Lighting Talk Sydney Spinal Symposium 2024

Efficacy and harms of non-steroidal anti-inflammatory drugs (NSAIDs) and opioids for musculoskeletal pain in older persons (#22)

Lisa Vizza 1 2 3 , Sujita Narayan 1 2 , Christina Abdel Shaheed 1 2
  1. Institute of Musculoskeletal Health, The University of Sydney, Camperdown, NSW, Australia
  2. School of Public Health, The University of Sydney, Camperdown, NSW, Australia
  3. Charles Perkins Institute, The University of Sydney, Camperdown, NSW, Australia

Introduction: Management of musculoskeletal pain commonly includes medicines such as opioids and non-steroidal anti-inflammatory drugs (NSAIDs). Older adults may experience unique challenges, impacting the type of care they receive for musculoskeletal conditions. There is a need to synthesise the evidence available on the benefits and harms of these medicines for musculoskeletal pain in older adults.

Aim: To evaluate the efficacy and harms of opioid analgesics and NSAIDs compared to placebo, in individuals aged >60 years, for musculoskeletal conditions limited to osteoarthritis, low back pain and total arthroplasty.

Methods: A structured search strategy was undertaken (Medline and Pubmed) to identify systematic reviews that included randomised controlled trials (RCTs) evaluating opioids and/or NSAIDs versus placebo for osteoarthritis, low back pain or arthroplasty in older adults. We identified low risk of bias RCTs including participants with a mean/median age >60 years. Risk of bias of individual RCTs was assessed using the 7-item Cochrane risk of bias scale. The quality of systematic reviews was assessed using AMSTAR-2.

Results: 35 reviews were identified, and a total of 15 systematic reviews were considered for inclusion, with a total of 605 trials. Of these, 186 trials met inclusion criteria and 30 trials were rated as low risk of bias by the reviews using various risk of bias measures. After adjusting for discrepancies in risk of bias scoring based on the Cochrane risk of bias criteria, only nine trials were assessed as low risk. Four trials were in osteoarthritis (OA) and measured topical NSAIDs (skin application), and five trials were on total knee arthroplasty (TKA) and measured NSAIDS (intravenous), or opioids (morphine). No low-risk of bias trials were identified in acute or chronic low back pain, or spinal pain for older adults >60.

Conclusion: There is a paucity of low risk of bias trials in older adults in the musculoskeletal field. Greater efforts are needed to focus on these individuals in future trials.