gain pain relief. Patients are willing to accept greater additional risk of stomach bleed than heart attack/stroke. However, there exists considerable variation in risk-taking attitudes across patients. We recommend that clinicians examine the risk attitude and treatment preferences of each patient on an individual basis when deciding on a treatment regimen. (First Release June 1 2007; J Rheumatol 2007;34:1569-75) Key Indexing Terms:
OSTEOARTHRITIS
From the Arthritis Research Centre of Canada, Vancouver, British Columbia, Canada. Supported by a grant from The Arthritis Society. Dr. Kopec was supported by a Michael Smith Foundation for Health Research Senior Scholar Award. Dr. Richardson was supported by a Canadian Institutes of Health Research Post-doctoral Fellowship. Dr. Llewellyn-Thomas is partially supported by The Andrew Thomson, Jr., MD, Fellowship in Shared Decision Making, and the Foundation for Informed Medical Decision Making. A. Chalmers, MD; A. Klinkhoff, MD, Division of Rheumatology; C.G. Richardson, PhD, Postdoctoral Fellow, School of Nursing; J.A. Kopec, PhD, Associate Professor, Department of Health Care and Epidemiology, University of British Columbia, Vancouver; A. Carswell, PhD, School of Occupational Therapy, Faculty of Health Professions, Dalhousie University, Halifax, Nova Scotia, Canada; H.A. Llewellyn-Thomas, PhD, Professor, Center for the Evaluative Clinical Sciences, Department of Community and Family Medicine, Dartmouth Medical School, Dartmouth College, Hanover, New Hampshire, USA. Address reprint requests to Dr. C.G. Richardson, School of Nursing, 302-6190 Agronomy Road, University of British Columbia, Vancouver, BC V6T 1Z3, Canada. E-mail: richardson_cg@yahoo.com Accepted for publication February 26, 2007. |
