Opioid Use in Osteoarthritis Linked to Worse Pain Interference, Functioning

Frontal view X-Ray of the knees showing early stage osteoarthritis
Frontal view X-Ray of the knees showing early stage osteoarthritis
In patients with osteoarthritis, chronic pain is a primary symptom that may limit daily activities and impair function.

The following article is part of conference coverage from the PAINWeek 2018 conference in Las Vegas, Nevada. Clinical Pain Advisor’s staff will be reporting breaking news associated with research conducted by leading experts in pain medicine. Check back for the latest news from PAINWeek 2018.

LAS VEGAS — Regardless of baseline functional status, patients with osteoarthritis pain who report persistent opioid use have worse outcomes regarding pain interference with daily activities and functional limitations, according to results presented during the 2018 PAINWeek conference, held September 4-8.

These results highlight the need for more effective and alternative pain management strategies in patients with osteoarthritis.

The study included data from the 2010-2015 Medical Expenditure Panel Surveys (MEPS), which consisted of 5 interview panels. During the 2-year survey period, each panel had 5 rounds of data collection. Participants included adults age ≥18 with osteoarthritis who did not have cancer (n=4172).

The researchers evaluated longitudinal change in pain interference with daily activities and functional limitations. They categorized pain interference with daily activities as no/mild, moderate, and severe using an item from the 12-item Short Form v2 scale. Participants’ opioid use was defined as persistent (opioid use in ≥2 consecutive rounds), intermittent (opioid use in any of the rounds), or no opioid use (no use in any rounds).

Data on pain interference was collected in rounds 2 and 4, while data on functional limitations was collected in rounds 3 and 5. Opioid use patterns from rounds 1 to 3 were used for pain interference analysis and rounds 2 to 4 for functional limitations.

In rounds 1 to 3, 15.9% of participants reported persistent opioid use, 18.0% reported intermittent use, and 64.6% reported no use. In rounds 2 to 4, 14.7% of participants reported persistent opioid use, 13.4% reported intermittent use, and 67.3% reported no use.

At follow-up, 62.1% of participants had no change in pain interference with daily activities, while 17.9% worsened and 20.0% improved.

At baseline, a majority (51.0% to 93.1%) of participants reported no limitations across functional categories. However, at follow-up, higher percentages of participants (3.8% to 13.1%) reported worsening than improvement (1.1% to 11.3%).

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After multivariable regression analysis, the researchers found that persistent opioid users had increased odds of reporting extreme/severe and moderate pain interference with daily activities compared with participants who did not use opioids (adjusted odds ratio [aOR] 2.91 and 2.04, respectively; P <.001 and P <.01, respectively). There was no significant difference between intermittent and non-opioid users.

Compared with non-opioid users, persistent opioid users with baseline functional limitations were more likely to report physical (aOR 1.63) and work (aOR 1.90) limitations at follow-up (both P <.05). Intermittent opioid users were less likely to report social (aOR 0.35) and cognitive (aOR 0.28) limitations compared with non-opioid users (both P <.01).

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Shah D, Zhao X, Gandhi K, et al. A longitudinal study of the impact of opioid use on change in pain interference with activities and functional limitations in a nationally representative cohort of adults with osteoarthritis in the United States. Poster 21. Presented at: PAINWeek 2018; September 4-8, 2018; Las Vegas, NV. doi:10.1080/00325481.2018.1512253

For more coverage of PAINWeek 2018, click here.