How Bad does the pain have to be? A qualitative study examining adherence to pain medication in older adults with osteoarthritis

Objective. To explore the experience of adherence to pain medication in older adults with osteoarthritis (OA). Methods. 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. Results. 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. Conclusion. 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.