Rheumatoid arthritis (RA) is a painful joint condition that affects about1.5 millionpeople in the United States.

Pain, tenderness, and stiffness are often the first symptoms of RA and can affect your ability to complete daily activities. These symptoms most often occur in the:

  • 手
  • wrists
  • knees
  • ankles

Pain management is a key part of the treatment of RA. While other medications are needed to treat the underlying causes of disease, pain medications can help relieve symptoms and improve your ability to move and function.

Opioids are one of the types of medication used to treat pain in RA. These medications work by blocking pain signals between nerve cells.

Opioids can be very effective for managing pain and are generally considered safe with short-term use. But they can be highly addictive, and many experts worry about the overuse of these medications in light of the recent opioid epidemic in the United States.

In this article, we take a closer look at the use of opioids in RA, including how well they control pain and potential safety concerns.

Using opioids to treat RA pain has become increasingly common in recent years. Recent studies suggest that up to 40 percent of people with RA are regular users of opioids.

A 2021 study found that opioid prescriptions in the United States more than doubled in recent years, from 1.43 million prescriptions in 2011–2012 to 3.69 million in 2015–2016.

But do opioids work to help relieve the pain of RA?

Despite how commonly used opioids are in RA treatment, the evidence supporting their use is limited.

Clinical trials from the early 2000s suggested that short-term use of certain opioids, including fentanyl and oxycodone , could help reduce the intensity of pain in RA and provide better control in those with difficult-to-treat pain.

In a more recent study, using a transdermal buprenorphine patch for 11 weeks helped provide pain relief and improved sleep quality in people with chronic musculoskeletal pain. This study only included 8 people with RA, though, so it’s difficult to say how these results translate to the majority of people with RA.

While short-term opioid use may provide some relief from immediate pain, research suggests that they don’t affect pain sensitivity or response to pain over time, meaning they must be continually taken to have an effect.

然而,长期使用阿片类药物被发现to change the chemistry of the brain in such a way that the body becomes more tolerant to the drug.

This means that the pain-relieving effects of opioids decrease over time, and higher and higher doses are needed to achieve the same level of relief.

This is one of the ways that opioid misuse and addiction occur.

Research suggests that opioid misuse occurs in approximatelyone-fifth to one-thirdof people taking opioids and that approximately 10 percent of opioid users experience addiction.

An estimated9.7 millionpeople over the age of 12 years misused prescription opioid pain relievers in the United States in 2019, and nearly 1.6 million people had an opioid use disorder.

Prolonged use or misuse of opioids can lead to not only opioid dependence and addiction, but a variety of other health problems, including :

  • bone disorders
  • sleep-disordered breathing
  • immune suppression
  • chronic constipation and bowel obstruction
  • heart conditions
  • dental disease

In an overdose situation, opioids can affect the part of the brain that controls breathing and, if left untreated, may lead to death.

Given the high numbers of opioid prescriptions, the heavy burden of misuse and addiction, and the serious risks associated with opioid misuse or overdose, the U.S. Department of Health and Human Services declared the opioid epidemic a public health emergency in 2017.

Experts recommend that healthcare professionals and patients work closely to assess the risks and benefits of treatment before starting opioids.

In general, non-opioid medications and alternative pain management approaches are recommended for chronic diseases like RA, even for short-term relief. This is in part because of the possible complications of opioid use, but also because evidence demonstrating they provide meaningful relief is limited.

However, some expertsarguethat a more nuanced approach to opioid prescribing is needed and that some people with chronic pain, including those with RA, may experience real benefits with opioid use.

If opioids aren’t right for you, a variety of other pain relievers are available for people with RA, including nonsteroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen and naproxen, or topical capsaicin.

Although pain relief with traditional disease-modifying treatments has been limited, research suggests that newer therapies that are typically used for more advanced disease, known as biologics, may help relieve pain and reduce opioid use in people with RA.

The Arthritis Foundation also suggests a variety of non-medication-based approaches for pain relief in RA,including:

  • maintaining regular movement and activity
  • eating a balanced diet that supports a healthy weight and joint health
  • hot and cold treatments for joints and muscles
  • massage or acupuncture

These options may provide some immediate relief from pain with RA, but they don’t treat the underlying causes of disease. Even with lifestyle changes, it’s important to continue any treatments prescribed by your rheumatologist to help prevent more damage to your joints and body.

Opioids are commonly used in RA treatment and can provide effective short-term pain relief. Long-term use can reduce the benefits experienced with treatment, though, and may cause serious health complications.

Before starting opioid medications for your RA, talk with your rheumatologist about the risks and benefits of treatment, and whether other options are available that can help provide relief from your RA pain.