Opioids for chronic osteoarthritis pain. An updated systematic review and meta‐analysis of efficacy, tolerability and safety in randomized placebo‐controlled studies of at least four weeks double‐blind duration

Abstract

Background and Objective

This updated systematic review evaluated the efficacy and safety of opioids compared to placebo for chronic osteoarthritis pain.

Databases and Data Treatment

Clinicaltrials.gov, CENTRAL, MEDLINE and PsycINFO were searched from October 2013 to July 2019. Randomized controlled trials comparing opioids with placebo and at least four weeks double‐blinded duration were analysed. Primary outcomes were pain relief of 50% or greater, disability, tolerability and safety. Effects were summarized by a random effects model using risk differences or standardized mean differences with 95% confidence intervals. We added two new studies with 397 participants for a total of 22 studies with 8,942 participants. Study duration ranged between four and 24 weeks. Studies with a parallel and cross‐over design: Based on very low to low quality evidence, opioids provided no clinically relevant pain relief of 50% or greater and no clinically relevant reduction of disability compared to placebo. There was a clinically relevant harm related to the dropout rate due to adverse events. The frequency of serious adverse events did not differ from placebo. Enriched enrolment randomized withdrawal design: Based on very low to low quality evidence, opioids provided no clinically relevant pain relief of 50% or greater and no clinically relevant reduction of disability compared to placebo. Dropout rates due to adverse events and frequency of serious adverse events did not differ from placebo.

Conclusions

Tolerability of opioids is low and efficacy is not clinically relevant in controlled studies from four to 24 weeks for osteoarthritis pain.

from Wiley: European Journal of Pain: Table of Contents https://ift.tt/2sccVqV
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