Literature Review to Understand the Burden and Current Non-surgical Management of Moderate–Severe Pain Associated with Knee Osteoarthritis.

Introduction: To conduct a literature review exploring the humanistic burden, costs, and guideline recommendations for non-surgical management of moderate–severe pain in knee osteoarthritis (KOA). Methods: Published studies (2018–25 April 2023) assessing the burden of moderate–severe pain in KOA were identified by searching Medline, Embase, EconLit, and Cochrane database, supplemented with grey literature hand searches and reference list snowballing. Treatment guidelines were also identified for key countries. Results: This review included 106 publications and 37 treatment guidelines. Patients with moderate–severe pain were found to experience a low quality of life (QoL) and an impaired ability to perform daily tasks. The economic burden of KOA was substantial, including cost of medical visits, non-operative treatment (physical therapy and hyaluronic acid [HA] being key drivers) and productivity losses. Non-steroidal anti-inflammatory drugs (NSAIDs) were among the most frequently used pharmacological treatments, with intra-articular (IA) injections used to varying degrees. Opioid use was also frequently reported. Guidelines universally recommended NSAIDs, albeit with limited dose and duration for oral NSAIDs. IA-corticosteroids were conditionally/moderately recommended for short-term use by most guidelines, while IA-HA and opioids were rarely recommended. Guidelines are not specific to patients with moderate–severe pain and do not distinguish between different KOA phenotypes. Conclusions: KOA with moderate–severe pain is associated with substantial humanistic and economic burden. Real-world data suggest that some treatments are regularly used at high cost regardless of the lack of evidence-based recommendations. There remains a need for new treatment options that successfully relieve pain, improve QoL and delay the need for surgery. Graphical abstract available for this article. Plain Language Summary: Knee osteoarthritis is a common cause of disability, especially for people with severe knee pain. Many treatments are used, but not all patients get enough pain relief. This review looked at 106 publications and 37 treatment guidelines published between January 2018 and April 2023. The aim was to understand the cost and burden of knee osteoarthritis in people with moderate to severe pain and the treatments they currently use. The review found that knee osteoarthritis pain makes it hard to perform daily activities and lowers quality of life. Knee osteoarthritis also leads to high costs, mainly due to medical visits and treatments such as physical therapy and hyaluronic acid. People with painful knee osteoarthritis are also less productive while at work, which can be costly. The most common treatments are non-steroidal anti-inflammatory drugs (NSAIDs) and injections into the knee which aim to reduce pain. Some studies also reported high use of opioids. Guidelines for how to treat knee osteoarthritis recommend NSAIDs (for short-term use). Injections with steroids are also recommended to reduce pain and swelling but should only be used for a short time. There are conflicting recommendations for whether hyaluronic acid injection should be used to relieve pain, and the use of opioids is generally not recommended. This review showed that some treatments are regularly used even though they are not recommended in guidelines. This shows the need for new treatment options that work better to relieve pain, improve quality of life and help delay surgery. [ABSTRACT FROM AUTHOR]