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The use of opioids in the treatment of osteoarthritis: When, why, and how?

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Abstract

As life expectancy increases every decade, the incidence and prevalence of osteoarthritis (OA) also will increase. Despite progress in our knowledge of the pathophysiology of OA, the management of OA-mediated pain continues to challenge physicians. Concern regarding the cardiovascular effects of cyclooxygenase-2 inhibitors and the gastrointestinal and renal side effects of nonsteroidal anti-inflammatory drugs (NSAIDs) in general has limited the use of these medications in the management of chronic non-cancer pain. Appropriately dosed and monitored use of opioids for OA pain, when more conservative methods have failed, has potentially fewer life-threatening complications associated with it than the more commonly and often less successfully employed pharmacotherapeutic approaches to care. When used as part of a multimodal approach to pain control, opioids are a safe and effective treatment for joint pain, including that of OA. Patients for whom NSAIDs are contraindicated, or for whom combined acetaminophen, tramadol, and NSAID therapy is ineffective, may be started on low-dose opioids and titrated as needed and tolerated. Patient education and informed consent, exercise, complementary medicine, and the use of a controlled substance agreement increases the likelihood of patient compliance with treatment guidelines, improving functional capacity and quality of life.

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References and Recommended Reading

  1. Ahmedzai S: Recent clinical trials of pain control: impact on quality of life. Eur J Can 1995, 31A(suppl 6):S2-S7.

    Article  Google Scholar 

  2. Pritzker K: Pathology of osteoarthritis. In Osteoarthritis, edn 2. Edited by Brandt K, Doherty M, Lohmander LS. Oxford: University Press; 2003:49–58.

    Google Scholar 

  3. Sutherland SP, Cook SP, McCleskey EW: Chemical mediators of pain due to tissues damage and ischemia. Prog Brain Res 2000, 129:21–28.

    Article  PubMed  CAS  Google Scholar 

  4. Lawrence RC, Helmick CG, Arnett FC, et al.: Estimates of the prevalence of arthritis and selected musculoskeletal disorders in the United States. Arthritis Rheum 1998, 41:778–799.

    Article  PubMed  CAS  Google Scholar 

  5. Centers for Disease Control: Impact of arthritis and other rheumatic conditions on the health-care system-United States. 1997. MMWR 1999, 48:349–353.

    Google Scholar 

  6. Nichol MB, Harada AS: Measuring the effects of medication use on health-related quality of life in patients with rheumatoid arthritis: a review. Pharmacoeconomics 1999, 16:433–448.

    Article  PubMed  CAS  Google Scholar 

  7. Giraudet-Le Quintrec JS, Coste J, Vastel L, et al.: Positive effect of patient education for hip surgery: a randomized trial. Clin Orthop Relat Res 2003, 414:112–120.

    Article  PubMed  Google Scholar 

  8. Tak E, Staats P, Van Hespen A, Hopman-Rock M: The effects of an exercise program for older adults with osteoarthritis of the hip. J Rheumatol 2005, 32:1106–1113.

    PubMed  Google Scholar 

  9. McQuay HJ, Moore RA: An Evidenced-based Resource for Pain Relief. New York: Oxford University Press; 1998.

    Google Scholar 

  10. Schnitzer TJ: Update of ACR Guidelines for Osteoarthritis: role of the coxibs. J Pain Symptom Manage 2002, 23:524–530.

    Article  Google Scholar 

  11. Henrich WL, Agodoa LE, Barrett B, et al.: Analgesics and the kidney: summary and recommendations to the Scientific Advisory Board of the National Kidney Foundation from an Ad Hoc Committee of the National Kidney Foundation. Am J Kidney Dis 1996, 27:162–165.

    PubMed  CAS  Google Scholar 

  12. Rygnestad T, Zahlsen K, Samdal FA: Absorption of effervescent paracetamal tablets relative to ordinary paracetamal tablets in healthy volunteers. Eur J Clin Pharmacol 2000, 56:141–143.

    Article  PubMed  CAS  Google Scholar 

  13. Flowe RJ, Vane JR: Inhibition of prostaglandin synthetase in brain explains the anti-activity of paracetamol (4-acetamidophenol). Nature 1972, 240:410–411.

    Article  Google Scholar 

  14. Chandrasekharan NV, Dai H, Ross KL, et al.: COX-3, a cyclooxygenase-1 variant inhibited by acetaminophen and other analgesic/antipyretic drugs: cloning, structure, and expression. Proc Natl Acad Sci U S A 2002, 99:13926–13931.

    Article  PubMed  CAS  Google Scholar 

  15. Bjordal JM, Ljunggren AE, Klovning A, et al.: Non-steroidal antiinflammatory drugs, including coxibs, in osteoarthritic knee pain: a meta-analysis of randomized, placebo-controlled trials. BMJ 2004, 329:1317–1320.

    Article  PubMed  CAS  Google Scholar 

  16. Zhang W, Jones A, Doherty M: Does paracetamol reduce the pain of osteoarthritis? A meta-analysis of randomized, controlled trials. Ann Rheum Dis 2004, 63:901–907.

    Article  PubMed  CAS  Google Scholar 

  17. American College of Rheumatology Subcommittee on Osteoarthritis Guidelines: Recommendations for the medical management of osteoarthritis of the hip and knee: 2000 update. Arthritis Rheum 2000, 43:1905–1915. These are current recommendations from the American College of Rheumatology.

    Article  Google Scholar 

  18. Grond S: Clinical pharmacology of tramadol. Clin Pharmacokinet 2004, 43:879–923.

    Article  PubMed  CAS  Google Scholar 

  19. Raffa RB, Friderichs E, Reiman E, et al.: Opioid and non-opioid components independently contribute to the mechanism of action of tramadol, an “atypical” opioid analgesic. J Pharmacol Exp Ther 1992, 260:275–285. Tramadol has lower affinity for μ receptors and is an alternative for patients who are intolerant of NSAIDs.

    PubMed  CAS  Google Scholar 

  20. Cicero TJ, Adams EH, Geller A: Assessment of tramadol abuse from April 5, 1995 until March 31, 2000: progress report of the Independent Steering Committee, USA 2000. ISC.

  21. Lewis KS, Han NH: Tramadol: a new centrally acting analgesic. Am J Health Syst Pharm 1997, 54:643–652.

    PubMed  CAS  Google Scholar 

  22. Fricke JR Jr, Karim R, Jordan D, et al.: A double-blind, singledose comparison of the analgesic efficacy of tramadol/acetaminophen combination tablets, hydrocodone/acetaminophen combination tablets, and placebo after oral surgery. Clin Ther 2002, 24:953–968.

    Article  PubMed  CAS  Google Scholar 

  23. Cicero TJ, Inciardi JA, Adams EH, et al.: Rates of abuse of tramadol remain unchanged with the introduction of new branded and generic products: results of an abuse-monitoring system, 1994–2004. Pharmacoepidemiol Drug Saf 2005, Epub ahead of print.

  24. Gasse C, Derby L, Vasilakis-Scaramozza C, et al.: Incidence of first-time idiopathic seizures in users of tramadol. Pharmacotherapy 2000, 20:629–634.

    Article  PubMed  CAS  Google Scholar 

  25. Emkey R, Rosenthal N, Wu SC, et al.: CAPSS-114 Study Group. Efficacy and safety of tramadol/acetaminophen tablets (Ultracet) as add-on therapy for osteoarthritis pain in subjects receiving a COX-2 nonsteroidal anti-inflammatory drug: a multicenter, randomized, double-blind, placebo-controlled trial. J Rheumatol 2004, 31:5–7.

    Google Scholar 

  26. Watson S, Arkinstall S: The G-protein Linked Receptor Facts Book. London: Academic Press; 1994.

    Google Scholar 

  27. Carvey PM: Drug Action in the Central Nervous System. New York: Oxford University Press;1998.

    Google Scholar 

  28. Bannwarth B: Risk-benefit assessment of opioids in chronic non-cancer pain. Drug Saf 1999, 21:283–296.

    Article  PubMed  CAS  Google Scholar 

  29. Pappagallo M, Heinberg LJ: Ethical issues in the management of chronic non-malignant pain. Semin Neurol 1997, 17:203–211.

    Article  PubMed  CAS  Google Scholar 

  30. Passik SD, Weinreb HJ: Managing chronic non-malignant pain: overcoming obstacles to the use of opioids. Adv Ther 2000, 17:70–83.

    PubMed  CAS  Google Scholar 

  31. Fishbain DA, Rosomoff HL, Rosomoff RS: Drug abuse, dependence, and addiction in chronic pain patients. Clin J Pain 1992, 8:77–85.

    Article  PubMed  CAS  Google Scholar 

  32. Becker N, Bondergaard TA, Olsen AK, et al.: Pain epidemiology and health-related quality of life in chronic non-malignant pain patients referred to a Danish multidisciplinary pain center. Pain 1997, 73:393–400.

    Article  PubMed  CAS  Google Scholar 

  33. Portenoy RK: Opioid therapy for chronic non-cancer pain. Can we get past the bias? Am Pain Soc Bull 1991, 1:4–7.

    Google Scholar 

  34. Hanks G, Cherny N: Opioid analgesic therapy. In Oxford Textbook of Palliative Medicine, edn 2. Edited by Doyle D, Hanks G, Macdonald N. Oxford: Oxford University Press; 1998:331–335.

    Google Scholar 

  35. Schimier J, Palmer C, Flood E, Gourlay G: Utility assessments of opioids treatment for chronic pain. Pain Med 2002, 3:218–230. Patient participation in the decision process is essential for the success of opioid therapy.

    Article  Google Scholar 

  36. Hochberg M, Lixing L, Bausell B, et al.: Traditional Chinese acupuncture is effective as adjunctive therapy in patients with osteoarthritis of the knee. Arthritis Rheum 2004, 50:S644. Traditional Chinese acupuncture can be an effective adjunctive therapy for osteoarthritis.

    Google Scholar 

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Authors and Affiliations

  1. P.O. Box 1676, 96067, Mount Shasta, CA, USA

    Jeremy L. R. Goodwin MS, MD

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  1. Jeremy L. R. Goodwin MS, MD
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  2. Jan J. Kraemer MD
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  3. Zahid H. Bajwa MD
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Goodwin, J.L.R., Kraemer, J.J. & Bajwa, Z.H. The use of opioids in the treatment of osteoarthritis: When, why, and how?. Current Science Inc 9, 390–398 (2005). https://doi.org/10.1007/s11916-005-0018-3

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  • DOI: https://doi.org/10.1007/s11916-005-0018-3

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