Dr Kola Tytler MBBS CertHE MBA MRCGPClinical Lead • iatroX
Recommended first-line pharmacological treatments for managing pain in patients with osteoarthritis include:
- Offer a topical non-steroidal anti-inflammatory drug (NSAID) for people with knee osteoarthritis as the first-line pharmacological option.
- Consider a topical NSAID for osteoarthritis affecting other joints if appropriate.
- If topical NSAIDs are ineffective or unsuitable, consider an oral NSAID, taking into account the patient's gastrointestinal, renal, liver, and cardiovascular risk factors.
- When prescribing oral NSAIDs, offer gastroprotective treatment such as a proton pump inhibitor to reduce gastrointestinal risks.
- Paracetamol and weak opioids should not be routinely offered and only considered for infrequent, short-term pain relief when other treatments are contraindicated, not tolerated, or ineffective.
- Do not offer glucosamine or strong opioids for osteoarthritis management due to lack of evidence of benefit and unfavorable risk-benefit profile.
These pharmacological treatments should be used alongside non-pharmacological approaches and at the lowest effective dose for the shortest possible time.
NICE NG226