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Drug hope for severe hand pain in osteoarthritis patients

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The debilitating hand pain often experienced by osteoarthritis patients can be successfully treated with a drug normally used for epilepsy, anxiety and neuropathic pain, according to UK researchers.

The researchers noted that millions of people across the UK experienced debilitating hand pain due to the condition, with the usual care being ibuprofen and other non-steroidal anti-inflammatory drugs (NSAIDs).

“Centrally acting analgesics improve pain outcomes in people with hand arthritis”

Study authors

Patients were usually also sent for hand physiotherapy, but some said they could not continue the therapy because of the pain, they added.

The study, by St George’s University of London, showed that a drug called pregabalin was the most effective trial treatment. Patients took two pills daily and were treated during a three-month period.

The trial involved 65 patients, aged 40–75 years, who were given different medication and then monitored.

The participants were split into three, with one group taking pregabalin 150mg, one taking duloxetine 30mg and another given a placebo. All the pills involved were made to look the same.

“We wanted to focus on hands as no one had really investigated that area before”

Nidhi Sofat

The primary endpoint was the Numerical Rating Scale (NRS) pain score. Secondary ones included pain, stiffness and function scores using the Australian and Canadian Hand Osteoarthritis Index (AUSCAN).

After 13 weeks, compared to placebo, the study authors said they found “significant” differences between the three groups, with both active drugs showing an “improvement in pain”

Comparison of pregabalin versus placebo showed a significant improvement in the pregabalin group for primary outcomes of NRS pain, AUSCAN pain, and AUSCAN function but not AUSCAN stiffness.

In contrast, for duloxetine, none of the measured outcome improvements were significantly different to placebo.

The researchers said their clinical study provided the “first evidence” in chronic painful hand osteoarthritis that pregabalin and duloxetine were analgesics with “potential for use”.

The highlighted that, based on their findings, pregabalin provided the “best treatment response and sustained effects beyond the reduction in dose”.

“We conclude that centrally acting analgesics improve pain outcomes in people with hand arthritis, offering new treatment paradigms for osteoarthritis pain,” they said.

“The results of our trial have strong clinical relevance, since many patients report lack of efficacy or side effects on NSAIDs and other patients have important safety concerns,” they added.

St George’s University of London

Drug hope for severe hand pain in osteoarthritis patients

Nidhi Sofat

Lead study author Dr Nidhi Sofat, a reader in rheumatology, said: “Usually, drug trials for arthritis are aimed at helping patients with problems in their knees or hips, but we wanted to focus on hands as no one had really investigated that area before.

“To tackle the pain would mean an improvement in the general wellbeing and care of patients with this condition,” said Dr Sofat. “This led us to run a trial to try to switch off the pain receptors in the brain to enable patients to manage their condition more easily.

“They reported an improvement in not only pain, but also their abilities to do daily tasks like cooking, washing dressing. They also used six times less extra pain relief than the placebo group,” she said.

The study, published in the Journal of Pain Research, was funded by Rosetrees’ Trust and the National Institute for Health Research.

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Readers' comments (2)

  • I am not sure ,Is that the side effects of pregabalin is not causing the elderly patients other risks?

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  • Does the word “significant” to describe results in this hand osteoarthritis double blind study have the same meaning as “significant” does in common parlance?

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