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Painkiller use in inflammatory arthritis is ‘widespread’ despite no benefit

Painkiller use in inflammatory arthritis is ‘widespread’ despite no benefit

Prescribing of painkillers in patients with inflammatory arthritis is ‘widespread’ say researchers, despite no evidence suggesting they are beneficial.

An analysis of GP data on patients with rheumatoid arthritis, psoriatic arthritis, and axial spondyloarthritis found around two thirds of patients receiving a prescribed analgesic medicine in 2020.

Although the data going back to 2004 showed that analgesic prescribing in these groups had fallen over time especially for NSAIDs.

By 2020, the data from around 1400 GP practices the one-quarter a chronic opioid prescription, and one in ten a chronic NSAID prescription.

The team also reported that the annual prevalence of non-NSAID analgesic prescriptions is higher in patients that are older, female, living in northern England and from deprived areas.

Their analysis published in Rheumatology showed chronic NSAID and opioid prescriptions are commonly initiated ‘peri-diagnosis’, likely while a GP is awaiting a specialist assessment, and often continue once started, which could be a crucial time period for safer prescribing interventions, they concluded.

The researchers from Keele University said the findings showed an urgent need to improve the way pain is managed in patients with inflammatory arthritis.

Previous studies have found a similar pattern but have mainly focused on opioid prescribing, the researchers noted. The team could not look at the relationship between analgesic and biologic prescribing as biologics are prescribed in secondary care and so the data was not available.

Use of analgesics in this population is neither evidence-based nor in line with guidelines recommending treat-to-target and biopsychosocial care, they said, and ‘urgent efforts are needed to understand how clinical practice can be improved’.

Study lead Dr Ian Scott, consultant rheumatologist and honorary senior lecturer at Keele University, said the fact that one in four patients were prescribed opioids long-term, and 1 in 10 patients were prescribed gabapentinoid medicines in 2020 despite these drugs having many potential side-effects and no clinical trials data to show they help as ‘very concerning’. 

He added: ‘There are better ways to treat pain in patients with inflammatory arthritis, which have been shown to help in clinical trials.

‘These include reducing joint inflammation using specialist disease-modifying medicines and exercise.

‘We need to move the focus of pain care away from the long-term use of ineffective painkillers, towards the use of treatments that have been shown to help.’

Professor Carolyn Chew-Graham, professor of general practice research, said long waiting times for patients needed to be taken into account, particularly given the importance of early assessment and intervention.

‘The waiting time for first routine rheumatology appointment in some localities is six months,’ she said.

‘It is really difficult for patients, who also are aware that early treatment is necessary.’


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Please note, only GPs are permitted to add comments to articles

David Ruben 13 October, 2023 6:33 pm

Perhaps if Rheumatologists reviewed patients with inflammatory arthritis to see if they were actually pain free on “better” treatments, then advise to stop peri-diagnostic analgesia and then check whether they remain pain free that might help? Instead I suspect pushed to discharge from followup noting satisfactory CRP, FBC, U&E & LFTs results with advise GP can referred back; not that I could refer back locally as indicative wait for 1st appointments are running at 30 weeks.

David Banner 13 October, 2023 10:02 pm

So patients in severe pain are requesting painkillers? And their incompetent GPs are prescribing them??

Burned Out 15 October, 2023 6:12 pm

Patients whose “soft tissue” inflammatory disease may be controlled can continue to suffer mechanical pain, especially when there is longstanding disease and deformity. Are they to be denied analgesia? Yet again ivory tower expert opinion undermines General Practice.