Opioid Therapy for Arthritis Patients

Sung, Choon Ho

Abstract

Chronic pain is one of the most common pain diagnoses for arthritis patients. The primary goals of treating patients with chronic pain are to reduce the pain as much as possible and facilitate functional restoration. There are many reasons physicians are reluctant to consider opioids for arthritis patients, including: a perception that pain and suffering are an inevitable part of life; a fear of opioid side effects, including addiction; political and social pressures to control illicit drug use, and lack of knowledge about opioid efficacy in arthritis. The American Geriatric Society stated, "for many patients chronic opioid therapy may have fewer life threatening risks than the long-term daily use of NSAIDs" and "patients should not be overburdened with opiophobia." Addiction is rare among individuals who truly have pain. Studies of addictive behavior for the patients with the rheumatoid arthritis, osteoarthritis and other rheumatic diseases have found a very rare incidence of abnormal opioid behavior. Recent reports have proven that intraarticular morphine produces analgesia, and has an anti-inflammatory effect, in chronic arthritis conditions, including osteoarthritis and rheumatoid arthritis. Furthermore, peripherally active opioids, in inflammatory painful conditions, are especially noteworthy. Of these, some new kappa-opioid drugs, which were proven to be powerfully anti-inflammatory, reducing the disease severity; attenuating arthritis in dose-dependent, stereoselective and antagonist-reVersible manners. Peripherally active opioids for arthritis provide the potential for fewer side effects, as they act outside the central nervous system.