Oral or transdermal opioids for osteoarthritis of the knee or hip

Nüesch E, Rutjes AWS, Husni E, Welch V, Jüni P

Summary

Opioids for osteoarthritis

This summary of a Cochrane review presents what we know from research about the effect of opioids on osteoarthritis.

The review shows that in people with osteoarthritis:

- Opioids moderately improve pain or physical function.
- Opioids probably cause side effects. However, we do not have precise information about rare but serious side effects.

What is osteoarthritis and what are opioids?

Osteoarthritis (OA) is a disease of the joints, such as your knee or hip. When the joint loses cartilage, the bone grows to try and repair the damage. Instead of making things better, however, the bone grows abnormally and makes things worse. For example, the bone can become misshapen and make the joint painful and unstable.  This can affect your physical function or ability to use your knee.

Opioids are powerful pain-relieving substances that are used for the pain of cancer or osteoarthritis. Some examples of opioids are codeine-containing Tylenol® (1, 2, 3 and 4), hydromorphone (Dilaudid), oxycodone (Percocet, Percodan), morphine and others.  They can be taken in a pill form, as an injection, or as a patch placed on the painful area.
 

Best estimate of what happens to people with osteoarthritis who take Opioids

Pain

- People who took opioids rated improvement in their pain to be about 3 on a scale of 0 (no pain) to 10 (extreme pain) after 1 month.
- People who took a placebo rated improvement in their pain to be about 2 on a scale of 0 (no pain) to 10 (extreme pain) after 1 month.

Another way of saying this is:
- 35 people out of 100 who use opioids respond to treatment (35%).
- 31 people out of 100 who use placebo respond to treatment (31%).
- 4 more people respond to treatment with opioids than with placebo (difference of 4%). 

Physical Function

- People who took opioids rated improvement in their physical function to be about 2 on a scale of 0 (no disability) to 10 (extreme disability) after 1 month.
- People who took a placebo rated improvement in their physical function to be about 1 on a scale of 0 (no disability) to 10 (extreme disability) after 1 month.

Another way of saying this is:

- 29 people out of 100 who use opioids respond to treatment (29%).
- 26 people out of 100 who use placebo respond to treatment (26%).
- 3 more people respond to treatment with opioids than with placebo (difference of 3%).

Side effects

- 23 people out of 100 who used opioids experienced side effects (23%).
- 15 people out of 100 who used a placebo experienced side effects (15%).
- 7 more people experienced side effects with opioids than with placebo (difference of 7%).