Treating Pain in Rheumatologic Diseases With Opioids

Pain is common in patients with rheumatologic diseases, and 2 abstracts presented at the American College of Rheumatology’s annual meeting analyzed opioid use in these patients.

The first abstract evaluated how use of opioids and other medications changed in the management of chronic pain.¹

“Pain is the hallmark symptom of many rheumatologic conditions and chronic pain management is a major part of clinical practice in rheumatology,” the authors wrote. “Therefore, as the country and medical community evaluate and respond to the opioid epidemic, rheumatologists should be in the forefront of these discussions and response.”

They retrospectively reviewed electronic medical charts of randomly selected patients who had primary diagnoses of fibromyalgia, osteoarthritis (OA), and rheumatoid arthritis (RA). Records were from 2011 to 2017 and information such as demographic information and medication use.

Overall, 300 patients were evaluated. In 2011, 34% of patients with OA were using opioids compared with 30% with RA and 22% with fibromyalgia. During the study period, there was a significant decrease in use of opioids, tramadol, and pregabalin. Use of selective serotonin reuptake inhibitors was unchanged, and there were significant increases in gabapentin use.

The authors noted that it does appear as if the rheumatology community has responded to the opioid epidemic by decreasing use of opioids.

“Rheumatologists should be major contributors to the discussions regarding management of chronic pain and we should continue to evaluate optimal chronic pain management regimens that provide improved quality of life for our patients without substantial risk,” they concluded.

In the second abstract, the researchers identified patients with knee OA who used opioids chronically and occasionally using the Medicare Beneficiary Survey in 2015. They included 620 patients with knee OA with a mean age of 78.5 years. Nearly one-third (31%) of the patients had at least 1 opioid prescription in 2015 with 10% of the overall cohort being identified as chronic users and 21% as occasional users.

The patient features associated with greater risk of opioid use compared with no use included:

• At least 1 fall in the previous year
• At least 2 comorbidities
• Use of nonsteroidal anti-inflammatory drugs (NSAIDs)

Features associated with chronic use compared with no use included:

• Household income below $30,000 annually
• At least 2 comorbidities
• Use of NSAIDs

Comparing chronic use to occasional use of opioids, the features associated chronic use were low income and current smoking.

The researchers also found that marriage was associated with a lower risk of use, but they noted the causal relationship between marital status, prior falls, and low income required further study.

“Efforts to find non-opioid regimens for knee OA would be especially useful for patients with risk factors identified in this study,” the authors concluded.

References

1. Grant M, Kwiatkowski, Shakoor N. The opioid epidemic: the rheumatology response to management of chronic pain. Presented at: The American College of Rheumatology Annual Meeting, November 8-13, 2019; Atlanta, Georgia. Abstract #2076.

2. Losina E, Song S, Katz J. Opioids use among Medicare beneficiaries with knee osteoarthritis: prevalence and correlates of chronic use. Presented at: The American College of Rheumatology Annual Meeting, November 8-13, 2019; Atlanta, Georgia. Abstract #2056.