Sale Joanna E M, Gignac Monique, Hawker Gillian
Sunnybrook & Women's College Health Sciences Centre, 76 Grenville Street, Rm. 812B, Toronto, Ontario, Canada M5S 1B2.
Arthritis Rheum. 2006 Apr 15;55(2):272-8. doi: 10.1002/art.21853.
To explore the experience of adherence to pain medication in older adults with osteoarthritis (OA).
Individuals were recruited from an existing cohort (n = 1,300) of persons with disabling hip and knee OA. Twenty-seven individuals who reported previous physician visits for their arthritis, spoke English, were Toronto residents, and were receptive to in-depth interviews were approached by the cohort telephone interviewer to discuss their experiences with prescribed painkillers for OA. Semistructured face-to-face interviews were conducted by a qualitative researcher in participants' homes.
Nineteen adults (10 women, 9 men) ages 67-92 years were interviewed for 1-3 hours. Participants varied in their socioeconomic status and education levels. Most had comorbidities, such as heart disease and diabetes, for which they were also being treated. Findings indicated that adherence to pain medication differed from that of other prescribed medications. Participants were reluctant to take painkillers, and when they did, they generally took them at a lower dose or frequency than prescribed. This behavior did not reflect their recommendations for others, who they expected to be treated appropriately for pain and to adhere to pain medication. Perceptions and attitudes to pain played an integral role in participants' adherence to painkillers. Despite obvious physical limitations, participants minimized their pain and claimed to have a high pain tolerance.
These findings suggest that reevaluation of the prescription of pain medication for OA is warranted and that the effectiveness of pain management in OA needs to account for adherence behavior in older adults.
探讨骨关节炎（OA）老年患者服用止痛药物的依从性情况。
从一个现有的队列研究（n = 1300）中招募患有髋部和膝部致残性OA的个体。队列电话访员联系了27名曾因关节炎就诊、会说英语、居住在多伦多且愿意接受深入访谈的个体，讨论他们使用OA处方止痛药的经历。一名定性研究人员在参与者家中进行了半结构化面对面访谈。
对19名年龄在67 - 92岁的成年人（10名女性，9名男性）进行了1 - 3小时的访谈。参与者的社会经济地位和教育水平各不相同。大多数人患有合并症，如心脏病和糖尿病，也正在接受相应治疗。研究结果表明，止痛药物的依从性与其他处方药物不同。参与者不愿服用止痛药，即便服用，通常也低于规定剂量或频次。这种行为与他们对他人的建议不符，他们期望他人能得到适当的疼痛治疗并坚持服用止痛药物。对疼痛的认知和态度在参与者对止痛药的依从性中起着不可或缺的作用。尽管存在明显的身体限制，参与者尽量淡化疼痛，并声称自己有很高的疼痛耐受性。
这些研究结果表明，有必要重新评估OA止痛药物的处方，且OA疼痛管理的有效性需要考虑老年患者的依从行为。
