Opioids for osteoarthritis

Examples

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Generic Name

codeine

Brand Name	Generic Name
Vicodin	hydrocodone

Brand Name	Generic Name
Roxicodone	oxycodone

Brand Name	Generic Name
Ultram	tramadol hydrochloride

Brand Name	Generic Name
Ultracet	tramadol and acetaminophen

How It Works

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Opioids are prescription narcotic medications and are usually reserved for treatment to relieve moderate to severe pain in people for whom acetaminophen, NSAIDs, exercise, and physical therapy have been ineffective.

Why It Is Used

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Some health professionals believe that opioids can be a responsible choice for treatment if pain from osteoarthritis is not relieved by other forms of treatment and if you are unable to engage in reasonable activities.^{1 2}

How Well It Works

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The opioid oxycodone has proven to be effective in relieving pain symptoms from severe osteoarthritis. Tramadol (a synthetic opioid), in combination with acetaminophen, has shown good results in early studies of osteoarthritis pain management.³

In clinical studies, the opioids codeine and propoxyphene have not proven to be any more effective than acetaminophen for relief of osteoarthritis pain.^{1 4} But, for patients who do not get relief from acetaminophen and NSAIDs, combinations of acetaminophen with codeine or propoxyphene are commonly used.

Side Effects

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Older people in particular may experience side effects from opioids. Side effects can include:

• Constipation.
• Urinary retention (bladder does not empty completely during urination).
• Mental confusion.
• Drowsiness.
• Nausea and vomiting.

See Drug Reference for a full list of side effects. (Drug Reference is not available in all systems.)

What To Think About

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If opioids are taken regularly and then stopped abruptly, many people will develop nausea, sweating, chills, diarrhea, and shaking. These are symptoms of withdrawal from the opioid and are referred to as "dependence." This physical dependence is not life-threatening and can be avoided if you taper off the opioids over a week.¹

In 1998, the Federation of State Medical Boards of the United States published guidelines to assure that opioid use for chronic nonmalignant (noncancer) pain meets medical and legal standards. These guidelines help you and your health professional treat your osteoarthritis pain with full awareness and watchfulness of possible long-term effects from medication. As part of the guidelines, your health professional will monitor your dose. Within 1 to 2 weeks, you and your health professional should find an effective dose for pain control. If after that time you think you need to increase the dose, check with your health professional. A dose increase could mean that you are developing tolerance to the medication or that the arthritis is getting worse. If you have a history of chemical dependency to alcohol or to prescription or nonprescription medications, you should avoid opioids or use them with caution.¹

Complete the new medication information form (PDF) (What is a PDF document?) to help you understand this medication.

References

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Citations

1. Lipman AG (2001). Treatment of chronic pain in osteoarthritis: Do opioids have a clinical role? Current Rheumatology Reports, 6(3): 513–519.

2. Lozada CJ (2005). Management of osteoarthritis. In ED Harris Jr et al., eds., Kelley's Textbook of Rheumatology, 7th ed., vol. 2, pp. 1528–1540. Philadelphia: Elsevier Saunders.

3. Emkey R, et al. (2004). Efficacy and safety of tramadol/acetaminophen tablets (Ultracet) as add-on therapy for osteoarthritis pain in subjects receiving a COX-2 nonsteroidal antiinflammatory drug: A multicenter randomized, double-blind, placebo-controlled trial. Journal of Rheumatology, 31(1): 150–156.

4. Rosenthal NR, et al. (2004). Tramadol/acetaminophen combination tablets for the treatment of pain associated with osteoarthritis flare in an elderly patient population. Journal of the American Geriatric Society, 52(3): 374–380.

Credits

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Author	Robin Parks, MS
Editor	Kathleen M. Ariss, MS
Associate Editor	Pat Truman, MATC
Primary Medical Reviewer	E. Gregory Thompson, MD - Internal Medicine
Specialist Medical Reviewer	Stanford M. Shoor, MD - Rheumatology
Last Updated	April 20, 2007