Results reveal that opioids are increasingly popular in treating pain connected with rheumatic and musculoskeletal diseases. Experts have indicated that measures need to be taken to ensure the safe and sensible use of these analgesics.
Data from several European countries provide evidence that opioid use is increasing among patients with rheumatic/musculoskeletal disease. In Spain, the consumption of opioids in patients with osteoarthritis increased from 15% in 2007 to 25% in 2016 [1]. German data demonstrated that approximately 70% of opioids are prescribed for patients with chronic, non-tumor associated pains, like osteoarthritis. When used for chronic osteoarthritis pains, a 4- to 12-week course of therapy is indicated; this has proven to be effective and safe. Their use should be discontinued after this period, due to the strong side effect profile of these agents [2]. However, it is mostly the physical withdrawal that poses the biggest obstacle for patients to stop taking the drugs, as the effect of opioids on the central nervous system ensures a strong addiction potential.
Data from Iceland shows that patients often do not discontinue and even increase their opioid intake after their pain has been treated and has disappeared [3]. This is even the case after patients have been treated with precise, effective anti-inflammatory agents including tumor necrosis factor (TNF) inhibitors.
Specific groups at risk for addiction/dependency on opioids, as identified by Junqing Xie (Oxford University, UK) and colleagues, included women, the elderly, and socially disadvantaged individuals [1]. Awareness of a responsible approach both by the prescribers as well as the patients is key when preventing abuse of opioids, and opioids should only be prescribed as part of a comprehensive therapy programme that involves close collaboration of doctors, psychologists, and physiotherapists as well as promptly ceasing the use of opioids if they are not effective or if the effect decreases [1].
Sources:
1. Xie J, et al. Temporal trends of opioid use among incident osteoarthritis patients in Catalonia, 2007-2016: a population-based cohort study. Abstract 3070. EULAR E-Congress, 3-6 June 2020.
2. Langzeitanwendung von Opioiden bei chronischen nicht-tumorbedingten Schmerzen (LONTS), Deutsche Schmerzgesellschaft e.V. [Long-Term Use of Opioids for Chronic Non-Tumour Associated Pains (LONTP), German Pain Society].
3. Palsson O, et al. Initiating TNF inhibitors in inflammatory arthritis does not decrease the average opioid analgesic consumption. Abstract 2587. EULAR E-Congress, 3-6 June 2020.