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Cognitive behavioral therapy not as good as NSAIDs for arthritis pain

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Taking placebo and then engaging in a telephone-based cognitive behavioral therapy (CBT) program is inferior to the nonsteroidal anti-inflammatory drug (NSAID) meloxicam for pain management in patients with knee osteoarthritis, according to a study in JAMA Internal Medicine. The authors note however that pain scores between the groups were small and after 14 weeks there was no statistically significant difference in participants’ global impression of change or function.

In the multicenter randomized withdrawal trial, participants taking NSAIDs for knee osteoarthritis pain on most days of the week for at least 3 months, stopped current NSAID use and took 15 mg per day of meloxicam during a 2-week run-in period.

Participants that remained eligible were randomized to receive meloxicam (n = 184) or placebo (n = 180) for 4 weeks; participants in the meloxicam group continued treatment for 10 weeks, whereas those in the placebo group participated in a 10-week CBT program.

After 4 weeks, the estimated mean difference in Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) pain score between the placebo and meloxicam groups was 1.4 (95% CI, 0.8-2.0; noninferiority test P  = 0 .92). At week 14, the adjusted mean difference in WOMAC pain score between the placebo meloxicam groups was 0.8 (95% CI, 0.2-1.4; noninferiority P  =  0.28).

After 14 weeks, no statistically significant difference was found between the groups in in global impression of change or lower extremity disability.


Fraenkel L, Buta E, Suter L, et al. Nonsteroidal anti-inflammatory drugs vs cognitive behavioral therapy for arthritis pain: A Randomized Withdrawal Trial. JAMA Intern Med. Published online July 20, 2020. doi:10.1001/jamainternmed.2020.2821