CODEINE AND OXYCODONE USE IN PATIENTS WITH CHRONIC RHEUMATIC DISEASE PAIN

Objective, Opioid treatment of chronic rheumatic disease pain is contr oversial because of concerns regarding efficacy, toxicity, tolerance, dependence, and abuse. This study examined opioid use in a cohort of p atients with pain due to defined rheumatic diseases. Methods. Opioid u se was studied retrospectively in a cohort of 644 rheumatology clinic patients, Computerized pharmacy records identified patients who had be en prescribed opioids during the previous 3 years. Medical records wer e reviewed to determine reasons for opioid dosage escalations. Patient s were interviewed to determine efficacy, frequency and types of side effects, and history of alcohol or street-drug abuse. Results. Opioid prescriptions were found in the 3-year pharmacy database for 290 of 64 4 clinic patients: 153 for <3 consecutive months and 137 fur greater t han or equal to 3 months, All opioid-treated patients received codeine and/or oxycodone, In this cohort, 133 patients in each opioid-treated group and 76 of the 354 non-opioid-treated control patients were stud ied. Opioids significantly reduced rheumatic disease pain severity sco res from 8.2 to 3.6 ton a 0-10 scale) (P < 0.001), Mild side effects w ere reported in 38%; nausea, dyspepsia, constipation, and sedation wer e the most common. The mean +/-SD initial dosage was 2.1 +/- 1.7 30-mg codeine equivalents/day, the mean peak was 3.4 +/- 3.3 per day, and t he mean current dose was 2.7 +/- 2.0 per day. Dosage escalations occur red in 32 patients and were attributable to worsening of the underlyin g painful condition or a medical complication thereof in all but 4 pat ients, who also displayed other abuse behaviors. Abuse behaviors were not more frequent in those with or without a history of abuse/ addicti on. Conclusion. Prolonged treatment of rheumatic disease pain with cod eine or oxycodone was effective in reducing pain severity and was asso ciated with only mild toxicity. Doses were stable for prolonged period s of time, with escalations of the opioid dose almost always related t o worsening of the painful condition or a complication thereof, rather than the development of tolerance to opioids, Doubts or concerns abou t opioid efficacy, toxicity, tolerance, and abuse or addiction should no longer be used to justify withholding opioids from patients with we ll-defined rheumatic disease pain.