What are the recommended therapeutic options for managing chronic pain in patients with osteoarthritis in primary care?

Non-pharmacological options: Offer therapeutic exercise tailored to the patient's needs, including local muscle strengthening and general aerobic fitness, and consider supervised sessions to support joint health and function ¹.

Advise patients that regular and consistent exercise may initially increase joint pain but will be beneficial in the long term, reducing pain and improving function ¹.

Support weight management strategies if the patient is overweight or obese, as weight loss can improve quality of life, reduce pain, and enhance physical function ¹.

Consider manual therapy, such as manipulation or mobilisation, alongside therapeutic exercise, but explain that evidence does not support manual therapy alone for OA management ¹.

Use assistive devices like walking aids to support mobility and reduce joint load, especially in lower limb OA ³.

Offer pharmacological treatments alongside non-pharmacological approaches, starting with topical NSAIDs for affected joints, and consider oral NSAIDs if topical treatments are ineffective or unsuitable, with attention to potential adverse effects ¹, ³.

Intra-articular corticosteroid injections may be considered if other treatments are ineffective, providing short-term relief (2–10 weeks) ¹.