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Rheumatology Advance Access published online on October 14, 2006
Rheumatology, doi:10.1093/rheumatology/kel355
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© The Author 2006. Published by Oxford University Press on behalf of the British Society for Rheumatology. All rights reserved. For Permissions, please email: journals.permissions@oxfordjournals.org
Received June 1, 2006
Accepted September 15, 2006

Original Papers

A longitudinal study exploring pain control, treatment and service provision for individuals with end-stage lower limb osteoarthritis

G. A. McHugh 1 *, K. A. Luker 1, M. Campbell 1, P. R. Kay 2, and A. J. Silman 3

1 School of Nursing, Midwifery and Social Work, University of Manchester, Oxford Road, Manchester M13 9PL, UK.
2 Department of Orthopaedics, Wrightington, Wigan and Leigh NHS Trust, Wrightington Hospital, Appley Bridge, Wigan, Lancashire WN6 9EP, UK.
3 School of Epidemiology and Health Sciences, University of Manchester, Oxford Road, Manchester M13 9PT, UK.

* To whom correspondence should be addressed.
G. A. McHugh, E-mail: gretl.mchugh{at}manchester.ac.uk


  Abstract

Objective. To investigate the level of pain control, treatment and service provision amongst individuals with end-stage lower limb osteoarthritis who were on the waiting list for hip or knee joint replacement.

Methods. A total of 105 patients on a waiting list for primary knee or hip replacement from a regional orthopaedic centre in the UK were recruited. The study was longitudinal and based on direct interviews at baseline and 6 months, with a postal questionnaire at 3 months. Data were collected on pain by a visual analogue scale (VAS) and the Western Ontario and McMaster Universities (WOMAC) osteoarthritis index. In addition, medication and the use of services and treatments were recorded.

Results. Participants experienced high levels of pain as measured by VAS [mean 7.0; 95% confidence interval (CI) 6.6-7.5] and WOMAC pain (mean 11.2; 95% CI 10.6-11.9). The majority of participants (78, 74%) was taking analgesics more than once a day. Primary care utilization was variable. Of the 74 (70%) participants who had consulted their GP in the previous 3 months, 41 (55%) had not discussed their pain or osteoarthritis during these consultations. Just below one-third of participants (31, 30%) reported to have received information on osteoarthritis.

Conclusions. Pain appears to be difficult to manage in individuals with end-stage lower limb osteoarthritis. Individuals appeared not to be taking appropriate levels of analgesia in relation to levels of pain. Improvements are required in the provision of information on pain and osteoarthritis. Patients would benefit from more proactive management by health professionals (especially by GPs).

Keywords: Longitudinal study; Service provision; Pain; Osteoarthritis; Joint replacement; Waiting list.
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