P102 Pain management and its variation by deprivation in patients with inflammatory arthritis: the PAIN PATH survey

Scott, Ian C; Daud, Noor; Hider, Samantha; Paskins, Zoe; Twohig, Helen; Halliday, Nicola; Mallen, Christian D; Jordan, Kelvin P; Muller, Sara

Abstract

Background/Aims UK-based electronic health record studies show that many patients with inflammatory arthritis (IA) receive opioid and gabapentinoid prescriptions - particularly in areas of deprivation - despite little and no evidence for efficacy, respectively. The extent to which other pain care is used, and the causes of prescribing variation by deprivation, are uncertain. The PAIN PATH survey explored this using data collected from across the UK. Methods Recruitment: consenting patients with rheumatoid arthritis, psoriatic arthritis, or axial spondyloarthritis were recruited: (a) regionally (in 2022-2024 from 8 Midlands-based rheumatology unit clinics), and (b) nationally (in 2024 via advertisements/mailing lists from the National RA Society/National Axial Spondyloarthritis Society/Norfolk Arthritis Registry). Survey: captured cross-sectional data on sociodemographics, pain, and pain care (Likert-type questions evaluating care against European Alliance of Associations for Rheumatology guidance). Analysis: currently restricted to online survey completers (paper survey processing ongoing). Descriptive statistics summarised variables as means/proportions overall and stratified by Index of Multiple Deprivation (IMD) quintiles (1=most deprived; 5=least deprived). Results Participants: 1,673/1,048 regionally/nationally (mean age 56.9/59.7 years; 63.8/84.7% female). Pain: regionally/nationally high-impact chronic pain and meeting fibromyalgia diagnostic criteria were common, occurring in 54.1/48.6% and 33.6/36.0%, respectively. Fewer people reported receiving fibromyalgia diagnoses (12.1/16.9%). High-impact chronic pain/meeting fibromyalgia criteria were commoner in more deprived areas, with 65.5/63.3% vs. 45.5/48.0% in the most vs. least deprived quintiles having high-impact chronic pain, and 44.7/48.8% vs. 26.1/29.0% meeting fibromyalgia diagnostic criteria. Diagnosed fibromyalgia was similar across IMD quintiles regionally, but higher in more deprived areas nationally. Pain Assessment: regionally/nationally, 77.7/61.5% reported being asked about their pain “often/all the time” at IA consultations. However, specific to IA pain assessments, the following were undertaken “rarely/never”: use of patient-reported outcome measures (57.6/64.7%), being asked about mood/emotions (53.7/68.0%) and sleep (48.8/62.8%). No consistent variation in assessments across IMD quintiles was seen. Analgesic Use: regionally/nationally, 86.1/89.9% used analgesics in the past month. Oral opioid/gabapentinoid use was commoner in the most (opioid: 53.8/63.0%; gabapentinoid 13.5/18.8%) vs. least (opioid: 46.0/47.3%; gabapentinoid: 12.3/10.5%) deprived quintiles. Conversely, paracetamol/oral NSAID use was commoner in the least (paracetamol: 74.9/70.0%; NSAIDs: 47.4/49.5%) vs. most (paracetamol: 66.7/58.8%; NSAIDs: 45.6/43.8%) deprived quintiles. Non-Pharmacological Pain Care: more regionally (73.5%) than nationally (43.7%) received pain education. Regionally/nationally, approximately one-half reported seeing a physiotherapist. Of those with an indication, orthotic use “often/all the time” and anxiety/depression treatment were reported in approximately one-half, and receipt of sleep advice/weight management in 10-15%. Orthotic use and depression/anxiety treatment were consistently higher in respondents from more deprived areas regionally/nationally. Conclusion In patients with IA, high impact/widespread chronic pain is common, analgesic use frequent, and holistic assessments/non-drug care appear underused. Interventions are urgently needed to address this. Higher levels of IA opioid/gabapentinoid prescribing in areas of deprivation appear related to greater chronic pain. Disclosure I.C. Scott: Grants/research support; ICS is funded by an NIHR Advanced Research Fellowship [NIHR300826]. N. Daud: None. S. Hider: Honoraria; SH has received payment for lecture fees from UCB. Z. Paskins: Grants/research support; ZP is funded by a National Institute for Health and Care Research (NIHR) Clinician Scientist Award [CS-2018-18-ST2-010]/NIHR Academy. Keele University has received sponsorship from UCB Pharma Limited. H. Twohig: Grants/research support; NIHR Clinical Lectureship. N. Halliday: None. C.D. Mallen: Grants/research support; Keele University have received funding for CMD’s salary from the MRC, AHRC, Versus Arthritis, NIHR, and BMS. K.P. Jordan: Grants/research support; KPJ is partly funded by the NIHR Applied Research Collaboration West Midlands. S. Muller: Grants/research support; SM is partly funded by the NIHR Applied Research Collaboration West Midlands.

Citation

Scott, I. C., Daud, N., Hider, S., Paskins, Z., Twohig, H., Halliday, N., Mallen, C. D., Jordan, K. P., & Muller, S. (2025, April). P102 Pain management and its variation by deprivation in patients with inflammatory arthritis: the PAIN PATH survey. Poster presented at British Society for Rheumatology Annual Conference 2025, Manchester Central Convention Complex, Manchester, England, UK

• Presentation Conference Type: Poster
• Conference Name: British Society for Rheumatology Annual Conference 2025
• Start Date: Apr 28, 2025
• End Date: Apr 30, 2025
• Acceptance Date: Apr 28, 2025
• Online Publication Date: Apr 28, 2025
• Publication Date: Apr 28, 2025
• Deposit Date: Jun 6, 2025
• Journal: Rheumatology
• Print ISSN: 1462-0324
• Electronic ISSN: 1462-0332
• Publisher: Oxford University Press
• Peer Reviewed: Peer Reviewed
• Volume: 64
• Issue: Supplement_3
• DOI: https://doi.org/10.1093/rheumatology/keaf142.142
• Public URL: https://keele-repository.worktribe.com/output/1242669
• Publisher URL: https://academic.oup.com/rheumatology/article/64/Supplement_3/keaf142.142/8114987