BMJ  2005;330:673 (19 March), doi:10.1136/bmj.330.7492.673-b

Letter

Managing osteoarthritis of the knee

Opioids help manage pain in osteoarthritis

EDITOR—MacAuley raises an important point about the poor long term management of pain in osteoarthritis of the knee.¹

A recent survey carried out by Arthritis Care to assess the impact of osteoarthritis on patients showed that 81% of the sample said they experience constant pain and that when their osteoarthritis is bad, 69% have difficulty carrying out even the simplest of daily household tasks.² Exercise is undoubtedly of benefit to patients with mild to moderate osteoarthritis, so the priority of healthcare professionals should be the symptomatic relief of chronic pain. Along with paracetamol and non-steroidal anti-inflammatory drugs there is further ammunition for pain relief. Opioids can and should be considered in these patients. As stated by the Pain Society,³ the primary effect of the appropriate use of opioids in chronic pain is analgesia that leads to improved function, sleep, and reduced distress. Their use may also result in reduced use of other analgesics.

With improved education of healthcare professionals and the patient, opioid treatment can be initiated and managed in primary care through developing an individualised treatment plan in discussion with the patient. Doctors in general practice should therefore recognise that appropriate prescribing of opioids can offer a substantial improvement in a patient's quality of life.

Ashville Medical Centre, Barnsley S70 3RJ mjohnson{at}profiad.com

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Competing interests: MJ has carried out consultancy work with Napp Pharmaceuticals, Pfizer, Janssen-Cilag.

References

1. MacAuley D. Managing osteoarthritis of the knee. BMJ 2004;329: 1300-1. (4 December.)[Free Full Text]
2. Arthritis Care. OA nation: the most comprehensive UK report of people with osteoarthritis. London: Arthritis Care, 2004 (http://oanation.arthritiscare.org.uk/90.0.html).
3. Consensus statement. Recommendations for the appropriate use of opioids for persistent non-cancer pain. London: Pain Society, 2004 (www.britishpainsociety.org/pdf/opioids_doc_2004.pdf).

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Relevant Article

Managing osteoarthritis of the knee

Domhnall MacAuley
BMJ 2004 329: 1300-1301. [Extract] [Full Text] [PDF]