Opioid Use for Osteoarthritis Is Prevalent

Opioid medicines are used by a large percentage of patients who have advanced knee, hip, or spine osteoarthritis to manage their chronic pain.

Younger patients and women seem to be at highest risk for using opioid pain medicines for their osteoarthritis.

Besides the limitations on mobility that osteoarthritis imposes, pain presents the greatest challenge because prescriptive patterns have come under scrutiny in an age when opioid pain medicine abuse and dependence are all too common, researchers suggested.

With the present opioid epidemic at crisis levels, Y. Raja Rampersaud and colleagues in Toronto pointed out that some evidence suggests opioids might not even help patients with osteoarthritis when compared with other treatments.

The authors conducted a study of patients before orthopedic surgery on their knees, hips, or spine to determine rates of prescription opioid use and any association between opioid use and various sociodemographic and health status characteristics. They presented their findings at the 2017 ACR/ARHP Annual Meeting in San Diego.

The study
The authors looked at 1204 presurgical osteoarthritis patients prospectively with preoperative and postoperative opioid use being determined via questionnaire. The examined variables included gender, age, educational level, body mass index, medical comorbidities, pain levels, and depressive symptoms.

The results
• Opioids were used “sometimes” by 15% of patients.

• Opioids were used daily by another 15% of patients.
• The highest rate of opioid use, at 40%, was found in patients who had spine osteoarthritis.

• Subjects who had knee and hip osteoarthritis reported opioid use at rates of 28% and 30%, respectively.
• The highest likelihood of using opioids postoperatively was found in female patients with spine osteoarthritis who were younger than 65 years.

• Depression was linked to opioid use in osteoarthritis.

Implications for physicians
• The subjects who took the most opioids also reported the highest level of pain, suggesting that the opioids may not have been helping.

• Opioid use before surgery predicted opioid use after surgery.

• Special care should be taken with younger women, especially those with depression and spine osteoarthritis, when prescribing pain medicines.

• Starting treatment with non-opioid pain medicines should precede prescribing opioids, which should then be added only at the lowest effective doses.

• “Given the associated negative effects of opioids, we need to better understand the impact and means of mitigating adverse events associated with their use in end-stage OA, that is, the surgical population,” Dr Rampersaud said in a press release.

References:

American College of Rheumatology Press Release. “Spine Osteoarthritis Patients and Those Under 65 More Likely to Use Opioids to Manage Pain.” November 4, 2017.