Arthritis Current Topics in Arthritis

Are Strong Narcotics Good For Modest Arthritis Pain?

The withdrawal of Vioxx and growing safety concerns of similar drugs has forced many arthritis sufferers to return to the old stand by, Tylenol. While this drug might pack less of a pain relieving punch than the broad range of non-steroidal anti-inflamatory drugs (NSAIDs), it is still considered generally safer. Sales of two arthritis supplements, glucosamine and chondroitin, are also reported to be up. Yet pain specialists say that a more potent and generally safe option remains largely neglected.

"There is still an opioid phobia," says arthritis expert, Dr. Sanford Roth, referring to the long-standing concerns of using powerful narcotic medications to treat common aches and pains.

Opioid drugs are under close watch by the federal government due to their potential for being abused, and doctors are generally reluctant to prescribe them unless a patient is suffering severe pain, such as from a serious injury or cancer.

Various surveys, however, suggest that arthritis patients are in plenty of pain as well, a problem that is likely to get worse in the wake of the Vioxx withdraw. Roth is part of a growing number of doctors who say that narcotics deserve a shot.

"When used properly, they can be very effective," says Roth, a former advisor to the Food and Drug Administration who is now a professor of health management policy at Arizona State University.

Besides providing immediate relief for severe pain, opioids have shown a positive effect in chronic conditions, including osteoarthritis, rheumatoid arthritis and low back pain. These drugs are generally believed to be less effective for fighting pain primarily caused by inflammation.

Still, out of three rigorous studies that looked specifically at arthritis patients, the average reduction in pain intensity was nearly 36 percent from opioid drugs compared to 13 percent with a placebo, according to a review by Dr. Donna Bloodworth of Baylor Medical College.

In contrast, a separate large-scale review in the British Medical Journal found that NSAIDs barely beat out sugar pills in relieving arthritis pain. More importantly, opioids show little toxicity to the stomach and heart, a major detraction with both older NSAIDs, like Aleve and Advil, as well as newer ones, such as Celebrex.

To be sure, opioids are associated with their own problems, which range from constipation and dizziness to a risk of physical dependency. Recently, the FDA warned that a patch containing the potent narcotic Fentanyl is linked to potential overdoses.

But some experts contend that the abuse of more powerful opioids have unfairly tarnished attempts to use low doses of these drugs to relieve pain. Roth, for one, says there is a significant difference between those who take narcotics to get high and the average patient who needs the drug to feel better.

The typical drug addict, he says, "are people who already have problems searching for more problems." Most arthritis sufferers, on the other hand, will only want a drug that can relieve their pain.

Some patients may say they need to take more of an opioid drug to feel relief, which can be a sign of addiction. However, a recent study in Arthritis & Rheumatism suggests that tolerance to opioids may be related to the fluctuating symptoms of chronic pain. Looking at 152 patients who used narcotics to treat their spine disorder, researchers found that only 2 percent of them demonstrated abusive behavior.

Dr. Daniel Solomon, an arthritis specialist at the Brigham and Women's hospital in Boston, has been studying Medicaid records to determine if there are any problems with arthritis patients taking opioids. At the moment, there seems to be little concern because not all that many are using them.

"We've been slightly surprised by how few patients are getting these medications," Solomon says.

The idea of replacing one controversial pain reliever with another is bound to raise eyebrows, and even supporters of opioids say that patients who have history of alcoholism or drug addiction should not take such tempting drugs. But faced with the newfound dangers of other painkillers, some are reluctantly looking to opioids to provide relief.

"It is an option to consider," says Solomon.