Oral Opioids No Better Than NSAIDs for Knee OA Pain

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Oral Opioids No Better Than NSAIDs for Knee OA Pain



Oral opioids, including the less potent tramadol and the more potent hydromorphone and oxycodone, do not provide better pain relief than oral nonsteroidal anti-inflammatory drugs (NSAIDs) for knee osteoarthritis (OA), according to a systematic review published online February 1 in Osteoarthritis and Cartilage.


“Patients who failed NSAIDs and are considering opioids should be aware that the pain relief from opioids is likely to be no greater than the pain relief they had with NSAIDs, but may provide ‘an extra chance’ before considering total knee replacement,” senior author Elena Losina, PhD, professor of orthopedic surgery at Brigham and Women’s Hospital and Harvard Medical School, Boston, Massachusetts, told Medscape Medical News.


Nearly all patients with knee OA require long-term pharmaceutical pain control, beginning most commonly with NSAIDs or with the oral low-potency opioid tramadol. However, few head-to-head comparisons of NSAIDs and opioids have been performed in this setting, which inspired Savannah R. Smith, BA, from the Orthopaedic and Arthritis Center for Outcomes Research, Department of Orthopaedic Surgery, Brigham and Women’s Hospital, and colleagues to conduct a systematic review of randomized controlled trials that tested the different therapies.

“In general, the use of opioid analgesics for the treatment of OA should be discouraged. The national health implications of addiction secondary to this trend are significant.
“Unfortunately, NSAIDs have significant side effects, so the perfect answer doesn’t exist.”

Osteoarthritis Cartilage. Published online February 1, 2016. Abstract

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