Cochrane: Opioids for OA?

The Buzz: In OA of the hip and knee, opioids provide modest benefits that do not outweigh the risks
Citation: "Cochrane for Clinicians: Opioids for Osteoarthritis of the Knee or Hip" AFP May 1, 2010 81:9 1094-95 
Summary: The study authors reviewed ten outpatient trials involving 2,268 patients, reporting a response rate of 35% of patients in the treatment group, vs 31% in the control group (number needed to treat [NNT] = 25), as defined by a reduction of at least half of their pain. This was offset by adverse effects, though major adverse events were rare. No one opioid was found to be superior. The article authors recommend clinicians consider other interventions as outlined  by the Osteoarthritis Research Society International. They also recommended tramadol, as well as codeine, in patients with refractory pain.
Commentary: This seemingly focused review brings up a number of larger issues, including the overuse of narcotic medications (hydrocodone is the most prescribed medication in the US), and the approach to chronic pain. In addition, it points out a very useful resource available to California clinicians, the California Prescription Drug Monitoring Program (register here), which allows real-time controlled prescription reports on individual patients.
By: Spencer Blackman MD