Opioids such as codeine and hydrocodone are used for patients with severe arthritis who have not had success with Tylenol or NSAIDs. They are usually used for a short period of time because they can have undesirable side effects such as nausea, constipation, drowsiness, vomiting, and dizziness. Many times the modest benefits of the drugs do not outweigh the adverse effects. Physicians also need to closely monitor patients as patients may become addicted and abuse the drug. Because of these adverse effects, the OARSI recommends using weaker opioids like codeine and tramadol. Opioids are often combined with acetaminophen. In these cases one must also be aware not to exceed the safe daily dosages of Tylenol.
A 2006 review of the literature by Avouac, et al examined eighteen randomized placebo-controlled studies of opioid vs. placebo use for osteoarthritis patients. These studies demonstrated that opioids can significantly reduce OA pain compared to placebo, however they do not have a significant effect on function. Adverse effects caused many participants to discontinue use.6
Similarly, the Cochrane review examined ten outpatient trials of opioid use among 2,268 patients for treatment of knee and hip OA. The studies ranged from three days to three months and the dosage was an average of 51 mg of morphine equivalency. Thirty-five percent of patients in the treatment group had a reduction in pain vs. thirty-one percent in the control group. In the treatment group however the adverse effects outweighed the decrease in pain.7