Racial differences in pain management approaches in patients with osteoarthritis

Background: Osteoarthritis (OA), one of the most common musculoskeletal disorders, has no known cure at present. Limited studies show inconsistent evidence about racial differences in pain management in these patients. Methods: Using data from the Osteoarthritis Initiative, we identified 2,075 non-Hispanic Whites and 508 African-Americans with radiographic tibiofemoral knee OA in at least one knee. Information on CAM therapies (including alternative medical systems, mind-body interventions, manipulation and body-based methods, energy therapies, and 3 types of biologically based therapies) and conventional medication (prescription and OTC NSAIDs, acetaminophen, opioids and doxycycline) were collected by trained interviewers. Polytomous logistic regression was applied to estimate the association between race and treatment approaches after controlling potential confounders. Results: Generally, non-Hispanic Whites used CAM more commonly than African-Americans to alleviate symptoms (48.0% versus 41.5%). Non-Hispanic Whites used more biologically based supplements (35.4% versus 17.9%) and manipulation and body-based methods (6.1% versus 1.4%), while African-Americans used more topical agents (23.2% versus 10.7%). African-Americans used more conventional medication than non-Hispanic Whites (49.8% versus 38.4%). After adjusting for potential confounders, African-Americans were less likely than non-Hispanic Whites to use CAM therapies either alone (OR: 0.71; 95% CI: 0.51-1.00) or in combination with conventional medication (OR: 0.54; 95% CI: 0.38-0.76). Conclusion: Both CAM and conventional medication are commonly used for pain management in OA patients; however, use of these therapies varies by racial group. Some CAMs may be effective; others may interact with conventional medications. Further studies are necessary to determine the effects of different pain management approaches.