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Oral or transdermal opioids for osteoarthritis of the knee or hip
Cochrane Reviews, 10/09/09

Nuesch E et al. – The small to moderate beneficial effects of non–tramadol opioids are outweighed by large increases in the risk of adverse events. Non–tramadol opioids should therefore not be routinely used, even if osteoarthritic pain is severe.

Methods

The authors searched CENTRAL, MEDLINE, EMBASE, and CINAHL (up to 28 July 2008), checked conference proceedings, reference lists, and contacted authors.
Studies were included if they were randomised or quasi–randomised controlled trials that compared oral or transdermal opioids with placebo or no treatment in patients with osteoarthritis of the knee or hip.Studies of tramadol were excluded.

Results

Ten trials with 2268 participants were included.
Oral codeine was studied in three trials, transdermal fentanyl and oral morphine in one trial each, oral oxycodone in four, and oral oxymorphone in two trials.
Overall, opioids were more effective than control interventions in terms of pain relief and improvement of function.
The authors did not find substantial differences in effects according to type of opioid, analgesic potency (strong or weak), daily dose, duration of treatment or follow up, methodological quality of trials, and type of funding.
Adverse events were more frequent in patients receiving opioids compared to control. The pooled risk ratio was 1.55 for any adverse event (4 trials), 4.05 for dropouts due to adverse events (10 trials), and 3.35 for serious adverse events (2 trials).
Withdrawal symptoms were more severe after fentanyl treatment compared to placebo.