Short- vs Long-Acting Opioids for Osteoarthritis Pain

In addition to being safer and more cost-effective, short-acting opioids are comparable with long-acting opioids for pain management in patients with chronic osteoarthritis.

In addition to being safer and more cost-effective, short-acting opioids are comparable with long-acting opioid medications for pain management in patients with chronic osteoarthritis (OA), according to findings from a retrospective study published in Pain Medicine.

The researchers retrospectively evaluated average and lowest pain scores in patients with chronic OA and receiving either short- (n=118) or long-acting (n=53) opioid therapy. On average, participants receiving short-acting opioids had a lower morphine equivalent requirement compared with participants receiving long-acting opioids (P <.001). The average morphine equivalence in the long-acting and combination opioid therapy groups was 45.98% higher than in the group receiving short-acting medications (97±65.5 mg vs 52.4±37.7 mg, respectively).

Patients receiving short- and long-acting opioid medications reported no significantly different scores for average or low pain levels (P =.201 and P =.296, respectively). Although patients taking short-acting opioids had numerically higher average pain scores than patients receiving combination or extended-release therapies (5.67 vs 5.35, respectively), the analgesic effects between short- and long-acting opioids were not considered significant (P =.201). Smoking, age, gender, and adjunct analgesics did not affect pain scores when participants switched from long- to short-acting opioid therapies.

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The nonrandomized and retrospective design as well as the small sample size of this study represented the primary limitations. Also, the investigators believe there may have been unmeasured confounders that could have potentially influenced the findings.

Overall, the results of this study “could potentially aid practitioners in primary care environments to design equally efficacious and less costly opioid regimens,” according to the investigators, while optimizing therapy to minimize adverse events often attributed to long-acting opioid medications.

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Ghodke A, Barquero S, Chelminski PR, Ives TJ. Short-acting opioids are associated with comparable analgesia to long-acting opioids in patients with chronic osteoarthritis with a reduced opioid equivalence dosing. Pain Med [published online November 7, 2017]. doi:10.1093/pm/pnx245