Analgesia and the patient with osteoarthritis

Osteoarthritis is the most common form of arthritis, its prevalence increasing with age: as much as 80% of the population over 75 years show radiologic signs of the condition. Symptoms include pain, stiffness, and functional impairment; however, not all patients are symptomatic. Management starts with nonpharmacologic interventions, followed by pharmacologic means, and ultimately by surgical intervention. The management is multidisciplinary and is tailored to the needs of the individual patient. It is, therefore, a good model of collaborative care: multidisciplinary management of a chronic condition for which the patients themselves coordinate the use of the management options, with information and guidance from health care professionals and written materials, as needed. Guidelines for the management of osteoarthritis have been developed and are applied in different continents. These guidelines are based on searches of the literature and evidence-based interpretation, in combination with expert opinion. Pharmacologic management guidelines state that based on its overall efficacy, toxicity profile, and cost, paracetamol-acetaminophen should be tried first and, if successful, should be used as the preferred long-term analgesic. In patients who do not experience adequate symptomatic relief with paracetamol-acetaminophen, alternative or additional pharmacologic agents should be considered, especially nonsteroidal anti-inflammatory drugs (NSAIDs). When the combination of paracetamol-acetaminophen with NSAIDs fails, tramadol may be given. Most patients with osteoarthritis are able, after discussion with their physician, to manage their symptoms themselves. They make use of educational occupational, and physical advisers, and they use their medication on demand. The basis of this self-administered pharmacologic management is paracetamol-acetaminophen, sometimes in combination with NSAIDs. A promising option for the future is the development of symptomatic slow-acting drugs for osteoarthritis that possess structure-modifying properties.