The joint disease, osteoarthritis, is the most common cause of pain and physical disability in the elderly. A variety of analgesics are used to treat it, and opioids might be tried if the pain is severe or if other treatments cannot be used. A new Cochrane review looks at the evidence on these strong, but potentially addictive, painkillers and concludes that their harms outweigh their benefits
Ten randomised trials comparing opioids with placebo or no treatment in patients with osteoarthritis of the knee or hip were included in the review. The treatment was taken orally or applied to the skin. The review studied both the strong opioids, such as morphine, and weaker ones, such as codeine. It did not include the drug, tramadol.
Three of the trials assessed oral codeine and oral oxycodone was tested in four trials. There were also two trials of oral oxymorphone and one trial of oral morphine. Transdermal opioids were tested in one trial only, which used fentanyl. This collection of evidence, from more than 2200 patients, showed significant effects on pain relief and improvement of function. However, the authors of the review were disappointed by the small or moderate benefits that were achieved. On the other hand, their examination of the information on adverse effects found that that one trial had examined the effect of opioids on addiction and three trials had evaluated and reported serious harms. This research showed that patients receiving opioids were more likely to have serious side effects or symptoms of addiction than patients receiving placebo.
The authors of the new Cochrane review conclude that the small to moderate beneficial effects of non-tramadol opioids are outweighed by large increases in the risk of adverse events. They recommend that other treatments should be preferred to these opioids and that the drugs should not be routinely used, even if the pain from osteoarthritis is severe. .
This Cochrane review is available in full at www.mrw.interscience.wiley.com/cochrane/clsysrev/articles/CD003115/frame.html
Insider
November 16 2009