How "bad" does the pain have to be? A qualitative study examining adherence to pain medication in older adults with osteoarthritis.
OBJECTIVE
To explore the experience of adherence to pain medication in older adults with osteoarthritis (OA).


METHODS
Individuals were recruited from an existing cohort (n = 1,300) of persons with disabling hip and knee OA. Twenty-seven individuals who reported previous physician visits for their arthritis, spoke English, were Toronto residents, and were receptive to in-depth interviews were approached by the cohort telephone interviewer to discuss their experiences with prescribed painkillers for OA. Semistructured face-to-face interviews were conducted by a qualitative researcher in participants' homes.


RESULTS
Nineteen adults (10 women, 9 men) ages 67-92 years were interviewed for 1-3 hours. Participants varied in their socioeconomic status and education levels. Most had comorbidities, such as heart disease and diabetes, for which they were also being treated. Findings indicated that adherence to pain medication differed from that of other prescribed medications. Participants were reluctant to take painkillers, and when they did, they generally took them at a lower dose or frequency than prescribed. This behavior did not reflect their recommendations for others, who they expected to be treated appropriately for pain and to adhere to pain medication. Perceptions and attitudes to pain played an integral role in participants' adherence to painkillers. Despite obvious physical limitations, participants minimized their pain and claimed to have a high pain tolerance.


CONCLUSIONS
These findings suggest that reevaluation of the prescription of pain medication for OA is warranted and that the effectiveness of pain management in OA needs to account for adherence behavior in older adults.
Sunnybrook & Women's College Health Sciences Centre, 76 Grenville Street, Rm. 812B, Toronto, Ontario, Canada M5S 1B2. joanna.sale@sw.ca
Joanna E M
JE
Sale
Monique
M
Gignac
Gillian
G
Hawker
D000368:Aged; D000369:Aged, 80 and over; D000700:Analgesics / Q000627:therapeutic use*; D001294:Attitude to Health; D005260:Female; D006801:Humans; D008297:Male; D010003:Osteoarthritis / Q000150:complications*; D010146:Pain / Q000209:etiology* / Q000517:prevention & control*; D010147:Pain Measurement; D010349:Patient Compliance; D012720:Severity of Illness Index
D000700:Analgesics