Two new studies presented at the 2019 American College of Rheumatology Annual Meeting examine the role ofopioid medications用于治疗风湿病。第一项研究发现，在过去20年里，骨关节炎和其他肌肉骨骼疾病患者因阿片类药物使用障碍而住院的人数激增。第二项研究发现，这些药物对疼痛和功能只有很小的好处，并不能显著改善人们的生活质量。虽然这只是关于这一主题的众多研究中的两项，但它们突显了慢性疼痛的治疗是多么复杂。
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.
Over that 19-year period, OUD-associated hospitalizations surged 24-fold for gout, nine-fold for OA and six-fold for RA. Eventually the rates of OUD leveled out for people with gout and low back pain, but continued to rise for those with OA or RA. “For some conditions, like gout and fibromyalgia and to some extent rheumatoid arthritis, we weren’t aware of how extensive the problem was,” Dr. Singh says.
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.
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