Opioids for osteoarthritis

Bannuru, 2019Kloppenburg, 2019Kroon, 2014Sakellariou, 2017

Opioids have a very limited role in the management of osteoarthritis because of modest, if any, benefits and a significant risk of harms.

Opioids may be considered for patients with severe persisting functional impairment due to pain, despite maximal nonsurgical management (see Components of management for osteoarthritis); this may include patients awaiting surgery or in whom surgery is not possible. Opioids are not recommended for osteoarthritis of the hand.

If opioids are used, they should be prescribed on a short-term trial basis, as part of an overall pain management strategy, with clear goals and regular review of treatment response and adverse effects. Before starting an opioid, a plan for stopping ineffective therapy should be in place and discussed with the patient. If treatment response is inadequate, exercise caution when increasing the dose of opioids because there is an increased risk of harm and potentially no added benefit. Prolonged use of opioids indicates the need for specialist assessment.

Studies up to one year in patients with knee or hip osteoarthritis indicate that tapentadol may have a more favourable safety profile than oxycodone; however, the long-term safety of tapentadol is not known and the same precautions as for other opioids should be applied to tapentadol.