Poster Presentation Sydney Spinal Symposium 2026

Efficacy and harms of opioid analgesics in older adults with osteoarthritis: Meta-analysis (#119)

Lisa Vizza 1 2 3 , Daniel Gallacher 4 , Sujita Narayan 1 2 , Rowena Ivers 5 , Christina Abdel Shaheed 1 2
  1. Institute For Musculoskeletal Health, The University of Sydney, Camperdown, NSW, Australia
  2. School of Public Health, The University of Sydney, Camperdown, NSW, Australia
  3. Charles Perkins Institute, The University of Sydney, Camperdown, NSW, Australia
  4. Health Services Management centre, University of Birmingham, Birmingham, United Kingdom
  5. Graduate School of Medicine, University of Wollongong, Wollongong, NSW, Australia

Abstract

Objective

Opioids are commonly prescribed for osteoarthritis in older adults but their efficacy and safety in this population is unknown. This meta-analysis and meta-regression sought to evaluate the efficacy, harms and dose-dependent effects of opioids for older adults with osteoarthritis.

Methods

Twenty-one randomised controlled trials that compared opioids to placebo in older adults with osteoarthritis were included in the meta-analysis. Outcomes included pain (Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), and harms such as adverse events. Continuous outcomes were converted to a common 0 (no pain) to 100 (worst pain) scale and reported using the following time points: Immediate-term (<2 weeks), short-term (≥2 weeks and <6 weeks), medium-term (≥6 weeks but <12 months) and long-term (≥12 months). Meta-regression was performed to evaluate the opioid dose on pain for the primary time point (medium term).

Results

Opioids provided a small reduction in WOMAC pain for both the immediate (Mean difference (MD) -6.17 [95%CI -8.88, -3.46, moderate certainty evidence based on 9 studies n=2969] and short term (MD -7.26 [95%CI -9.89, -4.63] moderate certainty evidence based on 13 studies, n=4013). In addition, opioid use increased the risk of adverse events in both the short term (Risk Ratio (RR) 1.54 [1.29, 1.84], very low certainty evidence based on 5 studies, n=1367), and medium term (RR 1.43 [1.23, 1.65], moderate certainty evidence based on 10 studies, n=3728) timepoints. The meta-regression did not demonstrate an effect of dose on pain relief for the medium term.

 

Conclusion

Opioids provided minimal benefits for the management of osteoarthritis pain in older adults. Given the increased risk of adverse events, their use should be weighed carefully in this population.