Changing the narrative: Progress and challenges of improving osteoarthris (OA) care

“In rich countries, health care costs are rising faster than economic growth. We need to eliminate low-value interventions and practices,” said Dr. Stefan Lohmander, MD, PhD, at the recent Cy Frank Legacy Lecture in Calgary.

Lohmander, an orthopaedic surgeon from Lund University, Sweden, and a world leader in using patient reported outcomes to evaluate care, delivered his lecture to an audience in Calgary, before traveling to Edmonton, Ottawa and London ON for similar presentations.

Swimming upstream

Lohmander’s provocative talk focused on how OA care needs to change.

Stressing the importance of exercise as an effective OA drug, Lohmander raised concerns about prescribing opioids for pain relief in OA patients.  “The evidence shows that NSAIDS (non-steroidal anti-inflammatory drugs, such as ibuprofen) and opioids offer similar pain relief in OA. Why, then, are doctors prescribing opioids for OA? This has to stop.”

Lohmander also discussed the overuse of arthroscopic surgery for knee pain in middle-aged and older patients. “There are a series of studies that show that lifestyle modifications and exercise are as effective as arthroscopic surgery in the management of the painful knee in middle aged patients,” said Lohmander. “Given this, why would we prescribe surgery, which is costly and carries some risk. This is low value care.”

“Trying to get this message out is swimming upstream. There is obviously some resistance to these changes,” said Lohmander.  “We need to change the message, change the treatment focus and put the patient in charge. It’s not about decreasing OA, it’s about decreasing the burden of OA.”

You can view the slides and listen to Dr. Lohmander’s Calgary presentation here.