Opioids for osteoarthritis

Examples

Generic Name Brand Name
codeine  
hydrocodone Vicodin
oxycodone OxyContin, Roxicodone
tramadol Ultram
tramadol and acetaminophen Ultracet

How It Works

Opioids are prescription narcotic medicines and are usually reserved for treatment to relieve moderate to severe pain in people for whom acetaminophen, NSAIDs, exercise, and physical therapy have not worked.

Why It Is Used

Some doctors believe that opioids can be a responsible choice for treatment if pain from osteoarthritis is not relieved by other forms of treatment and if you are unable to engage in reasonable activities.

How Well It Works

Opioids are effective in reducing osteoarthritis pain that has not been relieved by other medicines. Opioids are sometimes used along with nonsteroidal anti-inflammatory drugs (NSAIDs).1

Side Effects

Older people in particular may experience side effects from opioids. Side effects can include:

  • Constipation.
  • Urinary retention (bladder does not empty completely during urination).
  • Mental confusion.
  • Drowsiness.
  • Nausea and vomiting.

See Drug Reference for a full list of side effects. (Drug Reference is not available in all systems.)

What To Think About

In some cases, the doctor may prescribe a second opioid medicine for pain rather than increasing the dose of one opioid. Also, opioids can be combined with non-opioids. For example, an opioid with aspirin or acetaminophen can help with pain.

You may become physically dependent on opioids if you take them regularly. Physical dependence is not addiction. But it is a gradual change in your body in response to the opioids. If you stop taking opioids abruptly, you may have nausea, sweating, chills, diarrhea, and shaking. The physical dependence and withdrawal symptoms are not dangerous. But you can prevent withdrawal symptoms if you gradually stop taking the opioids over a set period of time as prescribed by your doctor.

Opioid analgesics can be addictive. But the risk is small when these medicines are properly prescribed and taken by people who do not have a history of substance abuse. In the past, opioids were used only for a short time for short-term pain or for cancer pain. Many experts now also use opioids for a longer time to treat chronic pain. You can take opioids without getting addicted to them. If you use opioids as your doctor prescribes, your pain can be less and you may be able to be more active.

If you are about to start a long-term course of opioids, eat more fiber and drink more water. This will help prevent constipation. Also, talk to your doctor about whether you should take a stool softener or laxative.

Complete the new medication information form (PDF)(What is a PDF document?) to help you understand this medication.

References

Citations

  1. Lozada CJ (2009). Management of osteoarthritis. In GS Firestein et al., eds., Kelley's Textbook of Rheumatology, 8th ed., vol. 2, pp. 1563–1577. Philadelphia: Saunders Elsevier.

Last Updated: April 17, 2009

Author: Shannon Erstad, MBA/MPH

Medical Review: Anne C. Poinier, MD - Internal Medicine & Richa Dhawan, MD - Rheumatology

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