Researchers Compare NSAIDs And Opioids For Osteoarthritis Pain Relief

Medications are one of the most common treatments for osteoarthritic pain, and there is ongoing debate about which type of medication is most effective. Researchers recently compared the effectiveness of nonsteroidal anti-inflammatory drugs (NSAIDs) and opioids—and we share their findings with you.

Arthritis can be a painful disease, and research is constantly helping us to understand which treatments most effectively provide osteoarthritic pain relief. Researchers at Brigham and Women’s Hospital reviewed published studies that compare the benefits and risks of NSAIDs and opioids. What they found may surprise you.

“There is no cure for osteoarthritis, but there are a variety of conservative treatments available to ease the pain of this condition,” explains Summit orthopedic surgeon and arthritis subspecialist Dr. Dane Hansen. “We follow pain treatment research carefully so we can provide the most current information about effective pain management for our patients. When evaluating nonsteroidal and opioid medications, it is also important to make a distinction between acute and chronic arthritic pain. At Summit, we believe that although opioid—or narcotic—medications may be appropriate to treat short-term acute pain in some circumstances, opioids are inappropriate for the management of long-term chronic pain. For patients with chronic arthritic pain, the pain relief provided by opioids is overshadowed by the risks of addiction and dependence that come with long-term use.”

This month, the Osteoarthritis and Cartilage journal has published new findings that compare the effectiveness of NSAIDs versus opioid medications in reducing knee osteoarthritis pain. Researchers gathered the results of trials published between 1982 and 2015 that evaluated the effectiveness of NSAIDs and opioids to treat osteoarthritic knee pain. All of these trials measured pain relief using the widely accepted WOMAC pain measurement, which rates pain on a scale from 0 (no pain) to 100 (the worst pain). Their analysis revealed the following:

  • Data from over 5,500 patients was reviewed. On average, most patients began the study with pain ratings between 50 and 60 on the WOMAC scale.
  • Both NSAIDs and opioids effectively reduced pain. NSAIDs and less potent opioids, like tramadol, reduced pain by the same amount (a pain reduction of 18 points on the WOMAC scale). Patients treated with more potent opioids, like hydromorphone and oxycodone, experienced a pain reduction of 19 points. In short, both NSAIDs and opioids reduced patient pain by roughly 30 percent.
  • The patients who experienced the greatest pain reduction, regardless of the type of medication used, were men who began their trial with a higher level of pain.
  • The 30 percent pain reduction achieved by NSAIDs and opioids is consistent with pain improvement expectations for chronic pain treatments overall.

“Osteoarthritis is a chronic, or ongoing, pain condition like low back pain—and chronic pain problems tend to be more difficult to treat effectively,” notes Dr. Hansen. “This research gives us a benchmark for the amount of pain relief patients can expect, keeping in mind that the effectiveness of any pain medication varies from patient to patient, and that we will always weigh the risks as well as the benefits when personalizing pain treatment for our patients.”

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  • Dane Hansen, D.O.

    “Arthritis patients have high expectations for their activity level. With advanced training in minimally invasive surgical techniques and quick-recovery joint replacement, I strive to help my patients return to their fully active lifestyle as quickly as possible.”

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