Opiates for RA, Steroids for Tennis Elbow Fail to Ease Pain

Opiates for RA, Steroids for Tennis Elbow Fail to Ease Pain

Pain control

Opioid analgesics for rheumatoid arthritis pain
JAMA. Published online Feb. 6, 2013.  Full text $30

There is weak evidence that weak opioids (codeine, dextropropoxyphene, tramadol, tilidine, and pentazocine) provide short-term relief of rheumatoid arthritis pain. Adverse effects (most commonly nausea, vomiting, dizziness and constipation), though mild, may outweigh benefits. In this meta-analysis, one-fifth of patients withdrew from the treatment groups, so for those patients weak opioids were ineffective or not worth the side effects. But about one-fifth withdrew from the control groups too. There were no studies beyond six weeks, so there is no evidence about long-term treatment. There were insufficient data to draw conclusions about strong opioids (such as morphine and oxycodone). This article is a summary of the authors’ Cochrane review, Opioid therapy for treating rheumatoid arthritis pain.

Effect of corticosteroid injection, physiotherapy, or both on clinical outcomes in patients with unilateral lateral epicondylalgia: a randomized controlled trial
JAMA. Published online Feb. 6, 2013. Full text $30

After one year, physical therapy offered no more relief for lateral epicondylalgia (tennis elbow) than placebo. Patients who got corticosteroid injections did worse. A randomized, controlled trial compared physiotherapy, corticosteroid injections, both and neither. Although physical therapy was better than placebo at 4 weeks, the difference had disappeared by 26 weeks.

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