|Pharmacology for Nociceptive pain
|The European League Against Rheumatism (EULAR) recommendations for the treatment of OA are evidence-based four-step management guidelines.Following diagnosis, non-pharmacological treatments should be instigated, including patient education, exercise and weight loss (for overweight patients). At the same time, simple analgesics (paracetamol/acetaminophen) can be prescribed with the addition of topical nonselective nonsteroidal anti-inflammatory drugs (NSAIDs) as necessary (Step 1).With increasing pain, drug treatment can be stepped up with oral conventional NSAIDs (with gastroprotectant if appropriate) or selective COX-2 inhibitors in patients at risk of gastrointestinal (GI) AEs (Step 2).
If patients still experience increasing pain, an opiate (tramadol or similar) can be added or used as an alternative to NSAIDs and selective COX-2 inhibitors (Step 3).
Intra-articular injection of long-acting corticosteroids is indicated for knee flare pain. Finally, joint replacement should be considered for patients with refractory (unresponsive) pain and disability (Step 4).