Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Randomized Controlled Trial
. 2014 Sep;55(5):1379-85.
doi: 10.3349/ymj.2014.55.5.1379.

Progressive change in joint degeneration in patients with knee or hip osteoarthritis treated with fentanyl in a randomized trial

Tatsuya Fujii  1 , Koshi Takana  1 , Sumihisa Orita  1 , Gen Inoue  1 , Nobuyasu Ochiai  1 , Kazuki Kuniyoshi  1 , Yasuchika Aoki  1 , Tetsuhiro Ishikawa  1 , Masayuki Miyagi  1 , Hiroto Kamoda  1 , Miyako Suzuki  1 , Yoshihiro Sakuma  1 , Gou Kubota  1 , Yasuhiro Oikawa  1 , Kazuhide Inage  1 , Takeshi Sainoh  1 , Jun Sato  1 , Kazuyo Yamauchi  1 , Tomoaki Toyone  1 , Junichi Nakamura  1 , Shunji Kishida  1 , Kazuhisa Takahashi  1 , Seiji Ohtori  2
Affiliations
Randomized Controlled Trial

Progressive change in joint degeneration in patients with knee or hip osteoarthritis treated with fentanyl in a randomized trial

Tatsuya Fujii et al. Yonsei Med J. 2014 Sep.

Abstract

Purpose: Opioids 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 methods: Two 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.

Results: Overall, 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.

Conclusion: Fentanyl may induce progressive changes in knee or hip OA during a relatively short period, compared with oral Non-Steroidal Anti-Inflammatory Drugs or tramadol.

Keywords: Opioid; hip; knee; osteoarthritis.

PubMed Disclaimer

Conflict of interest statement

The authors have no financial conflicts of interest.

Figures

Fig. 1
Fig. 1
Flow diagram of this trial.
Fig. 2
Fig. 2
An 84-year-old woman showed knee OA before treatment (A) and progressive changes in OA (B) 12 weeks after 25 µg/h transdermal fentanyl treatment. A 55-year-old man showed hip OA before treatment (C) and progressive changes in OA (D) 12 weeks after 12.5 µg/h transdermal fentanyl treatment. A 65-year-old woman showed hip OA before treatment (E) and progressive changes in OA (F) 12 weeks after 50 µg/h transdermal fentanyl treatment. OA, osteoarthritis.
See this image and copyright information in PMC

References

    1. Centers for Disease Control and Prevention. National Center for Chronic Disease Prevention and Health Promotion. Arthritis types: overview. 2008. Available at: http://www.cdc.gov/arthritis/arthritis/osteoarthritis.htm.
    1. Zhang W, Nuki G, Moskowitz RW, Abramson S, Altman RD, Arden NK, et al. OARSI recommendations for the management of hip and knee osteoarthritis: part III: changes in evidence following systematic cumulative update of research published through January 2009. Osteoarthritis Cartilage. 2010;18:476–499. - PubMed
    1. Abdulla A, Adams N, Bone M, Elliott AM, Gaffin J, Jones D, et al. Guidance on the management of pain in older people. Age Ageing. 2013;42(Suppl 1):i1–i57. - PubMed
    1. Kellgren JH, Lawrence JS. Radiological assessment of osteo-arthrosis. Ann Rheum Dis. 1957;16:494–502. - PMC - PubMed
    1. Pocock SJ, Simon R. Sequential treatment assignment with balancing for prognostic factors in the controlled clinical trial. Biometrics. 1975;31:103–115. - PubMed

Publication types