In a report published by the CDC on October 7, 2016, researchers from the CDC analyzed data from the Health Interview Survey to determine the prevalence of severe joint pain (SJP) among adults with doctor diagnosed arthritis and the trend in SJP from 2002 to 2014. In the United States, arthritis is a leading cause of disability. Arthritis affected an estimated 52.5 million adults in 2010 to 2012 and has been projected to affect 78.4 million adults by 2040.
Severe joint pain is a common outcome among adults with arthritis that can limit a person’s ability to perform basic functions and seriously compromise the quality of life. In 2014, approximately one fourth of adults with arthritis had SJP (27.2%). Groups disproportionately affected by SJP included women, non-Hispanic blacks, Hispanics, those with a disability, those unable to work and those with less than a high school education, fair/poor health, obesity, heart disease, diabetes or serious psychological distress.
From 2002 to 2014, the age-standardized prevalence of SJP among adults with arthritis did not change. However, the number of adults with SJP was significantly higher in 2014 (14.6 million) than in 2002 (10.5 million). A strategy to improve pain management (e.g., the 2016 National Pain Strategy) has been developed, and more widespread dissemination of evidence-based interventions that reduce joint pain in adults with arthritis might reduce the prevalence of SJP.
The CDC used data from the National Health Interview Survey, an annual, nationally representative, in-person survey of health status and behaviors of the noninstitutionalized civilian U.S. adult population. Sampling weights were applied so that estimates were representative of the civilian noninstitutionalized U.S. population.
Respondents were classified as having doctor-diagnosed arthritis if they answered “yes” to the question, “Have you ever been told by a doctor or other health professional that you have some form of arthritis, rheumatoid arthritis, gout, lupus, or fibromyalgia?” Among adults reporting joint pain, respondents were asked to “please think about the past 30 days, keeping in mind all of your joint pain or aching and whether or not you have taken medication. During the past 30 days, how bad was your joint pain on average? Please answer on a scale of 0 to 10, where 0 is no pain or aching and 10 is pain and aching as bad as it can be.” SJP was defined as a response ≥7.
SJP can limit a person’s ability to perform basic functions and seriously compromise their quality of life. The CDC Guideline for Prescribing Opioids for Chronic Pain recommends use of exercise therapy, cognitive behavioral therapy, certain interventional procedures, acetaminophen, and nonsteroidal anti-inflammatory drugs for the treatment of arthritis. There is insufficient evidence for and serious risks associated with long-term use of opioid therapy to treat chronic pain. Medications can help, but low-impact physical activity (e.g., walking, biking, and swimming) is a non-pharmacologic and underused way of reducing joint pain.
For those concerned about safely increasing physical activity without worsening their joint pain or their arthritis, community-based program (e.g., Enhance Fitness and Walk with Ease) are available. In addition, participation in self-management education interventions (e.g., the Chronic Disease Self-Management Program) has been shown to improve health-related quality of life and confidence in managing symptoms of arthritis and other health conditions. Targeting specific subgroups with a high prevalence of SJP (e.g., non-Hispanic blacks, Hispanics, those unable to work, and those with poor health or chronic conditions) might help reduce the large disparities in SJP burden.
The 2016 National Pain Strategy, the first broad federal effort to develop strategies to reduce pain, has strategies and objectives in six categories (population research, prevention and care, disparities, service delivery and payment, professional education and training, and public education and communication) aimed at reducing the burden of pain for persons and the nation. Two major objectives are to (1) take steps to reduce barriers to pain care, and (2) to increase patient knowledge of treatment options and risks. The CDC currently funds arthritis programs in twelve states. Health care providers and public health practitioners can begin to implement the recommendations and improve pain care among adults with arthritis and SJP by prioritizing self-management education and appropriate physical activity interventions as effective non-pharmacologic ways to reduce pain and improve health outcomes.
See the CDC Report
See also Medical Law Perspectives, September 2015 Report: Arthritis Pain and Inflammation: Diagnosis and Treatment Risks
See also Medical Law Perspectives, January 2014 Report: Prescription Painkillers: Risks for Patients, Pharmacists, and Physicians
See also Medical Law Perspectives, July 2013 Report: New Hips, New Knees, New Problems: Hip and Knee Replacements