Prescription Opioid Use for Older Adults with Arthritis or Low Back Pain

What problem was studied?
Chronic pain is a common problem in people with arthritis and related conditions. For most people, first-line medications – including nonsteroidal anti-inflammatory drugs (NSAIDs) – used for these conditions are helpful for relieving pain. Yet many continue to have pain despite these treatments.

While narcotic pain medications (opioids) may be helpful for people whose pain is not relieved by first-line therapies -- in fact, both the American College of Rheumatology and American Pain Society recommend the use of opioids in this situation – there is some controversy surrounding the chronic use of these medications. At least one study has suggested the use of narcotic analgesics for chronic pain has doubled in the past two decades.

This study looked specifically at chronic use of opioids in older people with three specific conditions: rheumatoid arthritis (RA), osteoarthritis (OA) and chronic low back pain.

What was done in the study?
In this Arthritis Foundation-funded study, researchers at Harvard Medical School, led by Daniel H. Solomon, MD, analyzed the medical records of the Medicare beneficiaries who were enrolled in a drug benefit program for low-to-moderate income Pennsylvania residents. They identified selected patients who had a diagnosis of one of three arthritis-related conditions – RA, OA and chronic low back pain – since 1995. They also identified patients with ischemic heart disease – a condition associated with chest pain, which generally is not treated with narcotic analgesics – to serve as a comparison population.

What were the study results?
Overall, the researchers found that the prevalence of chronic opioid use, even among people with chronic painful conditions, was low. Four percent of people with rheumatoid arthritis used opioids chronically in 2001 compared to less than one percent in each of the other groups. There was no increase in the chronic use of opioids over the six-year study period. People in all groups studied were more likely to have had long-term prescriptions for opioids if they had previously used medicines for psychiatric illness, including benzodiazepines and barbiturates; however, people with a prior diagnosis of a psychiatric illness were less likely to receive chronic opioids.

What’s the relevance to people with chronic pain?
While the study looked at patterns of opioid usage in older adults with arthritis-related problems, the results do not allow the authors to comment on the appropriateness of a given individual’s opioid prescription. Rather, the data illustrate broad patterns that help the researchers to begin to understand opioid prescribing. These analyses may allow for a critical assessment of physicians’ patterns of opioid use.

The researchers say more research is needed to answer important questions raised by this study, such as:  Do some people with RA remain in pain yet never receive a trial of prescription opioids? Do some people some people with RA take chronic opioids without an adequate trial of treatment to control the disease itself and not just the pain? “These are questions for future studies that will include more detailed clinical information,” says Dr. Solomon. “If patients with arthritis are found to have under-treated pain then patient and physician interventions might be pursued.”

Source: Arthritis Care & Research, Vol. 55, No. 1
http://www3.interscience.wiley.com/cgi-bin/abstract/112395548/ABSTRACT

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