Approaches to pain management in women with osteoarthritis

Background: Knee osteoarthritis (OA) increases health care utilization and cost. Women have worse pain and quality of life measures compared to men even after accounting for differences in age, BMI and OA severity. Methods: Using data from the Osteoarthritis Initiative, we identified 2,679 women and men with radiographic tibiofemoral in at least one knee. We classified treatment approaches as current CAM therapy (alternative medical systems, mind-body interventions, manipulation and body-based methods, energy therapies, and 3 types of biologically based therapies) or conventional medication use (OTC or prescription); Gender-specific multivariable logistic regression models identified correlates of CAM use by sociodemographics and clinical/functional factors. Results: CAM use was common (51% women; 41% men). Compared to men, women used more mind-body interventions (14.1% vs. 5.7%), topical agents (16.1% vs. 9.5), and concurrent CAM strategies (18% vs. 9.9%). Increased quality of life measures and physical function indices in women were inversely associated with any therapy, while increased pain scores were positively associated with conventional medication use. History of hip replacement was a strong correlate of conventional medications in women but not men. Multijoint arthritis was associated with increased odds of all treatment: conventional alone (AOR: 2.00;95% CI: 1.36-2.96), CAM alone (AOR: 1.72; 95% CI: 1.25-2.36) or both (AOR: 2.61; 95% CI: 1.83-3.73). Conclusion: Women use CAM more frequently than men and often combine CAM with conventional medication. Clinicians prescribing conventional medications for women with OA of the knee should also consider the effectiveness of combining these treatments with CAM.