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Opioids Provide Few Pain Benefits, Yet Abuse Growing

Dispensing pills


11 Nov. 2019. Opioids appear to provide little benefit for patients with pain from osteoarthritis, yet opioid use disorder rates among patients with painful conditions continue to rise. These conclusions are reported in two separate papers presented at this week’s annual American College of Rheumatology meeting in Atlanta.

A team led by Raveendhara Bannuru, a professor specializing in comparative effectiveness research at Tufts University medical school in Boston, is seeking to better define benefits from opioid pain relievers. These drugs are often prescribed to osteoarthritis patients for pain relief, and while their addictive properties are well documented, evidence of actual benefits are sketchy, according to the authors.

Osteoarthritis is a degenerative disorder affecting cartilage in joints. Over time, the wear and tear of joints, mainly in hands, feet, knees, and back gradually hardens and deteriorates cartilage causing pain and inflammation.

Bannuru and colleagues from Tufts and Lund University in Sweden searched the Medline and Cochrane databases to April 2019 for randomized clinical trials testing the efficacy and safety of opioid pain relievers against a placebo, among patients with knee or hip osteoarthritis. Their search yielded 23 studies, both published and unpublished, enrolling some 11,400 participants. The researchers looked for evidence of opioid safety and benefits at 2, 4, 8, and 12 weeks after the initial prescription, as well as differences between strong versus weak opioid drugs.

The researchers found small yet statistically reliable improvements in pain relief and function at 2, 4, and 12 weeks and more sleep among patients. However, the team found no difference in benefits in the occurrence of depression among patients nor improvements in overall quality of life. In addition, the authors found dosage level made no difference in benefits to patients. Moreover, patients generally fared better with weaker rather than stronger opioids, although stronger opioids were associated with more safety problems, including withdrawal symptoms and other adverse effects.

Opioid abuse hospitalizations continue to rise

Another team led by Jasvinder Singh, a rheumatology and immunology professor at University of Alabama in Birmingham, reviewed hospitalizations for opioid use disorder among people with common musculoskeletal diseases. Singh and colleagues looked specifically at patients with five disorders: gout, osteoarthritis, lower back pain, rheumatoid arthritis, and fibromyalgia, a chronic condition marked by pain throughout the body.

The researchers searched and reviewed data from the National Inpatient Sample, a collection of databases on hospitalizations maintained by the Healthcare Cost and Utilization Project in the U.S. Department of Health and Human Services. The team took data from 1998 through 2016, looking for opioid use disorder hospitalizations reflected in insurance claims among patients with these conditions.

The authors found low initial rates of opioid use disorder among pain patients, but then the rates began climbing, and quickly. For the first three years, through 2000, hospitalizations for opioid use disorder were low. Beginning in 2001, however, hospitalization rates started rising and by 2016 the rates increased from 3.5 times higher for lower back pain to 24 times higher for gout. After 2011, hospitalizations for opioid use disorder or OUD plateaued for lower back pain and gout, but continued rising for osteoarthritis, rheumatoid arthritis, and fibromyalgia.

“This study’s findings should alert the patients and providers regarding the chronic opioid use in people with rheumatic diseases and should encourage them to have an open dialogue regarding the risk/benefit ratio at the time of starting or deciding to continue opioids,” says Singh in an American College of Rheumatology statement. “The dramatic increase in OUD hospitalizations in these five common rheumatic conditions should highlight these diseases for policy initiatives.”

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