No role of Opioids in reducing pain and disability in chronic osteoarthritis
Germany: Opioids provided no clinically relevant pain relief and no clinically relevant reduction in disability compared with placebo in chronic osteoarthritis pain (hip, knee), according to a recent study published in the European Journal of Pain.
Osteoarthritis (OA) is the most common form of arthritis which has become one of the leading causes of disability in older adults. It occurs due to the break down of cartilage, causing the bones within the joints to rub together causing pain, stiffness, and other symptoms.
OA occurs most often in older people, although it can occur in adults of any age. OA is also called degenerative joint disease, degenerative arthritis, and wear-and-tear arthritis.
The major treatment hurdle for osteoarthritis is the absence of any good disease-modifying drugs for this disease. Without effective treatment, physicians are left to manage patients symptomatically and the most common thing done by them is to manage their pain. One of the main culprits [driving opioid use] are chronic pain patients and one of the most highly prescribed conditions for opioids is osteoarthritis.
This updated systematic review by Winfried Häuser, Health Care Center for Pain Medicine and Mental Health, Saarbrücken, Germany, and colleagues, evaluated the efficacy and safety of opioids compared with placebo for chronic osteoarthritis pain.
For the purpose, the researchers searched the online databases from October 2013 to July 2019. Randomized controlled trials comparing opioids with placebo and at least 4 weeks double‐blinded duration were analyzed. A total of 22 studies with 8,942 participants were included in the meta-analysis. Study duration ranged between 4 and 24 weeks.
Primary outcomes were pain relief of 50% or greater, disability, tolerability and safety.
Key findings of the study include:
- Based on very low– to low‐quality evidence, opioids provided no clinically relevant pain relief of 50% or greater and no clinically relevant reduction in disability compared with the placebo.
- There was clinically relevant harm related to the dropout rate due to adverse events.
- The frequency of serious adverse events did not differ from placebo.
- Enriched enrolment randomized withdrawal design:
- Based on very low– to low‐quality evidence, opioids provided no clinically relevant pain relief of 50% or greater and no clinically relevant reduction in disability compared with placebo.
- Dropout rates due to adverse events and frequency of serious adverse events did not differ from placebo.
"Tolerability of opioids is low and efficacy is not clinically relevant in controlled studies from 4 to 24 weeks for osteoarthritis pain," wrote the authors.
The study, "Opioids for chronic osteoarthritis pain: An updated systematic review and meta‐analysis of efficacy, tolerability and safety in randomized placebo‐controlled studies of at least 4 weeks double‐blind duration," is published in the European Journal of Pain.