Opioid prescriptions in patients with osteoarthritis: a population-based cohort study

Abstract

Objectives To examine the incidence, prevalence and trends for opioid prescriptions in patients with OA. Furthermore, types of opioids prescribed and long-term prescription rates were examined. Finally, the patient characteristics associated with the prescription of opioids were assessed. Methods A population-based cohort study was conducted using the Integrated Primary Care Information database. Incidence and prevalence of opioid prescriptions were calculated for the period 2008–2017. Logistic regression was used to assess which patient characteristics were associated with opioid prescriptions. Results In total, 157 904 OA patients were included. The overall prescription rate remained fairly stable, at around 100 incident and 170 prevalent prescriptions per 1000 person years. However, the incident prescription rate for oxycodone increased from 7.1 to 40.7 per 1000 person years and for fentanyl from 4.2 to 7.4 per 1000 person years. The incident prescription rate for paracetamol/codeine decreased from 63.0 to 13.3 per 1000 person years. Per follow-up year, long-term use was found in 3% of the patients with incident OA. Finally, factors associated with more prescriptions were increasing age, OA in ≥2 joint groups [odds ratio (OR) 1.56; 95% CI: 1.51, 1.65] and the presence of other musculoskeletal disorders (OR 4.91; 95% CI: 4.76, 5.05). Men were less likely to be prescribed opioids (OR 0.78; 95% CI: 0.76, 0.80). Conclusion Prescription rates for opioids remained stable, but types of opioids prescribed changed. Oxycodone and fentanyl were increasingly prescribed, while prescriptions of paracetamol/codeine decreased. Since the benefit of opioids for OA pain is questionable and side effects are common, opioids should be prescribed with caution.

The evolution of nerve growth factor inhibition in clinical medicine

“…The evolution of nerve growth factor inhibition in clinical medicine Barton L. Wise 1,2,3,5 , Matthias F. Seidel 4,5 and Nancy E. Lane 1,3 ✉ Abstract | Nerve growth factor (NGF) is a neurotrophin that activates nociceptive neurons to transmit pain signals from the peripheral to the central nervous system and that exerts its effects on neurons by signalling through tyrosine kinase receptors. Antibodies that inhibit the function of NGF and small molecule inhibitors of NGF receptors have been developed and tested in clinical studies to evaluate the efficacy of NGF inhibition as a form of analgesia in chronic pain states including osteoarthritis and chronic low back pain.…”

“…The currently available treatments for these ailments, such as paracetamol (acetaminophen), NSAIDs, opioids, tramadol and anti-depressant medications, can be effective but also have substantial limitations. In addition, the incidence of opioid-related hospitalizations among patients with musculoskeletal disorders has increased over the past two decades and continues to increase in individuals with OA 2 . Although important advances have sharpened our understanding of the pathophysiology of musculoskeletal pain, the majority of new pharmaceuticals have failed when translated from the laboratory to clinical trials.…”

Opioids for Osteoarthritis: Cross-Sectional Survey of Patient Perspectives and Satisfaction

“…Despite these recommendations, both tramadol and non-tramadol opioids are prescribed for patients with OA in the United States [ 13 , 14 , 15 ] and elsewhere [ 16 , 17 , 18 , 19 , 20 ]. In the United States, opioid use for OA was stable during the period 2007–2014 [ 14 , 15 ].…”

Time trends in use of non-steroidal anti-inflammatory drugs and opioids one year after total hip arthroplasty due to osteoarthritis during 1996–2018: a population-based cohort study of 103,209 patients

“…Furthermore, overall NSAID and opioid use has decreased by 15% and 13%, respectively, for the entire Danish population from 2016 to 2020 14 . However, the knowledge on changes in prescription patterns of general analgesics over time in relation to THA is sparse 15,16 .…”