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

February 11, 2013

Evidence-based analysis shows that weak opioids have at best a weak effect in rheumatoid arthritis pain. Steroid injections offer no long-term relief for tennis elbow.

Pain controlOpioid analgesics for rheumatoid arthritis painJAMA. 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 trialJAMA. 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.