‘Disappointing’ data reveal modest benefit of exercise over pain meds in knee OA
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A meta-analysis comparing exercise, opioids and NSAIDs yielded “disappointing” and inconsistent results, in which exercise generally demonstrated some benefit over opioids and NSAIDs, according to a speaker at the 2022 OARSI World Congress.
“We have seen a lot of meta-analyses showing that exercise, weight loss and pain medications seem to work and seem to reduce pain in osteoarthritis,” Carsten B. Juhl, PhD, of the University of Southern Denmark, said in his presentation.
However, he noted that there may be differences in the way patients are instructed to exercise or lose weight, or how they are prescribed pain medications.
“That is why we wanted to investigate this a little further,” Juhl said.
Juhl and colleagues used a networks meta-analysis approach to compare these different interventions with one another, with the aim of comparing the effectiveness of exercise, NSAIDs or opioids for osteoarthritis knee pain.
Juhl noted that, in the initial analysis, they hoped to include only randomized, controlled trials comparing two or more of these interventions through 2021.
“Unfortunately, the number of studies was relatively low, so we made a second step,” he said. “In order to test the robustness of our model, we included meta-analyses comparing these treatments.”
Ultimately, 13 randomized trials met inclusion criteria for the first part of the study. Eleven of those compared opioids to NSAIDs, while two compared NSAIDs to exercise. No studies compared opioids to exercise.
“This was a little bit disappointing,” Juhl said. “More disappointing was that most of the studies were deemed to have a high risk of bias.”
Despite these setbacks, results showed that NSAIDs and opioids yielded “fairly the same” impact in pain management, according to Juhl.
“In this model, it was shown that exercise is extremely much better than the other two interventions,” he said.
However, Juhl warned caution in the interpretation of these results, largely due to the small sample size and the high bias.
“Can we really trust this model? No, definitely not,” he said. “I would never be able to get out of this room if I stated that exercise was incredibly much better than any pain medication.”
With that in mind, the group performed the second step, in which they analyzed 45 studies comparing the relevant interventions to control or placebo.
The main result of this analysis was that exercise showed some benefit over NSAIDs, albeit with “some kind of inconsistency,” Juhl said.
Statistically speaking, a cumulative analysis of both steps in the study demonstrated with 100% certainty that exercise is better than opioids or NSAIDs in managing knee OA pain. “But can we trust this? No,” Juhl said. “Maybe we can just conclude that there are comparable effects between exercise, NSAIDs and opioids. This is disappointing but we tried our best.”
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Juhl CB. Comparison of exercise therapy, non-steroidal anti-inflammatory drugs, and opioids for knee osteoarthritis pain: A systemic review and network meta-analysis. Presented at: OARSI 2022 World Congress on Osteoarthritis; April 7-10; Berlin, Germany (virtual meeting).
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