# Optimizing the value of pain management in knee OA patients with comorbidities

> **NIH NIH R01** · BRIGHAM AND WOMEN'S HOSPITAL · 2021 · $707,306

## Abstract

The broad objective guiding our research is to conduct analyses that will provide critical insights to clinicians
and decision makers to optimize knee OA pain management while reducing opioid use in persons with OA and
major comorbidities including mental health disorders and morbid obesity.
Symptomatic knee osteoarthritis (OA) affects over 14 million Americans and accounts for $27 billion/year in
healthcare expenditures. Traditional views of knee OA pain as nociceptive have been challenged by evolving
evidence that nervous system alterations often result in sensitization and neuropathic-like symptoms. Many
OA patients have comorbidities including depression, which leads to worse knee pain and complicates pain
management, especially regarding opioid use. Medications are only modestly efficacious, in part because they
are not tailored to pain mechanisms. Obesity, especially morbid obesity, further complicates both
pharmacologic and surgical OA pain management. The diversity of pain mechanisms and frequency of
comorbidities have begun to reframe knee OA as a syndrome comprised of multiple phenotypes, wherein a
single treatment strategy does not fit all.
The challenges in OA pain management posed by multiple pain phenotypes and comorbidities, coupled with
the threat of the opioid epidemic, are further exacerbated by the gap between `what we know' and `what we do.'
While the efficacy of pain phenotype-based pharmacotherapy, weight management and exercise have been
established in RCTs these approaches have not translated to routine care. PA is essential to managing OA pain,
yet most OA patients are inactive. Strong evidence suggests that exercise and physical activity (PA) are as
effective as analgesic medications, but implementation of exercise programs is hindered by lack of
infrastructure and funds. Comorbidities augment the risk of physical inactivity, despite strong evidence that PA
is efficacious in OA patients with comorbidities. Evidence of efficacy is not sufficient to facilitate the
implementation of these programs into clinical practice. Implementation requires investment; and knowledge
of the cost-effectiveness and budgetary impact of these programs will help to translate research findings into
day-to-day clinical management.
Decision analysis is an important methodology that helps to evaluate the value of programs that have been
shown to be efficacious. We propose to use a validated computer simulation model of knee OA (OAPol) to
narrow the gap between evidence and practice by assessing the value of three major therapeutic strategies in
managing pain in knee OA patients with comorbidities: 1) tailored pain management according to pain
phenotypes to optimize pharmacologic regimens; 2) weight management in morbidly obese persons to improve
outcomes of OA-focused treatments; and 3) PA programs as non-pharmacologic pain reduction regimens.

## Key facts

- **NIH application ID:** 10197756
- **Project number:** 5R01AR074290-04
- **Recipient organization:** BRIGHAM AND WOMEN'S HOSPITAL
- **Principal Investigator:** Elena Losina
- **Activity code:** R01 (R01, R21, SBIR, etc.)
- **Funding institute:** NIH
- **Fiscal year:** 2021
- **Award amount:** $707,306
- **Award type:** 5
- **Project period:** 2018-08-01 → 2023-06-30

## Primary source

NIH RePORTER: https://reporter.nih.gov/project-details/10197756

## Citation

> US National Institutes of Health, RePORTER application 10197756, Optimizing the value of pain management in knee OA patients with comorbidities (5R01AR074290-04). Retrieved via AI Analytics 2026-05-22 from https://api.ai-analytics.org/grant/nih/10197756. Licensed CC0.

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