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JAMA Clinical Evidence Synopsis | Clinician's Corner

Opioid Analgesics for Rheumatoid Arthritis Pain

Samuel L. Whittle, MBBS, MClinEpi; Bethan L. Richards, MBBS, MClinEpi; Rachelle Buchbinder, MBBS, PhD
JAMA. 2013;309(5):485-486. doi:10.1001/jama.2012.193412.
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Clinical Question Do the benefits of opioid analgesics outweigh the risks in patients with persistent pain due to rheumatoid arthritis?

Bottom Line Weak opioids (such as codeine, dextropropoxyphene, and tramadol) may be effective in the short-term management of rheumatoid arthritis pain, but adverse effects are common and may outweigh the benefits; alternative analgesics should be considered first.

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Figure. Comparison of Relative Risk (RR) for Efficacy, Safety, and Net Efficacy Adjusted for Risk (NEAR) for Opioids vs Placebo
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The NEAR RR is a composite measure of both benefit (efficacy) and harm (safety) that estimates the relative proportion of study participants receiving either opioid or placebo who achieve an analgesic response and also avoid harm. Efficacy and safety RR estimates may vary slightly from the estimates in the primary analysis due to different weighting methods in the meta-analysis vs the NEAR analysis. In this instance, the differences are slight and do not alter the conclusions. Source: Figure 3 in Whittle SL, Richards BL, Husni E, Buchbinder R. Opioid therapy for treating rheumatoid arthritis pain. Cochrane Database Syst Rev. 2011(11):CD003113. doi:10.1002/14651858.CD003113.pub3.

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