Oral or transdermal opioids for osteoarthritis of the knee or hip

Abstract

Background Osteoarthritis is the most common form of joint disease and the leading cause of pain and physical disability in the elderly. Opioids may be a viable treatment option if patients suffer from severe pain or if other analgesics are contraindicated. However, the evidence about their effectiveness and safety is contradictory. Objectives To determine the effects on pain and function and the safety of oral or transdermal opioids as compared with placebo or no intervention in patients with osteoarthritis of the hip or knee.

Efficacy and safety of fulranumab as monotherapy in patients with moderate to severe, chronic knee pain of primary osteoarthritis: a randomised, placebo- and active-controlled trial

“…The efficacy observed for fulranumab and oxycodone CR is consistent with prior pain studies. However, the high placebo response in this study is not consistent with previous successful studies of fulranumab, tanezumab or opioids used to treat OA pain . Placebo response has been discussed as a significant methodological issue in recent reviews .…”

Efficacy and safety of fulranumab as monotherapy in patients with moderate to severe, chronic knee pain of primary osteoarthritis: a randomised, placebo- and active-controlled trial

“…The efficacy observed for fulranumab and oxycodone CR is consistent with prior pain studies. However, the high placebo response in this study is not consistent with previous successful studies of fulranumab, tanezumab or opioids used to treat OA pain . Placebo response has been discussed as a significant methodological issue in recent reviews .…”

The efficacy of duloxetine, non-steroidal anti-inflammatory drugs, and opioids in osteoarthritis: a systematic literature review and meta-analysis

“…Eight studies were omitted from the Bayesian adjusted for baseline WOMAC analysis, due to the omission of baseline scores in study publications. These numbers were, however, similar to several other meta-analyses in OA [ 7 , 8 , 18 , 21 ]. Limiting the literature search to English language publications may have lead to missed RCTs.…”

Meta-analysis of dropout rates in randomized controlled clinical trials

“…The authors documented dry mouth (25%), nausea (21%), constipation (19%), dizziness (14%), somnolence (14%), pruritus (13%), and vomiting (10%) [25]. Therefore, our findings are supported by the published data from Nüesch [26]. Nausea, constipation, and somnolence are important adverse events in opioid-treated patients resulting in a high dropout rate as documented in randomized controlled trials.…”

Efficacy and safety of fulranumab as monotherapy in patients with moderate to severe, chronic knee pain of primary osteoarthritis: a randomised, placebo- and active-controlled trial

“…The efficacy observed for fulranumab and oxycodone CR is consistent with prior pain studies. However, the high placebo response in this study is not consistent with previous successful studies of fulranumab, tanezumab or opioids used to treat OA pain . Placebo response has been discussed as a significant methodological issue in recent reviews .…”

The efficacy of duloxetine, non-steroidal anti-inflammatory drugs, and opioids in osteoarthritis: a systematic literature review and meta-analysis

“…Eight studies were omitted from the Bayesian adjusted for baseline WOMAC analysis, due to the omission of baseline scores in study publications. These numbers were, however, similar to several other meta-analyses in OA [ 7 , 8 , 18 , 21 ]. Limiting the literature search to English language publications may have lead to missed RCTs.…”

Meta-analysis of dropout rates in randomized controlled clinical trials

“…The authors documented dry mouth (25%), nausea (21%), constipation (19%), dizziness (14%), somnolence (14%), pruritus (13%), and vomiting (10%) [25]. Therefore, our findings are supported by the published data from Nüesch [26]. Nausea, constipation, and somnolence are important adverse events in opioid-treated patients resulting in a high dropout rate as documented in randomized controlled trials.…”

Efficacy and safety of fulranumab as monotherapy in patients with moderate to severe, chronic knee pain of primary osteoarthritis: a randomised, placebo- and active-controlled trial

“…The efficacy observed for fulranumab and oxycodone CR is consistent with prior pain studies. However, the high placebo response in this study is not consistent with previous successful studies of fulranumab, tanezumab or opioids used to treat OA pain . Placebo response has been discussed as a significant methodological issue in recent reviews .…”

The efficacy of duloxetine, non-steroidal anti-inflammatory drugs, and opioids in osteoarthritis: a systematic literature review and meta-analysis

“…Eight studies were omitted from the Bayesian adjusted for baseline WOMAC analysis, due to the omission of baseline scores in study publications. These numbers were, however, similar to several other meta-analyses in OA [ 7 , 8 , 18 , 21 ]. Limiting the literature search to English language publications may have lead to missed RCTs.…”

Meta-analysis of dropout rates in randomized controlled clinical trials

“…The authors documented dry mouth (25%), nausea (21%), constipation (19%), dizziness (14%), somnolence (14%), pruritus (13%), and vomiting (10%) [25]. Therefore, our findings are supported by the published data from Nüesch [26]. Nausea, constipation, and somnolence are important adverse events in opioid-treated patients resulting in a high dropout rate as documented in randomized controlled trials.…”