BERLIN -- Consider a trial of opioids for patients with moderate-to-severe chronic osteoarthritis pain that doesn't respond to prescription nonsteroidal anti-inflammatory drugs, Dr. Nathaniel Katz advised at the 2003 World Congress on Osteoarthritis.
Opioids appear effective for a minority of patients whose pain is not relieved by conventional pain-management regimens, and for this subset opioids can be an effective, safe, and long-term option, said Dr. Katz, an anesthesiologist at Harvard Medical School, Boston.
In addition, addiction can occur with opioid use, but seems limited to a minority of patients. The best initial opioid options are probably the nonpure [micro]-agonists such as tramadol and possibly buprenorphine. Both may have reduced addiction potential compared with other opioids, but this has not been proved. If patients don't respond to tramadol, then try a pure [micro]-agonist, he suggested in an interview. Two posters presented at the congress reported a favorable clinical experience with new, once-daily formulations of tramadol that have yet to be approved in the United States.
More than 3 million American adults have uncontrolled, chronic, moderate-to-severe pain that's attributed to arthritis, according to the results of a 2001 survey of U.S. households. About 60% of those people have pain despite the use of prescription NSAIDs. These are the patients who are candidates for opioid therapy, Dr. Katz said.
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