anti-inflammatory drugs

The primary objective of this study was to examine ratings of helpfulness of analgesic and antiinflammatory medications among African-American and Caucasian veterans. To our knowledge, other observational studies of patients with OA have not directly examined patients’ perceptions of helpfulness of specific, current medications. In clinical trials, pre-and post-treatment scores on standardized pain scales are the usual primary outcome. Assessment of patients’ perceptions of medication helpfulness is a clinically useful alternative measure that may have implications for adherence and continuation of use.

The mean rating of medication helpfulness in this sample was relatively low—approximately 6, on a scale of 1 (not at all helpful) to 10 (very helpful). Patient perceptions of poor medication efficacy may contribute to the high rates of early discontinuation reported by some studies. Additional research is needed to examine factors related to perceptions of poor medication efficacy. These perceptions may be due to inherent limitations of analgesic/anti-inflammatory medications (particularly among patients with advanced OA). However, other modifiable factors (such as low dosing or patients not following prescription instructions) may also contribute to perceptions of poor efficacy.
African Americans in this study rated their current analgesic and anti-inflammatory drugs as being more helpful than Caucasians (6.57 vs. 5.94). Interestingly, African Americans also had higher self-reported OA severity (WOMAC score), which was associated with lower medication helpfulness in our sample. Thus, African Americans had more favorable perceptions of their medications despite reporting greater OA symptoms. When we controlled for demographic variables, disease severity, and the class of drug being taken, the racial difference in medica tion helpfulness was marginally significant. These results, as well as those of Ibrahim et al., indicate there may be some racial difference in perceptions of certain. However, additional systematic study is needed. Qualitative investigations may help to identify cognitive, social, and cultural factors that may influence perceptions of drug helpfulness in different racial and ethnic groups. In addition, clinical trials of analgesic and anti-inflammatory drugs should include adequate representation of racial/ethnic minorities and should conduct subgroup analyses according to subject race.

Three other factors were related to perceptions of medication efficacy in the multivariable analysis: number of drug classes being used, OA severity, and the class of drug being taken. Individuals taking three or more analgesic/anti-inflammatory drugs had greater perceptions of medication efficacy than those taking fewer drugs. This may reflect that some drug combinations being used were particularly effective, or that patients taking more drugs have a greater preference for pharmacotherapy in general. Subjects with greater OA severity (WOMAC score) rated drugs as being less efficacious. This suggests that analgesic/ anti-inflammatory drugs may be limited in their ability to control more severe OA symptoms. Alternatively, other psychological characteristics (i.e., depression) may have led to both a report of a higher level of pain and poorer perception of medication efficacy. Clinically, patients who continue to report high pain levels after multiple therapeutic trials should be referred for evaluation for arthroplasty.
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Perceptions of medication efficacy did not differ between acetaminophen and NSAIDs, but both COX-2 inhibitors and opioid analgesics were rated as more helpful than acetaminophen. Given the potency of opioid analgesics in relieving pain, it is not surprising that these medications were rated as more helpful than acetaminophen. Studies have been mixed with respect to comparisons of acetaminophen and traditional NSAIDs, but recent evidence suggests acetaminophen is not as effective as NSAIDs in treating OA. It is particularly interesting that COX-2 inhibitors—but not traditional NSAIDs—were rated as more helpful than acetaminophen in this study, since clinical trials have consistently shown comparable efficacy of traditional NSAIDs and COX-2 inhibitors. COX-2 inhibitors are more difficult to obtain than NSAIDs within the VA healthcare system. Therefore COX-2 inhibitors may be perceived as being more valuable and helpful than drugs that are easier to obtain. In addition, widespread direct-to-consumer marketing may impact perceptions of medication helpfulness. Regardless of the type of analgesic/anti-inflammatory prescribed, patient education regarding expected effects and possible risks is essential for optimizing adherence.

There are some limitations to this study. The study sample included individuals from a VA Medical Center. Examining racial differences in the context of the VA healthcare system is advantageous, as access-to-care issues are minimized. However, because this study sample was from one site and included a small number of women, generalizability may be limited. Further research is needed to examine these issues in other healthcare settings. Another limitation of our study sample is nonresponse. Much of our nonre-sponse was due to patients missing scheduled clinic appointments (before which the survey administration was scheduled). Because all subject data were gathered by self-report, we were not able to examine whether nonrespondents differed from respondents with respect to demographic characteristics, disease severity, medication use, or perceptions of medication helpfulness. An additional limitation is that we did not assess patients’ adherence to specific drugs. Adherence to prescription instructions may have influenced perceived medication efficacy. eriacta tablets

In summary, African Americans in this study perceived their pain medications to be somewhat more helpful than Caucasians. However, ratings of medication helpfulness were fairly low overall. With the expected rise in the prevalence of OA, it will become increasingly important to assess patients’ perceptions of analgesic/anti-inflammatory medication efficacy and to understand factors that may influence these perceptions.