Opioid analgesics for rheumatoid arthritis pain
Date
2013
Authors
Whittle, S.
Richards, B.
Buchbinder, R.
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Journal article
Citation
JAMA: Journal of the American Medical Association, 2013; 309(5):485-486
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Samuel L. Whittle, Bethan L. Richards, Rachelle Buchbinder
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Abstract
Clinical Question: Do the benefits of opioid analgesics outweigh the risks in patients with persistent pain due to rheumatoid arthritis? Bottom Line: Weak opioids (such as codeine, dextropropoxyphene, and tramadol) may be effective in the short-term management of rheumatoid arthritis pain, but adverse effects are common and may outweigh the benefits; alternative analgesics should be considered first. The role of opioid analgesics is clearly established in acute pain and chronic cancer pain, but their long-term use in chronic noncancer pain is controversial.¹ The recent increase in the rate of opioid prescriptions for chronic noncancer pain has not seen a parallel growth in the evidence base. Pain management remains a major challenge in rheumatoid arthritis (RA) despite the major advances in RA treatment strategies over the last 2 decades. Patients with RA report pain management as their highest priority.² Pain in RA may occur when disease-modifying antirheumatic drugs (DMARDs) are ineffective or yet to achieve their full effect, when irreversible joint damage has occurred, or when noninflammatory mechanisms of pain generation (such as central sensitization) are activated. Opioids are often prescribed in these circumstances,³ but existing guidelines for treating RA have provided little direction to prescribers. This article summarizes the results of a recent Cochrane review of opioids for RA pain.⁴
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© 2013 American Medical Association. All Rights Reserved.