- A new study reports that opioids only provide small benefits in pain management for people with osteoarthritis.
- Researchers say techniques such as heat, ice, and exercise can be more effective than opioids.
- Experts also suggest that people with osteoarthritis can use the “inner pharmacy” in their brain to ease pain.
Opioid drugs should almost never be used in the management of pain associated with osteoarthritis.
That’s the conclusion from researchers at Tufts University in Boston and Lund University in Sweden in a new study released today.
“Oral opioids are only advisable in [osteoarthritis] patients who have failed all other medical therapy and in whom surgical intervention is contraindicated,” Raveendhara R. Bannuru, MD, FAGE, lead study author and director of the Center for Treatment Comparison and Integrative Medicine at Tufts Medical Center, told Healthline.
Overall, “opioids demonstrate only small benefits on pain and function from 2 to 12 weeks of treatment [and] no measurable benefit to quality of life or depression” when compared to a placebo, the study authors wrote.
The conclusion was reached after researchers reviewed 23 previously published clinical trials.
“Strong opioids demonstrated consistently worse pain relief with greater risk of any safety outcome than weak opioids,” the study researchers said. “In light of this evidence, clinicians and policy makers should reconsider the utility of strong opioids in the management of [osteoarthritis].”
The research was presented at the American College of Rheumatology’s annual meeting in Atlanta.
Osteoarthritis is a common joint disease that most often affects middle age and older adults.
It’s characterized by the breakdown of cartilage tissue, bone changes in the joints, deterioration of tendons and ligaments, and various degrees of inflammation of the joint lining.
Pain associated with osteoarthritis can be significant.
Dr. Bannuru said that the ongoing controversy regarding the use of opioid drugs to treat chronic pain led researchers to examine the effectiveness of such drugs in people with osteoarthritis.
David Ring, MD, PhD, the associate dean for comprehensive care at Dell Medical School at the University of Texas at Austin, told Healthline that prior to intense marketing of opioid drugs by pharmaceutical companies such as Purdue Pharma over the past few decades, opioids were rarely used to treat chronic pain.
“We only use opiates for acute pain,” such as after surgery, Dr. Ring said.
John Xerogeanes, MD, chief of sports medicine and professor of orthopaedic surgery at the Emory University School of Medicine in Georgia, told Healthline that the findings make a strong case for choosing other interventions over opiates for pain management.
“People think you take these drugs and your pain magically disappears, but really they just distract you by making you tired or feeling dystrophic,” he said. “They don’t really get rid of the pain.”
Even for postsurgical pain, Dr. Xerogeanes said a mix of the common pain reliever Tylenol and NSAID-class anti-inflammatory drugs such as ibuprofen are more effective than opioid drugs.
“The last thing you want to do for someone with chronic pain is give them opioids,” he said. “Not only will they suffer side effects [such as constipation], but over the long run they can become dependent on these drugs.”
“Standard care for [osteoarthritis] has never been opioids,” Xerogeanes said.
Despite this fact, Bannuru told Healthline, “[Osteoarthritis] is still a major contributor to opioid consumption both in the U.S. and abroad.”
“For example, in a large European observational study that was just published this year, opioid prescription rates within the first year of knee or hip [osteoarthritis] diagnosis were shown to range from 15 percent to 21 percent,” he said.
Xerogeanes acknowledged that the physicians’ toolbox is limited when it comes to mitigating chronic pain from osteoarthritis.
“Non-medications that work well include contrasting heat and ice,” he said. Exercise can help ease knee pain, he added.
“For long-term management of knee and hip [osteoarthritis] symptoms, dietary management and regular physical activity are always recommended,” Bannuru said. “More awareness is being raised about the potential benefits of mind-body interventions as well.”
Ring said that mental attitude can often be as effective in pain management as medication may be.
The human body has an “inner pharmacy” that produces its own opiate chemicals, he said, and can be activated by such diverse factors as placebos, cognitive behavioral therapy, or even just the reinforcement of getting good care from doctors and nurses and support from friends and family.
“Being pharma-centric can be problematic, opioid or otherwise,” he said.
Ring noted that while 1 in 5 Americans report experiencing chronic pain, far fewer define themselves as being “ill with pain,” suggesting that they have found coping mechanisms to adapt (and even accept) the discomfort that sometimes accompanies age or injury.
“If your inner narrative [about pain] is a healthy one, you can deal with it much better,” he said.