Analgesics for Osteoarthritis—An Update
Comparative Effectiveness of Oral Agents: NSAIDs versus Other Agents
Acetaminophen was modestly inferior to NSAIDs in reducing osteoarthritic pain. Pain severity ratings averaged less than 10 points higher for acetaminophen when compared to NSAIDs on 100-point visual analogue scales. When compared with NSAIDs, acetaminophen was associated with fewer side effects in clinical trials and fewer serious GI complications in observational studies.
Strength of evidence: High
Seven randomized trials showed no clear difference between glucosamine and oral NSAIDs for pain or function (Strength of evidence: High). One randomized trial showed no clear difference between chondroitin and an oral NSAID for pain or function (Strength of evidence: Low). A systematic review including recent, higher quality trials found glucosamine to be associated with statistically significant but clinically insignificant beneficial effects on pain (-0.4 cm on a 10-cm scale) and joint space narrowing (-0.2 mm, 95% CI -0.3 to 0.0) when compared to placebo. Similar results were reported for chondroitin.
It is important to note that most trials showing therapeutic benefits from glucosamine were conducted with pharmaceutical-grade glucosamine not available in the United Stats. Therefore, the findings of these trials may not be applicable to currently available over-the-counter preparations.
Keywords: comparative effectiveness | outcomes | strength of evidence | efficacy | NSAIDs | acetaminophen | glucosamine | chondroitin | pain
- Chou R, McDonagh M, Nakamoto E, et al. Comparative Effectiveness and Safety of Analgesics for Osteoarthritis: An Update of the 2006 Report. Comparative Effectiveness Review No. 38 (Prepared by Oregon Evidence-based Practice Center under Contract No. HHSA 290-2007-10057-I). Rockville, MD: Agency for Healthcare Research and Quality; October 2011. AHRQ Publication No. 11(12)-EHC076-EF. Available at: http://www.effectivehealthcare.ahrq.gov/reports/analgesicsupdate.cfm.
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