Yonsei Med J.  2014 Sep;55(5):1379-1385. 10.3349/ymj.2014.55.5.1379.

Progressive Change in Joint Degeneration in Patients with Knee or Hip Osteoarthritis Treated with Fentanyl in a Randomized Trial

• Fujii T
• Takana K
• Orita S
• Inoue G
• Ochiai N
• Kuniyoshi
• Aoki Y
• Ishikawa T
• Miyagi M
• Kamoda H
• Suzuki M
• Sakuma Y
• Kubota G
• Oikawa Y
• Inage K
• Sainoh T
• Sato J
• Yamauchi K
• Toyone T
• Nakamura J
• Kishida S
• Takahashi
• Ohtori S

• KMID: 1799506
• DOI: http://doi.org/10.3349/ymj.2014.55.5.1379

Abstract

PURPOSE
Opioids improve pain from knee and hip osteoarthritis (OA) and decrease the functional impairment of patients. However, there is a possibility that opioids induce analgesia and suppress the physiological pain of OA in patients, thereby inducing the progression of OA changes in these patients. The purpose of the current study was to investigate the possibility of progressive changes in OA among patients using opioids.
MATERIALS AND METHODS
Two hundred knee or hip OA patients were evaluated in the current prospective, randomized, active-controlled study. Patients were randomized 1:1:1 into three parallel treatment groups: loxoprofen, tramadol/acetaminophen, and transdermal fentanyl groups. Medication was administered for 12 weeks. Pain scores and progressive OA changes on X-ray films were evaluated.
RESULTS
Overall, pain relief was obtained by all three groups. Most patients did not show progressive OA changes; however, 3 patients in the transdermal fentanyl group showed progressive OA changes during the 12 weeks of treatment. These 3 patients used significantly higher doses than others in the transdermal fentanyl group. Additionally, the average pain score for these 3 patients was significantly lower than the average pain score for the other patients in the transdermal fentanyl group.
CONCLUSION
Fentanyl may induce progressive changes in knee or hip OA during a relatively short period, compared with oral Non-Steroidal Anti-Inflammatory Drugs or tramadol.

Keyword

Opioid; knee; hip; osteoarthritis

MeSH Terms

Aged
Aged, 80 and over
Analgesics, Opioid/*adverse effects/therapeutic use
Disease Progression
Female
Fentanyl/*adverse effects/therapeutic use
Humans
Male
Middle Aged
Osteoarthritis, Hip/*drug therapy/radiography
Osteoarthritis, Knee/*drug therapy/radiography
Pain/drug therapy
Analgesics, Opioid
Fentanyl

Figure

• 

  Fig. 1 Flow diagram of this trial.

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  Fig. 2 An 84-year-old woman showed knee OA before treatment (A) and progressive changes in OA (B) 12 weeks after 25 µg/h transdermal fentanyl treatment. A 55-year-old man showed hip OA before treatment (C) and progressive changes in OA (D) 12 weeks after 12.5 µg/h transdermal fentanyl treatment. A 65-year-old woman showed hip OA before treatment (E) and progressive changes in OA (F) 12 weeks after 50 µg/h transdermal fentanyl treatment. OA, osteoarthritis.

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