• Tatsuya Fujii, Koshi Takana, Sumihisa Orita, Gen Inoue, Nobuyasu Ochiai, Kazuki Kuniyoshi, Yasuchika Aoki, Tetsuhiro Ishikawa, Masayuki Miyagi, Hiroto Kamoda, Miyako Suzuki, Yoshihiro Sakuma, Gou Kubota, Yasuhiro Oikawa, Kazuhide Inage, Takeshi Sainoh, Jun Sato, Kazuyo Yamauchi, Tomoaki Toyone, Junichi Nakamura, Shunji Kishida, Kazuhisa Takahashi, and Seiji Ohtori.
• Department of Orthopaedic Surgery, Graduate School of Medicine, Chiba University, Chiba, Japan.
• Yonsei Med. J. 2014 Sep 1; 55 (5): 1379-85.

PurposeOpioids improve pain from knee and hip osteoarthritis (OA) and decrease the functional impairment of patients. However, there is a possibility that opioids induce analgesia and suppress the physiological pain of OA in patients, thereby inducing the progression of OA changes in these patients. The purpose of the current study was to investigate the possibility of progressive changes in OA among patients using opioids.Materials And MethodsTwo hundred knee or hip OA patients were evaluated in the current prospective, randomized, active-controlled study. Patients were randomized 1:1:1 into three parallel treatment groups: loxoprofen, tramadol/acetaminophen, and transdermal fentanyl groups. Medication was administered for 12 weeks. Pain scores and progressive OA changes on X-ray films were evaluated.ResultsOverall, pain relief was obtained by all three groups. Most patients did not show progressive OA changes; however, 3 patients in the transdermal fentanyl group showed progressive OA changes during the 12 weeks of treatment. These 3 patients used significantly higher doses than others in the transdermal fentanyl group. Additionally, the average pain score for these 3 patients was significantly lower than the average pain score for the other patients in the transdermal fentanyl group.ConclusionFentanyl may induce progressive changes in knee or hip OA during a relatively short period, compared with oral Non-Steroidal Anti-Inflammatory Drugs or tramadol.

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