News Release

Addressing pain in rheumatic disease: Opioids and other strategies

New data presented at the EULAR Congress in Copenhagen

Peer-Reviewed Publication

European Alliance of Associations for Rheumatology (EULAR)

Patients with RMDs often suffer from recurrent pain, restricted function and reduction of daily activities. The current standard of intra-articular therapy is the injection of steroids, which can increase risk of infection, cartilage degenerations, and other well-known systemic side effects.

Dr Hildrun Haibel and colleagues investigated a novel approach focused on the activation of peripheral opioid receptors, using small, systemically inactive doses of morphine. Adult patients with chronic knee arthritis and a high level of pain at baseline received a single dose of either morphine, steroid, or placebo – all delivered via intra-articular injection.

The results showed that a single dose of 3 mg intra-articular morphine did not lead to significant pain improvements in comparison to placebo, and was inferior to steroid at day 7. These data do not support the use of intra-articular morphine for pain reduction in patients with chronic arthritis.

In another abstract at the Congress, Dr Joyce (Yun-Ting) Huang presents UK opioid prescribing trends in new users with one of six RMDs: rheumatoid arthritis (RA), psoriatic arthritis (PsA), axial spondyloarthritis, systemic lupus erythematosus, osteoarthritis, or fibromyalgia.

The results show an increased in new opioid users among people with RA, PsA and fibromyalgia since 2006. However, a slight decrease in the trends of new opioid users among most RMDs after 2018 may reflect an increasing awareness of the opioid epidemic. The high proportions of long-term opioid users in RA and fibromyalgia patients highlight the importance of exploring the safety of long-term opioid use and effective pain interventions for patients with RMDs.

In 2019, low back pain was responsible for 64 million years lived with disability (YLDs). Dr Jacek Kopec shared findings from a microsimulation model looking at the impact of three strategies for reducing this burden: weight loss, ergonomic interventions, and an exercise program. The results show that a one unit reduction in body mass index (BMI) per year among overweight and obese individuals would be approximately equivalent in terms of disability reduction to an effective ergonomic intervention in 35% of at-risk workers, and an exercise intervention in 27% of eligible patients with back problems over the same period. This is the first population-based microsimulation study to compare currently available preventive strategies for low back pain in terms of YLDs averted, and to provide measures of equivalence between these strategies.

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