The use of beta-blockers in migraine suggests an anti-nociceptive effect but emerging data indicate that these drugs are of value in the management of chronic pain.
Osteoarthritis (OA) is the most common form of arthritis and affects a large number of people aged 50 years and over. Non-steroidal anti-inflammatory drugs are often used to manage the condition although these agents are associated with adverse cardiovascular, gastrointestinal and renal effects that are potentially more problematic in the age group affected by the condition. Some evidence from animal studies suggests that beta-blockers have anti-nociceptor effects and pindolol has been shown to be of value in the treatment of fibromyalgia. In a 2017 study among 873 patients with OA, it was observed that among those prescribed beta-blockers, pain scores were lower. However, a more recent study failed to confirm the earlier findings. This uncertainty prompted a team from the School of Medicine, University of Nottingham, UK, to retrospectively examine data from the clinical practice research datalink which contains anonymised data on over 10 million people in the UK. The researchers looked at people aged 40 years and over, prescribed a beta-blocker and propensity matched to a group not prescribed these drugs. The outcome of interest was primary care consultations for knee osteoarthritis (OA), hip OA, knee pain or hip pain.
Data were available for 223,436 individuals (111,718 beta-blocker exposed) and (111,718 non-exposed). Compared with matched controls, the use of a beta-blocker was associated with a reduced cumulative risk of knee OA, (hazard ratio, HR = 0.90, 95% CI 0.83 – 0.98) and similar, significant associations were noted for knee pain (HR = 0.88) and hip pain consultations (HR = 0.85). In addition, beta-blockers associated with a lower incidence of knee OA were propranolol (HR = 0.78) and atenolol (HR = 0.91) with similar associations seen for knee pain.
In discussing their findings, the authors noted how the impact of beta-blockers on OA pain and consultations disappeared once these drugs were stopped as evidenced by a higher level of pain-related consultations. They also described how other evidence had indicated how the nociceptor effects were mediated only through beta-2 receptor blockade.
They concluded that propranolol might be more suited to those with both OA and anxiety, whereas atenolol would be more appropriate for those with OA and cardiovascular comorbidities.
Nakafero G et al. Beta-blocker prescription is associated with lower cumulative risk of knee osteoarthritis and knee pain consultations in primary care: a propensity score matched study. Rheumatology (Oxford) 2021