How Effective Are NSAIDs for Arthritis Pain?

A combination of placebo and cognitive behavioral therapy (CBT) was inferior to nonsteroidal anti-inflammatory drugs (NSAIDs) such as Meloxicam for treating patients with arthritis pain, according to the results of a new study.

Researchers conducted a multicenter randomized withdrawal trial to assess how treatment with NSAIDs vs placebo affected the pain scores of patients with knee osteoarthritis. The study consisted of 364 patients who were taking NSAIDs for knee osteoarthritis pain the majority of days during the week for a minimum of 3 months between September 2013 and September 2018.

All participants discontinued their current NSAID regimen and began taking 15 mg of meloxicam daily for 2 weeks. Next, the patients were randomly assigned to receive meloxicam or placebo for 4 weeks. The 184 participants who were receiving meloxicam then continued the NSAID for 10 weeks and the 180 participants receiving the placebo were to participate in a CBT program for 10 weeks.

Patients’ pain scores were measured using the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC). The primary outcome of the study was the measurement of pain scores at 4 weeks with the noninferiority margin set to 1. Secondary outcomes included the area under the curve of the pain score after 4 weeks, WOMAC pain score, WOMAC disability score, and global impression of change after treatment at 14 weeks.

The results indicated that the estimated mean difference in WOMAC pain scores between both the placebo and meloxicam groups was 1.4 (95% CI, 0.8-2.0; noninferiority test P = 0.92) after adjustment for confounding factors. At week 14, the mean difference in WOMAC pain scores was 0.8 (95% CI, 0.2-1.4; noninferiority P = 0.28).

“Among patients with knee osteoarthritis, placebo and CBT (after placebo) are inferior to meloxicam. However, the WOMAC pain score differences between the 2 groups were small, and there were no statistically significant differences in participants’ global impression or change or function after 14 weeks,” the researchers concluded.

—Leigh Precopio

Reference:  

Fraenkel L, Buta E, Suter L, et al. Nonsteroidal anti-inflammatory drugs vs cognitive behavioral therapy for arthritis pain: a randomized withdrawal trial. July 20, 2020. Jama Intern Med. 2020;180(9):1194-1202. Doi: 10.1001/jamainternmed.2020.2821