Opioids Use for Osteoarthritis Has Little Benefit and Increased Risk of Adverse Events, Experts

The upper back and neck of a skeleton is shown. (Pxhere)

A study conducted by the University of Sydney has concluded that opioids for the treatment of osteoarthritis (OA), the most common form of arthritis, results in little improvements and actually comes with an increased risk of adverse events.

OA is a degenerative joint disorder that commonly affects older populations. The disorder is due to erosion of joint cartilage that works to lubricate and protect joints resulting in its eventual degradation causing bones to rub against each other, causing pain and inflammation.

Currently, the most common drugs to treat OA are non-steroidal anti-inflammatory drugs NSAIDs such as aspirin and ibuprofen to reduce inflammation and pain as well as analgesics that target pain.

Opioids like tramadol, oxycodone, codeine can also be used to treat pain in OA and are often prescribed for knee joint OA and chronic pain from OA. However, they are not the first choice and are often used in the short-term and in synergy with NSAIDs and analgesics like paracetamol and ibuprofen.

Additionally, stronger opioids such as fentanyl and buprenorphine have also been administered by injections through the skin for OA.

The study led by Dr. Christina Abdel Shaheed argued that the advice around using opioid analgesics is currently “inconsistent” despite 40 percent of people with knee OA in the US being treated with opioids.

Shaheed and her team conducted a review and analysis of previous randomised and placebo-controlled trials of opioid treatments to investigate the medication’s effectiveness in treating pain from osteoarthritis, disability, health-related quality of life, and adverse events data from 36 trials.

Results from 19 trials for medium-term treatment showed that opioids had low-quality effects in pain relief and 16 trials showed a small effect on disability.

The opioid, tramadol was found to be statistically significant in minor decreases to pain and both disability in medium term uses.

However, the authors wrote that given its “very small effects, the appropriateness of single-ingredient opioids for managing osteoarthritis is debatable.”

Nevertheless, the team advised that for “some people with osteoarthritis, short term use of these combination analgesics may be a reasonable option” with the drug commonly being prescribed for joint pain.

Nonetheless, 16 interventional studies showed an elevated risk of adverse events in patients when opioids are administered.

The studies showed that participants within the control group suffered a greater proportion of adverse effects as opposed to the placebo group. The most common adverse events are gastrointestinal events such as nausea, vomiting, constipation and diarrhoea.

Shaheed and her colleagues also debunked the current common thought that increased opioid dosages improve the effect of the treatment with analysis showing that dosage was not “statistically significantly associated” with either a degree of pain relief or incidences of adverse events.

The authors called for further research into the adverse effects of opioids, though the association between adverse events and opioids are found, the association is small.

“Alternative pain management strategies for people with osteoarthritis should be investigated, as well as opioid-sparing and tapering strategies for those being treated with opioids.”