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Opioid use in OA may mean more activity-limiting pain



– Patients with OA pain who used opioids persistently were more likely to report worse pain interference with daily activities and more functional limitations than nonopioid users in a nationally representative survey, Drishti Shah and her colleagues reported at the annual PAINWeek.

An older man hold his painful knee. Thinkstock/Zinkevych

“These findings suggest an unmet need and calls for better patient management, including consideration of alternative treatment strategies,” said Ms. Shah, a graduate student at West Virginia University, Morgantown.

The authors examined data from 4,172 adults with OA aged 18 years and older who took part in the nationally representative Medical Expenditure Panel Survey during 2010-2015.

Each respondent was followed for up to 2 years, with five rounds of surveys. The primary outcomes were longitudinal changes in pain interference with daily activities (PIA) as measured by the bodily pain item of the Short Form Health Survey scale and functional limitations in social, physical, work, and cognitive activities.

Opioid use was considered persistent when reported in at least two consecutive rounds and intermittent use was opioid use reported in any one or alternative rounds of the panel. Multivariate regression analyses were conducted, controlling for baseline sociodemographics, clinical characteristics, and prescription NSAID use.

Most of the patients were female (66%), and the mean age was 62 years. The majority (83%) were aged 50 years or older. About 45% were employed at baseline.

About one-third of patients reported opioid use in each round, and 25% reported prescription NSAID use. About 15% of patients reported persistent opioid use and 19% disclosed intermittent use.

At the end of follow-up, persistent opioid users were nearly three times more likely to report extreme or severe PIA when compared with nonopioid users (odds ratio, 2.91) and twice as likely to report moderate PIA (OR, 2.04). No significant differences were observed for intermittent opioid users.

Regardless of baseline functional status, persistent opioid users had a significantly higher likelihood of reporting functional limitation at end of follow-up when compared against nonopioid users. Similar results were observed for intermittent opioid users who reported no functional limitations at baseline. However, intermittent opioid users who reported functional limitation at baseline were less likely to report social and cognitive limitations at end of follow-up than were nonopioid users.

Regeneron and Teva Pharmaceuticals supported the study. Ms. Shah was a paid consultant for both companies and has no other personal financial relationships with either company.

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