Is Kratom (mitragynine) safe to take for osteoarthritis of the hip pain?

Kratom is Not Recommended for Osteoarthritis Hip Pain

Kratom (mitragynine) is not recommended for osteoarthritis of the hip pain due to insufficient evidence of efficacy, safety concerns, and the availability of better-studied alternatives.

Evidence-Based Treatment Options for Hip OA

Current guidelines from the American College of Rheumatology (ACR) and European League Against Rheumatism (EULAR) provide clear recommendations for managing hip osteoarthritis pain:

First-Line Approaches

• Non-pharmacological interventions:
  • Exercise therapy (both land-based and aquatic) 1, 2
  • Weight loss for overweight patients 2
  • Appropriate assistive devices (walking stick used on contralateral side) 2

Pharmacological Options (in order of recommendation)

1. Topical NSAIDs: Not recommended for hip OA due to joint depth 1
2. Oral NSAIDs: Strongly recommended as initial oral medication of choice 1
   • Use lowest effective dose for shortest duration
   • Consider cardiovascular, GI, and renal risk profiles
3. Acetaminophen: Conditionally recommended (up to 3g/day) 1, 2
   • Limited efficacy (small effect sizes)
   • Safer than NSAIDs but requires hepatic monitoring
4. Intraarticular glucocorticoid injections: Strongly recommended with ultrasound guidance 1
5. Duloxetine: Conditionally recommended 1
6. Tramadol: Conditionally recommended when other options fail 1, 2
7. Non-tramadol opioids: Conditionally recommended against but may be considered when all alternatives are exhausted 1

Why Kratom is Not Recommended

1. Lack of Clinical Evidence:

   • No mention of kratom in any major OA treatment guidelines 1, 2
   • Limited research on kratom's efficacy specifically for osteoarthritis 3, 4
   • Available studies are primarily observational or small-scale 5, 6, 7

2. Safety Concerns:

   • Potential for dependence and withdrawal symptoms 4
   • Reported adverse effects without clear treatment guidelines 4
   • FDA issued a public health warning about kratom in 2017 4
   • 36 deaths have been attributed to kratom 4

3. Regulatory Issues:

   • Classified as a "Drug of Concern" by the DEA 3
   • Illegal in many countries 3
   • No standardization of products or dosing

4. Better Alternatives Available:

   • Multiple evidence-based pharmacological and non-pharmacological options exist 1, 2
   • Established safety profiles and dosing guidelines for recommended medications

What Limited Evidence Shows About Kratom

While not recommended for OA, some research on kratom shows:

• Pain-relieving properties through opioid and α-2 receptor agonistic effects 4
• Increased pain tolerance in a small randomized controlled trial 6
• Self-reported pain relief among users in observational studies 7

Conclusion

For hip osteoarthritis pain, follow the evidence-based approach outlined in current guidelines, starting with non-pharmacological interventions and progressing through recommended pharmacological options as needed. Kratom should not be used due to insufficient evidence for efficacy in OA, significant safety concerns, and the availability of better-studied alternatives.

If pain control remains inadequate despite appropriate conservative management, surgical options like total hip arthroplasty should be considered rather than turning to unproven remedies like kratom 2.