Pain treatment in osteoarthritis

Joint pain is the most serious symptom of osteoarthritis (OA) which needs to be paid enough attention to in the clinical practice since it

is this symptom that significantly affects the functional capacity as well as quality of life of OA patients. The pain in OA can be managed

nonpharmacologically (education, lifestyle modifications, regular exercise, physiotherapy, supportive and orthopaedic devices) or with

pharmacotherapy. Paracetamol remains the analgesic of choice; given their toxicity, nonsteroid anti-inflammatory drugs are indicated as

second-choice analgesics. Particular caution must be taken in persons with an increased gastrointestinal and cardiovascular risk, especially

in long-term treatment. Symptomatic slow acting drugs for osteoarthritis (SYSADOA) are recommended for the treatment of symptomatic

OA of grade 2 and 3 according to Kellgren-Lawrence; this treatment is associated with a slow onset of effect (weeks) which lasts even

after treatment cessation for another two to three months. SYSADOA may be combined, particularly at the beginning of the treatment

before the onset of effect, with analgesics or nonsteroid anti-inflammatory drugs. For conditions associated with inflammatory complications,

local treatment with glucocorticoid injections is appropriate; however, it may only be used up to four times a year with intervals

between two injections of at least six weeks. When conservative therapy fails, surgical treatment procedures are indicated.

Keywords: osteoarthritis, pain, nonsteroid anti-inflammatory drugs, SYSADOA.