A number of clinical guidelines for treating OA-associated pain are available
Guideline updates over the last year have downgraded the use of paracetamol and opioids for OA-associated pain and highlighted the importance of individual patient management.
“all NSAIDs should be used at the lowest effective dose for the shortest period of time necessary to control pain, i.e. intermittently or in longer cycles rather than in chronic use”2.
The use of paracetamol has been downgraded in recent pain management guidelines
The use of opioids has been downgraded in recent pain management guidelines
Common OA comorbidities
The prevalence of comorbidities among patients with OA is high. In a large retrospective cohort study in Canada (n = 207,610 patients), 67 % of those with OA (14% of study population) had at least one comorbidity (after adjustment for age and sex) which included21:
- hypertension (prevalence ratio [PR] 1.17, 95% confidence interval 1.15–1.19)
- depression (PR 1.26, 95% confidence interval 1.22–1.30)
- chronic obstructive pulmonary disease (COPD) (PR 1.16, 95% confidence interval 1.11–1.21)
Pharmacologic treatment options
- Marie was initially started on 325 mg of paracetamol four times a day, dose was increased to 1 g four times a day after two weeks but it still did not alleviate her pain.
Guidelines no longer recommend regular paracetamol due to a minimal effect on pain and increasing evidence of gastrointestinal, cardiovascular and renal adverse events (AE), along with increased mortality risk11.
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