A large percentage of patients with end-stage osteoarthritis use opioids to manage their chronic pain, particularly younger patients and those who have symptoms of depression, according to a research team presenting study results at the 2017 annual meeting of the American College of Rheumatology (ACR) and the Association of Rheumatology Health Professionals (ARHP).
Osteoarthritis is a degenerative joint disease characterized by progressive damage to the joint cartilage (the cushioning material at the end of long bones. It is the most common joint disease in middle-aged and older adults and usually affects the knees, hips, spine, hands and other joints.
Opioids have garnered increasing scrutiny because of the risk of dependence, misuse, and abuse. Y. Raja Rampersaud, MD, of the Divisions of Orthopaedic and Neurosurgery at the University of Toronto, led a study of 1,204 presurgical patients with knee, hip or spine osteoarthritis to examine their rates of prescription opioid use. The study also sought any association between opioid use and socio-demographic and health characteristics.
The study included 577 patients (55.5% women; mean age = 65.6 years) scheduled for surgery to treat osteoarthritis of the knee, 459 of the hip and 168 of the spine.
The researchers collected data on opioid use through a questionnaire administered before surgery, which asked they patients if they used opioids for pain never, sometimes or daily. The tool also asked participants if they used other medications for arthritis or joint pain, such as non-steroidal anti-inflammatory drugs (NSAIDs), other over-the-counter medications, antidepressants and neuroleptics. Additionally, the questionnaire collected data on age, sex, education level, body mass index, comorbidities, depressive symptoms and pain.
According to the results, 15 percent of patients used opioids sometimes and an additional 15 percent used them daily. Use was most prevalent among those with osteoarthritis of the spine (40 percent), followed by hip (30 percent) and knee (28 percent).
Women younger than 65 years of age reported the greatest overall opioid use, particularly those with osteoarthritis of the spine. Other factors associated with a greater likelihood to use opioids: obesity, the presence of fibromyalgia, greater depressive symptoms, greater pain and use of other prescription pain medications.
“We found that those with the highest use also reported the highest levels of pain, suggesting that perhaps the opioids were not having their intended pain-reducing effect on all patients,” Dr. Rampersaud said. “Given the relative lack of efficacy, the simplest answer is to not start them on opioids to begin with, and if necessary, to do so for short durations at the lowest possible dose.”