From Paracetamol to Opioids - What You Need to Know
Simple analgesics non-steroidal anti-inflammatory drugs opioids
Professor David Hunter, rheumatologist
Following appropriate conservative non-pharmacologic treatments there are a number of medication options that are suitable to help a person control the pain that comes as a consequence of the osteoarthritis. Typically, in the first instance historically everybody used to use paracetamol as the first-line option for the treatment of osteoarthritis pain. The most recent guidelines would suggest that we shouldn't start with paracetamol in an ideal world the first treatment option for the management of that pain would ideally be either a topical anti-inflammatory or if a person doesn't have reason not to take a tablet anti-inflammatory taking that as a tablet. A second option which may be suitable for some people with osteoarthritis includes combination analgesics, so this would be taking a combination of paracetamol with an anti-inflammatory and then over and above that there's not a lot of recommendations that focus on the use of opioids or opiates in a context of osteoarthritis despite the fact that they are incredibly widely used for the management of osteoarthritis and it's largely because they have a scientific profile which is not ideal for the long-term management of a person's pain related to osteoarthritis and they've not been a lot of good trials done specifically on opiates in the context of osteoarthritis.
Non-Steroidal anti-inflammatory drugs (NSAIDs)
Non-steroidal anti-inflammatory drugs that are a treatment option for the management of pain for a person that has osteoarthritis. They are very effective form of medication they typically will relieve about 40% of a person's pain if they have osteoarthritis. It's important to recognize that like all medications they do have the risk for side effects and the side effects were particularly concerned about in for anti-inflammatories include gastrointestinal stomach upset potentially causing an ulcer or bleed in the gut in addition to also potentially increasing risk for cardiovascular side effects and particular heart attacks and all strokes that are slightly increased in the context of taking anti-inflammatories. It's important to bear in mind that those side effects cardiovascular side effects are rare, but they are increased in person who is at risk of that because of cardiac risk.
They are commonly used for the management of osteoarthritis get reasonably effective drugs and reasonably safe we've taken in the right person. They should be considered an option if a person's already tried conservative management modalities and they haven't relieved a person's pain adequately and a person is still finding limitations in function doing typical activities of daily living.
Opioids
Opiates and other morphine related products are used commonly in the management of osteoarthritis pain. They do have some effects in relieving pain for other health-related conditions but there's very little trial evidence in the context of osteoarthritis related pain to suggest that they are effective in that context. They do have important and unwanted side effects particularly making a person more likely to be constipated in addition to making them or drowsy making typical activities such as driving potentially risky in that instance they also do have the potential long-term to be addictive and to be abused in that context they should be considered as a last resort for the management of osteoarthritis pain using medication.
