What role do analgesics and anti-inflammatory medications play in the management of osteoarthritis?

In the management of osteoarthritis (OA), pharmacological treatments should be used alongside non-pharmacological approaches and to support therapeutic exercise, at the lowest effective dose for the shortest possible time ¹,³.

• Topical Non-Steroidal Anti-Inflammatory Drugs (NSAIDs): A topical NSAID, such as ibuprofen 5% gel, should be offered for knee OA and considered for OA affecting other joints ¹,³. These are clinically effective for pain relief, cost-effective, and carry a minimal risk of adverse effects, as they do not increase the risk of gastrointestinal adverse events ¹,².
• Oral Non-Steroidal Anti-Inflammatory Drugs (NSAIDs): If topical NSAIDs are ineffective or unsuitable, oral NSAIDs can be considered ¹,³. When prescribing oral NSAIDs, potential gastrointestinal, renal, liver, and cardiovascular toxicity must be considered, along with the person's risk factors, including age, pregnancy, current medication, and comorbidities ³. A gastroprotective treatment, such as a proton pump inhibitor (PPI), should be offered concurrently ¹,³. While effective in reducing pain and stiffness, oral NSAIDs are associated with significant morbidity and mortality due to adverse effects on various body systems ².
• Paracetamol: Paracetamol should not be routinely offered ³. It may be considered infrequently for short-term pain relief only if all other pharmacological treatments are contraindicated, not tolerated, or ineffective ¹,³. There is no strong evidence of benefit for paracetamol, with studies showing little to no efficacy in OA management ¹,³. However, it is less likely than NSAIDs to cause gastrointestinal adverse events ².
• Weak Opioids (e.g., Codeine): Similar to paracetamol, weak opioids like codeine should not be routinely offered ³. They can be considered for infrequent, short-term pain management if other drug treatments are contraindicated, not tolerated, or ineffective ¹,³. Strong opioids are not recommended for OA pain management, as their risks outweigh the benefits ¹,³.

It is important to review the continuation of treatment based on clinical need ³.