Treatment of pain in osteoarthritis

Clinical studies have demonstrated that osteoarthritic pain is strongly linked to disability and quality of life. Pain relief enables patients to regain their mobility and is therefore a key goal in the management of osteoarthritis (OA). Osteoarthritis pain is of multifactorial origin, and inflammatory mechanisms play only a partial role. Non-opioid analgesics are useful in the control of mild-to-moderate pain, but have limitations as regards efficacy, and may cause serious adverse reactions. Symptomatic slow-acting drugs in OA (SYSADOAs) are alternatives, but their usefulness is still unclear. For patients with moderate-to-severe pain, who do not obtain sufficient pain relief with paracetamol and non-steroidal anti-inflammatory drugs (NSAIDs) or do not tolerate them, the remaining options are opioids. Whereas the adverse reactions of most opioids may preclude the use of these drugs in OA patients, tramadol may be suitable. Tramadol has been investigated in various studies of OA pain and is indicated as an alternative to non-opioids, or as adjunctive therapy when non-opioid therapy is insufficient. However, the choice of analgesic treatment in OA must be highly individual. No guidelines can rigidly define a treatment regimen for such a condition as OA. Simple hints are given how to best use tramadol by selecting the right patients and choosing the right dosing strategy.