Pain relief in osteoarthritis: patients' willingness to risk medication-induced gastrointestinal, cardiovascular, and cerebrovascular complications.
OBJECTIVE
Information concerning patients' preferences for the treatment of osteoarthritis (OA) is limited. We examined patients' attitudes toward the acceptability of gastrointestinal, cardiac, and cerebrovascular events in order to obtain pain relief from OA.


METHODS
Patients responded to a set of threshold technique tasks. Each task described 2 treatment options, their levels of pain relief, and the risks of side effects. The risk for the side effect under investigation was then systematically increased to reveal the maximal acceptable risk increment associated with the pain reduction.


RESULTS
Of 196 patients, 22.3% and 14.7% were unwilling to accept any additional risk of stomach bleed or heart attack/stroke for 2-point and 5-point pain reductions, respectively. Patients were willing to accept significantly more risk for a 5-point pain reduction than for a 2-point pain reduction in stomach bleed and heart attack/stroke scenarios. Patients also accepted significantly greater additional risks of stomach bleed compared to heart attack/stroke for 2-point and 5-point pain reductions.


CONCLUSIONS
Most patients with OA are willing to accept some additional risk of stomach bleed and heart attack/stroke to gain pain relief. Patients are willing to accept greater additional risk of stomach bleed than heart attack/stroke. However, there exists considerable variation in risk-taking attitudes across patients. We recommend that clinicians examine the risk attitude and treatment preferences of each patient on an individual basis when deciding on a treatment regimen.
Richardson
Chris G
CG
Arthritis Research Centre of Canada, Vancouver, British Columbia, Canada. richardson_cg@yahoo.com
Chalmers
Andrew
A
Llewellyn-Thomas
Hilary A
HA
Klinkhoff
Alice
A
Carswell
Anne
A
Kopec
Jacek A
JA
D000368:Aged; D000893:Anti-Inflammatory Agents / Q000009:adverse effects*; D001294:Attitude to Health; D002318:Cardiovascular Diseases / Q000139:chemically induced*; D002561:Cerebrovascular Disorders / Q000139:chemically induced*; D005260:Female; D006471:Gastrointestinal Hemorrhage / Q000139:chemically induced*; D006801:Humans; D008297:Male; D008875:Middle Aged; D010003:Osteoarthritis / Q000150:complications / Q000188:drug therapy / Q000523:psychology; D010146:Pain / Q000209:etiology / Q000517:prevention & control*; D010342:Patient Acceptance of Health Care / Q000523:psychology; D012309:Risk-Taking
D000893:Anti-Inflammatory Agents