Arthritis & Allergy

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Ormond Beach, FL 32174
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Treating Osteoarthritis with Opiods

Presently, because there is no known cure for osteoarthritis, the major focus when treating osteoarthritis is symptom relief. Commonly, non-steroidal anti-inflammatory drugs (NSAIDs) and pain relievers are prescribed to reduce joint pain and stiffness and to enhance the patient’s quality of life.

To meet these goals, a broad array of interventions are used, one of which is drug therapy; non-opiod medications, such as acetaminophen, aspirin, and non-steroidal anti-inflammatory drugs (NSAIDs), followed by opiod (narcotic) analgesics if the latter fail to control symptoms.

Opiods, derived from opium found in poppy seeds, are classified as either naturally occurring (such as morphine and codeine), semi synthetic (hydromorphone, hydrocodone, or oxycodone) or synthetic (methadone, meperidine, or fentanyl). By chemically binding themselves to receptors in the brain, dorsal horn of the spinal cord, ad even peripheral tissue such as skin, muscles, tendons, and joints, opiods can produce an analgesic effect

For the most part, codeine, hydrocodone, hydromorphone, oxycodone and morphine are “short-acting” opiods, requiring several daily doses. However, “long acting” opiods such as Oxycontin, MScontin, Avinza, Kadian or Duragesic patch are the preferred treatment option for moderate to severe osteoarthritis pain because they can deliver a constant stable level of amount of drug with only one or two doses daily, thus improving adherence to the therapy. On occasion, a combination of a short-acting opiod treatment may be suggested on as “as needed” basis for breakthrough pain with a fixed-schedule long-acting drug.

Fortunately, because of improvements in drug delivery method, several new long acting opiod options have been developed and are currently being studied. Before long, patients suffering with severe osteoarthritis pain should have more long acting opiods to choose from.

When beginning opiod treatment, it is not unusual to feel drowsy, nauseated, or confused, but these are short-lasting and can be expected to lessen with time as the body adapts to the medication. Constipation, however, can be more severe, but is usually reversed with the use of supplemental medication.

Even though consensus statements and guidelines from major professional organizations endorsing the use of opiod analgesics for persistent moderate to severe pain in osteoarthritis, their use remains a controversial topic.

The key to effective opiod treatment is close monitoring of efficacy, side effects, physical tolerance and addiction. However, when these options fail and pain persists and interferes with daily function, the possibility of surgery such as knee or hip replacement should be considered.

At this point, while there is no particular drug available that can modify the process of osteoarthritis, maintaining an ideal weight, exercising regularly and receiving the right treatment such as pharmacologic therapy, physical therapy and even surgery, can help minimize your pain.

Please join us at Florida Hospital Ormond on Monday January 10, 2005, from 6pm to 8pm in the Cafeteria Annex to learn more about pharmacologic options for treating osteoarthritis.

By Dr. Yong H. Tsai
Published in The Daytona Beach News-Journal
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