PAIN MANAGEMENT IN ELDERS DIAGNOSED WITH OSTEOARTHRITIS

Andrea SportNurs 7940EBP Oral Presentation

BACKGROUND AND SIGNIFICANCE Musculoskeletal pain in the elderly population is common and

disabling, yet often underreported, underestimated, and undertreated. Some form of symptomatic arthritis affects at least 50%of the elderly population, and over 80% of the population will experience back pain at some point in life.

In the elderly, osteoarthritis is by far the most prevalent arthritic complaint and is the cause of an increasing public health problem. Because OA greatly impacts all aspects of life and there is no cure for the disease, symptom management is paramount for affected individuals.

Pain affects many day-to-day functions such as sleep, appetite, energy, mobility, independence, and overall state of health.

Better pain management leads to better quality of life.

TARGET POPULATION

Elders (age 60 +) diagnosed with Osteoarthritis

PICO QUESTION

• In elders diagnosed with osteoarthritis (P), is the addition of complementary and alternative medicine to standard treatment (I) more effective than standard treatment alone (C) in order to reduce pain levels, enhance quality of life, and decrease occurrences of medication interactions (O)

LITERATURE SEARCH

Databases used for literature search included CINAHL, Health Source: Nursing/Academic Edition, Medline, ERIC, PsycARTICLES, and the Cochrane Library. The literature search returned numerous randomized controlled trials, descriptive cross-sectional studies, and literature reviews.

SUMMARY OF EVIDENCE Glucosamine sulfate, when used long term such as six

months, can be used to improve joint function, reduce pain, and decrease analgesic consumption in those diagnosed with osteoarthritis.

- Grade: A

- Wu, Huang, Gu, & Fan (2013)

- Giordano et al. (2009)

A comfrey root extract (Symphytum officinale L.) cream applied to affected joints three times daily can significantly reduce pain, stiffness, and swelling, improve joint function, and potentially decrease the usage of oral pain-relieving medications.

- Grade: B

- Smith & Jacobson (2011)

- Laslett et al. (2012)

SUMMARY OF EVIDENCE Both aquatic and land-based exercises are beneficial to reduce

pain and improve joint function in those with osteoarthritis.

- Grade: B

- Wang et al. (2011)

- Hiyama et al. (2011)

Self-management education, including disease-specific processes, exercise regimens, healthy lifestyle choices, and other relevant information, is beneficial in reducing pain and improving quality of life in those diagnosed with osteoarthritis.

- Grade: B

- Coleman et al. (2012)

- Coleman et al. (2008)

THESE TWO RECOMMENDATIONS WERE CHOSEN AS THE FOCUS FOR THE SMALL TEST OF CHANGE!

SMALL TEST OF CHANGE

Setting: East Alabama Orthopaedics and Sports Medicine

Participants: Patients of Dr. Bob McAlindon aged 60+ that have been diagnosed with Osteoarthritis

IMPLEMENTATION STEPS Intervention: Consenting patients fitting into the

population of interest were provided with the Measure of OA Pain Self-Assessment Questionnaire- Pre. Patients were then educated about OA, disease management, and the importance of exercise. Patients were then given an exercise regimen to follow at home. Patients were asked to exercise for an average of 30 minutes per day for 5 days out of the week.

Follow-up: After 3-4 weeks of exercising, patients were contacted via telephone or e-mail and answered questions from the Measure of OA Pain Self-Assessment Questionnaire-Post.

TOOLS AND OUTCOME MEASURES

Tools: Measure of Osteoarthritis Pain Self-Assessment Questionnaire-Pre and Post

Outcome measures: Results measured OA pain, medication consumption/frequency, and quality of life.

RESULTS The implementation of an educational session and exercise

regimen significantly reduce (p=<0.05) the impact OA pain symptoms have on quality of life measures as determined by the Measure of OA Pain Self-Assessment Questionnaire

Education and exercise were shown to decrease pain scale ratings from 4.3 (mean-pre) to 3.5 (mean-post). However, this decrease is not statistically significant (p=0.14).

Education and exercise led to decreases in the frequency of acetaminophen and opioid pain medication consumption, but these decreases were not statistically significant (p=0.29, p=0.20).

90% of participants strongly agreed or agreed that education and exercise were beneficial for managing OA pain symptoms.

RESULTS

RESULTS CONTINUED

60%

SUMMARY Education and exercise are beneficial

components of osteoarthritis symptom management.

The benefits of education and exercise include reduced pain, decreased oral pain medication consumption, and an improved quality of life.

Further implementation of the education and exercise program is warranted in this setting with evaluations every three months to determine long-term effectiveness of this program.

REFERENCESWu, D., Huang,Y., Gu, Y., & Fan, W. (2013). Efficacies of different preparations of glucosamine for the treatment of osteoarthritis: A meta-analysis of randomized, double-blind, placebo-controlled trials. International Journal of Clinical Practice, 67(6), 585-594. doi: 10.1111/ijcp.12115

Giordano, N., Fioravanti, A., Papakostas, P., Montella, A., Giorgi, G., & Nuti, R. (2009). The efficacy and tolerability of glucosamine sulfate in the treatment of knee osteoarthritis: A randomized, double-blind, placebo-controlled trial. Current Therapeutic Research, 70(3), 185-194. doi: 10.1016/j.curtheres.2009.05.004

Smith, D. & Jacobson, B. (2011). Effect of a blend of comfrey root extract (Symphytum officinale L.) and tannic acid creams in the treatment of osteoarthritis of the knee: Randomized, placebo-controlled, double-blind, multiclinical trials. Journal of Chiropractic Medicine, 10, 147-156. doi: 10.1016/j.jcm.2011.01.003

Laslett, L.L., Quinn, S.J., Darian-Smith, E., Kwok, M., Fedorova, T., Korner, H.,…Jones, G. (2012). Treatment with 4Jointz reduces knee pain over 12 weeks of treatment in patients with clinical knee osteoarthritis: A randomized controlled trial. Osteoarthritis and Cartilage, 20, 1209-1216. doi: 10.1016/j.joca.2012.07.019

REFERENCESWang, T., Lee, S., Liang, S., Tung, H., Wu, S., & Lin, Y. (2011). Comparing the efficacy of aquatic exercises and land-based exercises for patients with knee osteoarthritis. Journal of Clinical Nursing, 20, 2609-2622. doi: 10.1111/j.1365-2702.2010.03675.x

Hiyama, Y., Yamada, M., Kitagawa, A., Tei, N., & Okada, S. (2011). A four-week walking exercise programme in patients with knee osteoarthritis improves the ability of dual-task performance: A randomized controlled trial. Clinical Rehabilitation, 26(5), 403-412. doi: 10.1177/0269215511421028

Coleman, S., Briffa, N.K., Carroll, G., Inderjeeth, C., Cook, N., & McQuade, J. (2012). A randomized controlled trial of a self-management education program for osteoarthritis of the knee delivered by health care professionals. Arthritis Research & Therapy, 14(1), R21. doi: 10.1186/ar3703