Pain management and its variation by deprivation in patients with inflammatory arthritis: the PAIN PATH surveys

Background Inflammatory arthritis (IA) is a common cause of chronic pain, which is often managed with long-term opioids and gabapentinoids (particularly in deprived areas) despite no evidence for efficacy. The extent to which efficacious, non-drug pain treatments are used is unclear. We addressed this by examining pain profiles and pain management in patients with IA from across the UK and exploring how they vary by deprivation. Methods Two surveys were conducted - a Regional Hospital Survey (RHS), recruiting patients via Midlands’ rheumatology departments, and a National Patient Survey (NPS), recruiting patients from across the UK via online publicity, national patient organisations, and a research register. A cross-sectional questionnaire assessed pain and its care. Descriptive analyses summarised pain profiles and the prevalence of drug and non-drug pain management overall and across Index of Multiple Deprivation (IMD) quintiles. Logistic regression models examined associations between deprivation and opioid/gabapentinoid use. Results RHS included 1,842 and NPS 1,049 patients (RHS/NPS mean ages 57.6/59.6 years; 64.6/84.7% female). High-impact chronic pain affected approximately one-half. Most reported being asked about pain regularly by clinicians (RHS 77.3/NPS 61.5%) but pain assessments were infrequently holistic. Opioid use was commonplace (RHS 43.5/NPS 47.8% used opioids in the past month). Obesity (RHS 38.8/NPS 35.3%) and persistent poor-quality sleep (RHS 68.9/NPS 74.4%) were prevalent; non-drug pain care, including weight/sleep management, was infrequent. Approximately half had seen a physiotherapist, and one third an occupational therapist/podiatrist post-IA diagnosis. High-impact chronic pain (65.9 vs. 46.0% RHS/61.3 vs. 48.0% NPS) and opioid use (48.5 vs. 39.4% RHS/51.9 vs. 41.6% NPS) were commoner in the most vs. least deprived IMD quintiles, with the latter association statistically significant in RHS (OR 1.45; 95% CI 1.07, 1.98), but not after adjusting for pain intensity. Pain-related factors like obesity were commoner in more deprived regions. Non-pharmacological pain management was similar across IMD quintiles. Conclusions In patients with IA, chronic pain/opioid use are common, and holistic pain assessments/non-drug pain care are underused. Those in more deprived areas have more high-impact chronic pain. An increased focus on biopsychosocial IA pain care is needed, supported by policies to reduce health inequalities in pain.