From the Guidelines
Oral medications for pain management in severe Osteoarthritis (OA) include paracetamol, oral nonsteroidal anti-inflammatory drugs (NSAIDs), and cyclo-oxygenase-2 (COX-2) inhibitors.
Key Medications
- Paracetamol: is recommended as the first line of treatment for pain relief in OA, with a dose of up to 4g/day 1, 2, 3.
- Oral NSAIDs: such as ibuprofen, naproxen, and diclofenac, are effective for pain relief in OA, but should be used at the lowest effective dose for the shortest possible period of time due to potential gastrointestinal, liver, and cardiorenal toxicity 1, 2, 3.
- COX-2 inhibitors: such as celecoxib, are also effective for pain relief in OA, and may have a lower risk of gastrointestinal toxicity compared to traditional NSAIDs, but may have a higher risk of cardiorenal toxicity 1, 2.
- Duloxetine: a selective serotonin and norepinephrine reuptake inhibitor, may be considered as an alternative or adjunctive therapy for patients with OA who have an inadequate response or contraindications to acetaminophen or NSAIDs, with a dose of 30-60mg/day 4.
Important Considerations
- Opioids: are not recommended for the management of OA pain due to the high risk of adverse effects and limited evidence of efficacy 5, 4.
- Gastroprotective agents: such as proton pump inhibitors, should be considered for patients taking oral NSAIDs or COX-2 inhibitors to reduce the risk of gastrointestinal toxicity 1.
- Individualized treatment: the choice of oral medication should be based on the individual patient's risk factors, medical history, and preferences 1, 5, 4.
From the Research
Oral Medications for Pain Management in Severe Osteoarthritis (OA)
The following oral medications are used for pain management in severe OA:
- Oral nonsteroidal anti-inflammatory drugs (NSAIDs) 6, 7, 8, 9, 10
- Duloxetine, especially in patients with pain from central sensitization 6, 8, 9
- Opioids, although their use is not routinely recommended due to potential side effects and risks 6, 7, 8, 10
- Tramadol, a less potent opioid, which may be considered for pain management 7, 8, 10
- Acetaminophen (paracetamol), although its efficacy and safety are controversial and it is not always recommended as a first-line treatment 8, 9, 10
Considerations for Oral Medication Use
When using oral medications for pain management in severe OA, the following considerations should be taken into account:
- The lowest effective dose should be used for the shortest possible duration to control symptoms 6
- Drug-related side effects and gastrointestinal, cardiovascular, and renal comorbidities need to be considered 6
- Patient-related comorbidities and nonpharmacological therapies should be taken into account when selecting oral medications 6, 8
- The potential benefits and risks of each medication should be discussed with patients to inform treatment decisions 7, 8