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Opioids for osteoarthritis Updated

da Costa BR, Nüesch E, Kasteler R, Husni E, Welch V, Rutjes AWS, Jüni P
Published Online: 
17 September 2014

This summary of a Cochrane review of 22 studies with 8275 participants (search update: 15 August 2012) presents what we know from research about the effect of opioids on osteoarthritis (OA). We searched scientific databases for clinical trials looking at pain, function, safety, and addiction of oral or transdermal opioids compared with placebo or no intervention in people with knee or hip osteoarthritis.

The review shows that in people with osteoarthritis:

- Opioids have a small effect on pain or physical function.
- Opioids probably cause side effects. However, we do not have precise information about rare but serious side effects.

What is osteoarthritis and what are opioids?

OA is a disease of the joints, such as your knee or hip. When the joint loses cartilage, the bone grows to try to repair the damage. Instead of making things better, however, the bone grows abnormally and makes things worse. For example, the bone can become misshapen and make the joint painful and unstable. This can affect your physical function or ability to use your knee.

Opioids are generally conceived as powerful pain-relieving substances that are used for the pain of cancer or osteoarthritis. Some examples of opioids are codeine-containing Tylenol® (1, 2, 3, and 4), hydromorphone (Dilaudid), oxycodone (Percocet, Percodan), morphine, and others. They can be taken in a pill form, as an injection, or as a patch placed on the painful area. 

Best estimate of what happens to people with osteoarthritis who take opioids

Pain

- People who took opioids rated improvement in their pain to be about 3 points on a scale of 0 (no pain) to 10 (extreme pain) after one month.
- People who took a placebo rated improvement in their pain to be about 2 points on a scale of 0 (no pain) to 10 (extreme pain) after one month.

Another way of saying this is:
- 41 people out of 100 who used opioids responded to treatment (41%).
- 31 people out of 100 who used placebo responded to treatment (31%).
- 10 more people responded to treatment with opioids than with placebo (difference of 10%). (High-quality evidence)

Physical function

- People who took opioids rated improvement in their physical function to be about 2 points on a scale of 0 (no disability) to 10 (extreme disability) after one month.
- People who took a placebo rated improvement in their physical function to be about 1 point on a scale of 0 (no disability) to 10 (extreme disability) after one month.

Another way of saying this is:

- 34 people out of 100 who used opioids responded to treatment (34%).
- 26 people out of 100 who used placebo responded to treatment (26%).
- 8 more people responded to treatment with opioids than with placebo (difference of 8%). (High-quality evidence)

Side effects

- 22 people out of 100 who used opioids experienced side effects (22%).
- 15 people out of 100 who used a placebo experienced side effects (15%).
- 7 more people experienced side effects with opioids than with placebo (difference of 7%). (Moderate-quality evidence)

Drop-outs because of side effects

- 64 people out of 1000 who used opioids dropped out because of side effects (6.4%).
- 17 people out of 1000 who used a placebo dropped out because of side effects (1.7%).
- 47 more people dropped out because of side effects with opioids than with placebo (difference of 4.7%). (High-quality evidence)

Side effects resulting in hospitalisation, persistent disability, or death

- 13 people out of 1000 who used opioids experienced side effects resulting in hospitalisation, persistent disability, or death (1.3%).
- 4 people out of 1000 who used a placebo experienced side effects resulting in hospitalisation, persistent disability, or deaths (0.4%).
- 9 more people experienced side effects resulting in hospitalisation, persistent disability, or death with opioids than with placebo (difference of 0.9%). (Low-quality evidence)

Withdrawal symptoms

- 24 people out of 1000 who used opioids experienced withdrawal symptoms (2.4%).
- 9 people out of 1000 who used a placebo experienced withdrawal symptoms (0.9%).
- 15 more people experienced withdrawal symptoms with opioids than with placebo (difference of 1.5%). (Moderate-quality evidence)

This record should be cited as: 
da Costa BR, Nüesch E, Kasteler R, Husni E, Welch V, Rutjes AWS, Jüni P. Oral or transdermal opioids for osteoarthritis of the knee or hip. Cochrane Database of Systematic Reviews 2014, Issue 9. Art. No.: CD003115. DOI: 10.1002/14651858.CD003115.pub4
Assessed as up to date: 
15 August 2012