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. Conclusion. 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.