When It Comes to Pain, Medication Trumps Advice

Pharmaceutic management or physical therapy for older adult knee-pain patients yielded significantly greater short-term pain reduction than written and oral advice on coping with knee pain, according to a randomized clinical trial.

The trial (BMJ 2006 Oct. 20 [Epub doi:10.1136/bmj.38977.590752.0B]) randomized 325 knee-pain patients 55 years of age and older from North Staffordshire (England), into equal-sized groups—one received up to six 20-minute sessions of physical therapy over 10 weeks with additional home exercises, another received advice from a community pharmacist in up to six 20-minute meetings, and a control group received a booklet and a telephone call from a rheumatology nurse.

Researchers, led by Dr. Elaine Hay, a professor in community rheumatology at the Primary Care Musculoskeletal Research Centre, Keele University, chiefly measured improvements on the Western Ontario and McMaster Universities osteoarthritis index (WOMAC) at 3, 6, and 12 months.

At 3 months, the researchers found that the intervention groups both had shown a significantly greater improvement than the control group on the 20-point WOMAC pain scale.

The pharmacy group had improved by a mean of 1.59 points to 7.49, the physiotherapy group by a mean 1.56 to 7.36, compared with the control group's improvement of 0.41 to 8.99.

By 6 months, neither intervention group was showing a significant improvement over the control group.

On the 68-point WOMAC physical function scale, the physiotherapy group improved by a mean score of 4.79 points to 24.27 at 3 months, significantly better than the control group's improvement of 0.80 to 30.18, the trial found. The difference was not sustained to 6 or 12 months.

The researchers added, however, that the physical therapy group consulted general practitioners less frequently, and the pharmacy and physical therapy groups took fewer NSAIDs than the control group. The pharmacy group did take significantly more analgesics, however.

“Interventions by pharmacists have been shown to favorably influence prescribing to reduce adverse drug reactions, improve the appropriateness of drug use, reduce drug costs, and improve compliance in a range of conditions,” the authors wrote.

“Our trial adds to this evidence by showing that evidence-based care for adults over 55 with knee pain, delivered by primary care pharmacists and physiotherapists, results in short-term improvements in health outcome, reduction in use of nonsteroidal anti-inflammatory drugs, and high patient satisfaction,” the investigators continued.

The researchers cited as a potential weakness of the trial their “lack of information about patients' adherence to treatment, which is likely to be an important determinant of clinical outcome.”

Pharmaceutic management or physical therapy for older adult knee-pain patients yielded significantly greater short-term pain reduction than written and oral advice on coping with knee pain, according to a randomized clinical trial.

The trial (BMJ 2006 Oct. 20 [Epub doi:10.1136/bmj.38977.590752.0B]) randomized 325 knee-pain patients 55 years of age and older from North Staffordshire (England), into equal-sized groups—one received up to six 20-minute sessions of physical therapy over 10 weeks with additional home exercises, another received advice from a community pharmacist in up to six 20-minute meetings, and a control group received a booklet and a telephone call from a rheumatology nurse.

Researchers, led by Dr. Elaine Hay, a professor in community rheumatology at the Primary Care Musculoskeletal Research Centre, Keele University, chiefly measured improvements on the Western Ontario and McMaster Universities osteoarthritis index (WOMAC) at 3, 6, and 12 months.

At 3 months, the researchers found that the intervention groups both had shown a significantly greater improvement than the control group on the 20-point WOMAC pain scale.

The pharmacy group had improved by a mean of 1.59 points to 7.49, the physiotherapy group by a mean 1.56 to 7.36, compared with the control group's improvement of 0.41 to 8.99.

By 6 months, neither intervention group was showing a significant improvement over the control group.

On the 68-point WOMAC physical function scale, the physiotherapy group improved by a mean score of 4.79 points to 24.27 at 3 months, significantly better than the control group's improvement of 0.80 to 30.18, the trial found. The difference was not sustained to 6 or 12 months.

The researchers added, however, that the physical therapy group consulted general practitioners less frequently, and the pharmacy and physical therapy groups took fewer NSAIDs than the control group. The pharmacy group did take significantly more analgesics, however.

“Interventions by pharmacists have been shown to favorably influence prescribing to reduce adverse drug reactions, improve the appropriateness of drug use, reduce drug costs, and improve compliance in a range of conditions,” the authors wrote.

“Our trial adds to this evidence by showing that evidence-based care for adults over 55 with knee pain, delivered by primary care pharmacists and physiotherapists, results in short-term improvements in health outcome, reduction in use of nonsteroidal anti-inflammatory drugs, and high patient satisfaction,” the investigators continued.

The researchers cited as a potential weakness of the trial their “lack of information about patients' adherence to treatment, which is likely to be an important determinant of clinical outcome.”

Pharmaceutic management or physical therapy for older adult knee-pain patients yielded significantly greater short-term pain reduction than written and oral advice on coping with knee pain, according to a randomized clinical trial.

The trial (BMJ 2006 Oct. 20 [Epub doi:10.1136/bmj.38977.590752.0B]) randomized 325 knee-pain patients 55 years of age and older from North Staffordshire (England), into equal-sized groups—one received up to six 20-minute sessions of physical therapy over 10 weeks with additional home exercises, another received advice from a community pharmacist in up to six 20-minute meetings, and a control group received a booklet and a telephone call from a rheumatology nurse.

Researchers, led by Dr. Elaine Hay, a professor in community rheumatology at the Primary Care Musculoskeletal Research Centre, Keele University, chiefly measured improvements on the Western Ontario and McMaster Universities osteoarthritis index (WOMAC) at 3, 6, and 12 months.

At 3 months, the researchers found that the intervention groups both had shown a significantly greater improvement than the control group on the 20-point WOMAC pain scale.

The pharmacy group had improved by a mean of 1.59 points to 7.49, the physiotherapy group by a mean 1.56 to 7.36, compared with the control group's improvement of 0.41 to 8.99.

By 6 months, neither intervention group was showing a significant improvement over the control group.

On the 68-point WOMAC physical function scale, the physiotherapy group improved by a mean score of 4.79 points to 24.27 at 3 months, significantly better than the control group's improvement of 0.80 to 30.18, the trial found. The difference was not sustained to 6 or 12 months.

The researchers added, however, that the physical therapy group consulted general practitioners less frequently, and the pharmacy and physical therapy groups took fewer NSAIDs than the control group. The pharmacy group did take significantly more analgesics, however.

“Interventions by pharmacists have been shown to favorably influence prescribing to reduce adverse drug reactions, improve the appropriateness of drug use, reduce drug costs, and improve compliance in a range of conditions,” the authors wrote.

“Our trial adds to this evidence by showing that evidence-based care for adults over 55 with knee pain, delivered by primary care pharmacists and physiotherapists, results in short-term improvements in health outcome, reduction in use of nonsteroidal anti-inflammatory drugs, and high patient satisfaction,” the investigators continued.

The researchers cited as a potential weakness of the trial their “lack of information about patients' adherence to treatment, which is likely to be an important determinant of clinical outcome.”