With over 54 million people (23 percent of adults) afflicted with arthritis, it has emerged as a leading cause of disability in the United States. The medical costs inflicted by this disease are about 81 billion. The term arthritis encompasses more than 100 diseases and conditions that affect the joints. Of these, osteoarthritis (OA) is the most prevalent form of arthritis, particularly among the middle-aged and older population.
The most common symptoms that accompany this disease include pain, aching, stiffness, and swelling in or around the joints. These symptoms reduce quality of life and drastically limits daily functioning leading to impairment and immobility in older adults. Since OA generally occurs along with chronic diseases, it is highly prevalent among the common masses.
OA is a degenerative disease of the joints of the knees, hips, spine, hands, etc. in which the joint cartilage—the cushioning material at the end of long bones—is progressively damaged. This leads to inflammation in the joints and changes in the structures around them. Although nonsteroidal anti-inflammatory drugs (NSAIDs) are commonly used for relieving joint swelling, stiffness and pain caused due to OA, a high percentage of patients at the advanced stage of the disease use opioids to manage their chronic pain. Compared to other populations, there has been a marked rise in the use of opioids among younger and women patients grappling with depression due to OA.
With the current opioid epidemic tearing the country apart, prescription opioids widely used for pain management have come under scrutiny. As a result, there has been increased concerns related to the misuse of prescription opioids by OA patients.
To determine the effectiveness of opioids in addressing OA, Y. Raja Rampersaud, a professor at the University of Toronto in the Divisions of Orthopedic and Neurosurgery, and his colleagues conducted a study. They studied 1,204 pre-surgical patients due for an orthopedic surgery on their knees, hips or spine, to determine the association between opioid use and various sociodemographic and health status characteristics, as well as the prescription rates of opioids. A few key findings, of the study, presented at the 2017 ACR/AR/ARHP Annual Meeting in San Diego, are as follows:
Spine OA patients women below 65 years report the highest opioid use
The study participants belonged to a mean age of 65.6 years and more than half of them were women (55.5 percent). There were 577 patients with knee OA, 459 with hip OA and 168 with spine OA. All these participants, who were awaiting surgery, were assessed based on their response to a range of variables shared through a questionnaire. Besides opioid use, other variables mentioned in the questionnaire were age, sex, education level, body mass index (BMI) level, comorbidities, depressive symptoms, etc.
The key findings of the study are as follows:
- Around 15 percent of patients reported using opioids occasionally and another 15 percent reported using them daily.
- While spine OA patients had the highest opioid use at 40 percent, knee OA patients were at 28 percent and hip OA patients were at 30 percent.
- From the direction of gender and age, women below 65 years reported the highest opioid use, especially those with spine OA.
- A greater chance of opioid use was found in the case of spine OA, younger age, obesity and fibromyalgia, presence of heightened depressive symptoms, intense pain and use of other prescription pain medications.
Opioids are not the answer for pain
As joint replacement and spine surgery are prevalent form of inpatient elective surgeries in both the U.S. and Canada, these findings could prove crucial. Therefore, an assessment of the efficacy of other pre-surgical treatment, including multimodal pain management strategies that eliminate or reduce opioid use, is required. Moreover, there are evidences to suggest that opioids may be less effective in managing pain among OA patients compared to other treatments.
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