Perspective

AAHKS: Opioids should not be used to treat hip, knee osteoarthritis in most patients

In a position statement, The American Association of Hip and Knee Surgeons said opioids should be avoided for the treatment of hip and knee osteoarthritis and should be reserved for certain circumstances.

“Opioids should not be a first-line treatment, nor a maintenance therapy, for acute or chronic symptoms of osteoarthritis of the hip or knee,” Mark J. Spangehl, MD, lead author of the position statement, told Healio.com/Orthopedics. Spangehl said patients should be educated on alternative treatments for hip and knee OA such as ice, NSAIDs, acetaminophen, ambulatory walking aids, weight loss in overweight patients and non-impact exercises with or without the guidance of a physical therapist. AAHKS recommended that orthopedic surgeons follow the recommendations of the American Academy of Orthopaedic Surgeons Clinical Practice Guidelines on nonsurgical treatment and non-arthroplasty treatment of arthritis of the hip and knee.

In its position statement, AAHKS stated that opioids may be considered in a small subset of patients who cannot undergo joint replacement surgery and have failed non-opioid treatments. Patients should be prescribed a low dosage of opioids and the fewest number of opioids for the shortest time. If patients need prolonged opioid use, the AAHKS said they should be referred to a pain management specialist. In addition, patients who are prescribed opioids need to be educated about the risks of prolonged use such as addiction and dependency.

“Patients need to understand that opioids should not be used as a first-line treatment and be educated on the potential downsides of opioid use, which include dependency, drowsiness, constipation, nausea, altered mental alertness and tolerance (the need for stronger dosages to achieve the same pain-relieving effect),” Spangehl said.

AAHKS also stated that patients should understand how to properly store or dispose of opioids when they no longer need the medications.

“Furthermore, patients also need to understand that, while non-opioid treatment modalities are usually effective, OA can be a painful condition and complete resolution of symptoms with no pain whatsoever may be unrealistic in moderate or severe OA,” Spangehl said. “Patients should be educated appropriately by all members of their health care team including their primary care providers, orthopedic surgeon and physical therapists.” – by Monica Jaramillo

Reference:

www.aahks.org/position-statements/opioid-use-for-the-treatment-of-osteoarthritis-of-the-hip-and-knee/

In a position statement, The American Association of Hip and Knee Surgeons said opioids should be avoided for the treatment of hip and knee osteoarthritis and should be reserved for certain circumstances.

“Opioids should not be a first-line treatment, nor a maintenance therapy, for acute or chronic symptoms of osteoarthritis of the hip or knee,” Mark J. Spangehl, MD, lead author of the position statement, told Healio.com/Orthopedics. Spangehl said patients should be educated on alternative treatments for hip and knee OA such as ice, NSAIDs, acetaminophen, ambulatory walking aids, weight loss in overweight patients and non-impact exercises with or without the guidance of a physical therapist. AAHKS recommended that orthopedic surgeons follow the recommendations of the American Academy of Orthopaedic Surgeons Clinical Practice Guidelines on nonsurgical treatment and non-arthroplasty treatment of arthritis of the hip and knee.

In its position statement, AAHKS stated that opioids may be considered in a small subset of patients who cannot undergo joint replacement surgery and have failed non-opioid treatments. Patients should be prescribed a low dosage of opioids and the fewest number of opioids for the shortest time. If patients need prolonged opioid use, the AAHKS said they should be referred to a pain management specialist. In addition, patients who are prescribed opioids need to be educated about the risks of prolonged use such as addiction and dependency.

“Patients need to understand that opioids should not be used as a first-line treatment and be educated on the potential downsides of opioid use, which include dependency, drowsiness, constipation, nausea, altered mental alertness and tolerance (the need for stronger dosages to achieve the same pain-relieving effect),” Spangehl said.

AAHKS also stated that patients should understand how to properly store or dispose of opioids when they no longer need the medications.

“Furthermore, patients also need to understand that, while non-opioid treatment modalities are usually effective, OA can be a painful condition and complete resolution of symptoms with no pain whatsoever may be unrealistic in moderate or severe OA,” Spangehl said. “Patients should be educated appropriately by all members of their health care team including their primary care providers, orthopedic surgeon and physical therapists.” – by Monica Jaramillo

Reference:

www.aahks.org/position-statements/opioid-use-for-the-treatment-of-osteoarthritis-of-the-hip-and-knee/

    Perspective
    Michael Ast

    Michael Ast

    The statement released by AAHKS affirms the position that opioids should be avoided in the treatment of hip and knee arthritis pain. Only in rare circumstances when patients are not candidates for surgery and nonopioid modalities fail should opioids be considered. If used, the risk of dependency and addiction should be discussed with the patient and the smallest dose for the shortest duration should be prescribed.

    This statement provides clarity to the previous guidelines published by the AAOS for the nonoperative treatment of hip and knee arthritis. Although the AAOS hip guidelines stated that opioids should be avoided for such treatment, the knee guidelines grouped opioids with acetaminophen, which effectively preserved its potential use for nonoperative knee arthritis. The AAHKS statement clarifies that opioids of any kind, including tramadol, should not be used for arthritis-related pain, except in rare cases.

    The key take-away of this statement is to affirm that opioids are not generally an appropriate treatment for chronic OA symptoms. NSAIDS and acetaminophen should be the pharmacologic treatment considered for OA-related pain, except in the rarest of circumstances.

    Reference:

    https://epmonthly.com/article/painful-reality-behind-americas-surge-tramadol-prescriptions/

    • Michael Ast, MD
    • Hospital for Special Surgery
      New York

    Disclosures: Ast reports no relevant financial disclosures.

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