The American College of Rheumatology and the American College of Orthopaedic Surgeons recommend opioids such as Tramadol as a front line intervention for knee osteoarthritis (OA), either on their own or in association with NSAID’s.

This paper looked at the 1 year all cause mortality risk associated with knee OA and the use of opioids (Tramadol and Codeine) compared to NSAID’s. Over 1 year the risk of all cause mortality was higher in those who used opioids compared to NSAID’s. This presents a strong case that opioids shouldn’t be used to treat knee OA. However, it must be pointed out that this paper didn’t confound for risks such as cardiovascular disease, diabetes, obesity etc which are commonly seen in patients with knee OA and can be associated with all cause mortality. Therefore further research is required to better understand these results.

Having said that, there is good evidence that supports the use of exercise therapy for improvements in pain and function associated with knee OA. Therefore a more appropriate front line intervention would be to avoid opioids and to utilise exercise therapy and NSAID’s when needed to treat knee OA.