title: Patterns of analgesic use, pain and self-efficacy: a cross-sectional study of patients attending a hospital rheumatology clinic.
abstract: BACKGROUND
  Many people attending rheumatology clinics use analgesics and non-steroidal anti-inflammatories for persistent musculoskeletal pain. Guidelines for pain management recommend regular and pre-emptive use of analgesics to reduce the impact of pain. Clinical experience indicates that analgesics are often not used in this way. Studies exploring use of analgesics in arthritis have historically measured adherence to such medication. Here we examine patterns of analgesic use and their relationships to pain, self-efficacy and demographic factors.
  
  
  METHODS
  Consecutive patients were approached in a hospital rheumatology out-patient clinic. Pattern of analgesic use was assessed by response to statements such as 'I always take my tablets every day.' Pain and self-efficacy (SE) were measured using the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) and Arthritis Self-Efficacy Scale (ASES). Influence of factors on pain level and regularity of analgesic use were investigated using linear regression. Differences in pain between those agreeing and disagreeing with statements regarding analgesic use were assessed using t-tests.
  
  
  RESULTS
  218 patients (85% of attendees) completed the study. Six (2.8%) patients reported no current pain, 26 (12.3%) slight, 100 (47.4%) moderate, 62 (29.4%) severe and 17 (8.1%) extreme pain. In multiple linear regression self efficacy and regularity of analgesic use were significant (p < 0.01) with lower self efficacy and more regular use of analgesics associated with more pain.Low SE was associated with greater pain: 40 (41.7%) people with low SE reported severe pain versus 22 (18.3%) people with high SE, p < 0.001. Patients in greater pain were significantly more likely to take analgesics regularly; 13 (77%) of those in extreme pain reported always taking their analgesics every day, versus 9 (35%) in slight pain. Many patients, including 46% of those in severe pain, adjusted analgesic use to current pain level. In simple linear regression, pain was the only variable significantly associated with regularity of analgesic use: higher levels of pain corresponded to more regular analgesic use (p = 0.003).
  
  
  CONCLUSIONS
  Our study confirms that there is a strong inverse relationship between self-efficacy and pain severity. Analgesics are often used irregularly by people with arthritis, including some reporting severe pain.
authors.affiliation: School of Health and Population Sciences, University of Birmingham, Edgbaston, Birmingham, B15 2TT, UK. r.v.blamey@bham.ac.uk
authors.forename: Ruth
authors.initials: R
authors.lastname: Blamey
authors.forename: Kate
authors.initials: K
authors.lastname: Jolly
authors.forename: Sheila
authors.initials: S
authors.lastname: Greenfield
authors.forename: Paresh
authors.initials: P
authors.lastname: Jobanputra
mesh_terms: D000328:Adult; D000368:Aged; D000700:Analgesics / Q000627:therapeutic use*; D001168:Arthritis / Q000150:complications / Q000188:drug therapy* / Q000208:ethnology / Q000523:psychology; D003430:Cross-Sectional Studies; D005006:Ethnicity; D005260:Female; D006801:Humans; D016014:Linear Models; D008297:Male; D055118:Medication Adherence; D008875:Middle Aged; D010044:Outpatient Clinics, Hospital; D010146:Pain / Q000175:diagnosis / Q000188:drug therapy* / Q000208:ethnology / Q000209:etiology / Q000523:psychology; D010147:Pain Measurement; D012219:Rheumatology; D020377:Self Efficacy; D012720:Severity of Illness Index; D011795:Surveys and Questionnaires
chemical_list: D000700:Analgesics