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.

美国疾病控制与预防中心(CDC)宣布，阿片类药物问题在美国是一种“流行病”。1999年至2017年间，近40万人死于阿片类药物过量。Still, doctors continue to prescribe these drugs for patients who are inchronic pain.

该研究的主要作者、阿拉巴马大学伯明翰分校医学和流行病学教授Jasvinder Singh医学博士说，慢性肌肉骨骼疾病，如关节炎，是慢性疼痛的主要原因之一，所以关节炎患者接受阿片类药物的风险特别高，并可能发展为阿片类药物使用障碍(OUD)。

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.

“Additionally, we found that the magnitude of these effects [on pain and function] remains small and continues to decrease over time,” says lead author Raveendhara R. Bannaru, MD, PhD, director of the Center for Treatment Comparison and Integrative Analysis at Tufts Medical Center in Boston. “In light of dependency concerns and the discomfort that many patients feel while taking the drugs, it would appear that there is no optimal therapeutic window for the use of oral opioids in OA.”

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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