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Analgesics for Osteoarthritis—An Update

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Background: Nonopioid Analgesics for Osteoarthritis

In addition to nonpharmacologic interventions (such as physical therapy, weight reduction, and exercise), numerous nonopioid analgesics and over-the-counter supplements are available to treat pain and potentially improve functional status in patients with osteoarthritis.

Oral nonopioid analgesics commonly used to treat osteoarthritis include selective and nonselective nonaspirin nonsteroidal anti-inflammatory drugs (NSAIDs), aspirin, salsalate, acetaminophen, over-the-counter supplements (glucosamine and chondroitin), and topical agents (NSAIDs and rubefacients, including capsaicin).

The over-the-counter supplements glucosamine and chondroitin have grown in popularity; however, they are not regulated by the U.S. Food and Drug Administration (FDA).

Opioid medications are also used for patients with chronic osteoarthritic pain, especially if it is refractory to other therapies. However, recommendations suggest cautious use of opioids because of risks for addiction, tolerance, diversion, and other adverse effects. Opioid medications are not covered in this review.

Each class of medication or supplement is associated with a unique balance of risks and benefits. Efficacy and safety may also vary for individual drugs within a class.