Complexities in the pharmacologic management of osteoarthritis pain

Bill McCarberg, Penny Tenzer

Research output: Contribution to journalArticle

22 Citations (Scopus)

Abstract

Objective: To discuss challenges in the pharmacologic management of osteoarthritis (OA) pain. Scope: Literature searches through MEDLINE and Cochrane databases were used to identify relevant journal articles. The search was limited to articles published from January 1982 to January 2013. Additional references were obtained from articles extracted during the database search. Findings: Pharmacologic management of OA is aimed at alleviating pain and reducing functional impairment. Limitations of the most commonly prescribed agents (non-steroidal anti-inflammatory drugs [NSAIDs], acetaminophen, and opioids) and conflicting practice guidelines have led to physician and patient dissatisfaction. OA management guidelines advocate the use of acetaminophen, NSAIDs, serotonin-norepinephrine reuptake inhibitors (SNRIs) and opioids; however, these agents are associated with serious adverse events (AEs) and, in some cases, efficacy concerns. Acetaminophen, particularly at higher dosages, may lead to acute liver failure and gastrointestinal (GI) bleeding. NSAIDs present a significant GI bleeding risk and are also associated with a variety of renal complications, myocardial infarction and other serious cardiovascular complications. SNRIs can cause AEs such as hepatotoxicity and drug/drug interactions that can lead to serotonin syndrome. Opioids exhibit abuse potential and tramadol may demonstrate limited efficacy. Conclusions: The safety and efficacy concerns associated with currently available OA treatment options establish a need to develop new treatment strategies. Disease-modifying agents and novel drug formulations are currently under investigation. As these new pharmacologic options evolve, their adoption may lower risk and improve clinical outcomes.

Original languageEnglish
Pages (from-to)539-548
Number of pages10
JournalCurrent Medical Research and Opinion
Volume29
Issue number5
DOIs
StatePublished - May 1 2013

Fingerprint

Pain Management
Osteoarthritis
Acetaminophen
Opioid Analgesics
Pharmaceutical Preparations
Anti-Inflammatory Agents
Serotonin Syndrome
Databases
Hemorrhage
Tramadol
Drug Compounding
Acute Liver Failure
Non-Steroidal Anti-Inflammatory Agents
Drug Interactions
Practice Guidelines
MEDLINE
Myocardial Infarction
Guidelines
Physicians
Kidney

Keywords

  • Acetaminophen
  • Musculoskeletal
  • NSAIDs
  • Opioids
  • Osteoarthritis
  • Practice guidelines

ASJC Scopus subject areas

  • Medicine(all)

Cite this

Complexities in the pharmacologic management of osteoarthritis pain. / McCarberg, Bill; Tenzer, Penny.

In: Current Medical Research and Opinion, Vol. 29, No. 5, 01.05.2013, p. 539-548.

Research output: Contribution to journalArticle

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