Perspectives of Healthcare Professionals Towards Combination Use of Oral Paracetamol and Topical Non-Steroidal Inflammatory Drugs in Managing Mild-to-Moderate Pain for Osteoarthritis in a Clinical Setting: An Exploratory Study

Vidhu Sethi; Luke Van der Laan; Sanjeev Gupta; K Cornelius Piros

doi:10.2147/JPR.S373382

Perspectives of Healthcare Professionals Towards Combination Use of Oral Paracetamol and Topical Non-Steroidal Inflammatory Drugs in Managing Mild-to-Moderate Pain for Osteoarthritis in a Clinical Setting: An Exploratory Study

J Pain Res. 2022 Aug 6:15:2263-2272. doi: 10.2147/JPR.S373382. eCollection 2022.

Authors

Vidhu Sethi¹, Luke Van der Laan², Sanjeev Gupta³, K Cornelius Piros⁴

Affiliations

¹ GlaxoSmithKline Consumer Healthcare, Singapore.
² Faculty of Business, Education, Law & Arts, University of Southern Queensland, Queensland, Australia.
³ Department of Orthopaedic Surgery, Royal Prince Alfred Hospital, Sydney, Australia.
⁴ Regena Healthcare, Selangor, Malaysia.

Abstract

Purpose: To seek indicative evidence on clinical prescription practice and perspectives regarding combined oral paracetamol (APAP) and/or topical non-steroidal anti-inflammatory drugs (NSAIDs) therapy for managing mild-to-moderate osteoarthritis (OA) pain.

Participants and methods: An exploratory qualitative study to investigate the perspectives towards using APAP and/or topical NSAIDs for OA pain management and whether current clinical practices are aligned with OA guidelines was conducted using a two-round modified Delphi methodology among three general practitioners, three orthopedists, and two pharmacists from Australia, Malaysia, and Sweden during January-June 2021. In the first round, 60-minute virtual in-depth interviews were conducted individually; in the second round, summary of the key findings was shared with the panel to seek clarity on the level of consensus (≥70% unanimity) and disagreement.

Results: The healthcare professionals (HCPs) agreed that APAP was considered as a universally accepted pharmacologic for most OA patients except those with contraindications or allergies. Consensus was achieved towards APAP combination with topical NSAIDs being a safer alternative than with oral NSAIDs. However, prescription uptake of combined therapy APAP with topical NSAIDs was low among the panel due to lack of strong scientific evidence on efficacy and awareness. Differences in clinical practice across and within countries could be due to different reference sources for OA pain - clinical practice experience or local/international guidelines/medical products handbooks.

Conclusion: The study suggests an opportunity to raise awareness of the suitability and potential benefits for adjuvant topical NSAIDs to APAP for effective OA pain management as well as a need for universal OA guidelines.

Keywords: Delphi methodology; combination therapy; consensus; pain relief; prescription uptake.

Grants and funding

This study was funded by GlaxoSmithKline (GSK); the study sponsor (GSK) provided valuable support in project execution. Cerner Enviza received funding from GSK to conduct the study. The authors acknowledge the team from Cerner Enviza for supporting the development of the study (Mr James McManus and Dr Shikha Singh) and providing medical writing and editorial support (Dr Amanda Woo).