Two new studies presented at the 2019 American College of Rheumatology Annual Meeting examine the role ofopioid medicationsin treating rheumatic conditions. The first study found hospitalizations for opioid use disorder in people with osteoarthritis and other musculoskeletal disorders have surged over the past two decades. The second found that these drugs have only a small benefit for pain and function and do not significantly improve people’s quality of life. While these are just two of many studies on the topic, they highlight how complicated the treatment of chronic pain is.
The Centers for Disease Control and Prevention (CDC) has declared the opioid problem in this country an “epidemic.” Nearly 400,000 people died from opioid overdose between 1999 and 2017. Still, doctors continue to prescribe these drugs for patients who are inchronic pain.
Chronic musculoskeletal diseases, like arthritis, are among the top causes of chronic pain, so people with arthritis are at particularly high risk of receiving opioids and potentially developing an opioid use disorder (OUD), says lead study author Jasvinder Singh, MD, professor of medicine and epidemiology at the University of Alabama at Birmingham.
To understand the magnitude of the problem, Dr. Singh and his colleagues analyzed rates of OUD hospitalizations from 1998 to 2016 for five conditions: gout, osteoarthritis (OA), fibromyalgia, rheumatoid arthritis (RA) and low back pain.
在这19年期间，因oud而住院的痛风患者增加了24倍，OA增加了9倍，RA增加了6倍。最终，痛风和下腰痛患者的患病率趋于稳定，但OA或RA患者的患病率继续上升。“对于某些疾病，如痛风、纤维肌痛和某种程度上的类风湿关节炎，我们没有意识到问题的严重性，”辛格博士说。
Given the increasing awareness of the risks linked to opioid use, a drop in those numbers may occur as more recent data becomes available, Dr. Singh says. But until better solutions for chronic pain are available, opioids will likely remain an integral part of arthritis treatment. “We’re talking about diseases that outstrip cancer and heart disease in terms of numbers by several million in the United States. But the progress we’ve made in adequately treating pain in these conditions is somewhat limited,” he adds.
The other research presented at the conference included results from 23 studies on the efficacy of opioids in more than 11,000 people with knee and/or hip OA. The authors analyzed participants’ pain and function after two, four, eight and 12 weeks of opioid use. Although the drugs offered small improvements in pain and function after two to 12 weeks of treatment, they did not improve quality of life or depression.
“此外，我们发现这些(对疼痛和功能)的影响程度仍然很小，并随着时间的推移继续下降，”主要作者Raveendhara R. Bannaru博士说，他是波士顿塔夫茨医学中心治疗比较和综合分析中心的主任。“考虑到依赖问题和许多患者在服药时感到的不适，口服阿片类药物在OA中的使用似乎没有最佳的治疗窗口。”
Perhaps surprisingly, the authors found that strong opioids had consistently smaller effect on pain than weak opioids did. Dr. Bannaru says it’s possible that many participants who received strong opioids couldn’t reach a dose high enough to relieve their pain because they couldn’t tolerate the side effects. “Participants receiving strong opioids were twice as likely as participants receiving weak/intermediate opioids to discontinue the study due to adverse events,” he says.
Given the risk of dependency and side effects with opioids, the results of these studies should make people and their doctors more wary of these drugs. “I think that patients need to be fully informed with regard to benefits and risks,” Dr. Singh says. Having more information about opioid risks and their effects on quality of life from future studies should make it easier for patients and their doctors to choose the most appropriate pain reliever.
Author: Stephanie Watson for the Arthritis Foundation.
加入Live Yes!Arthritis Network FOR FREE.Our community is here to help you.
