The role of analgesics in the management of osteoarthritis pain.

摘要: Osteoarthritis (OA), previously called degenerative joint disease, is a common condition. Figures from the United States indicate that as many 80% of population has radiographic evidence this disease by age 65 years, and difficulty with ambulation, mostly attributable to OA, accounts for 30% all visits doctor. There no known cure OA hence treatments are used reduce pain other symptoms, maintain and/or improve mobility, limit functional disability, overall management goal improving patients' quality life. To point, one key objectives treatment manage knee pain. In past, was most often initiated prescription nonsteroidal anti-inflammatory drugs (NSAIDs). However, (1) NSAIDs offer additional symptomatic benefit over simple analgesics, such paracetamol (acetaminophen), patients (2) NSAID-related adverse gastrointestinal (GI) effects significant cause or morbidity mortality, (3) could have possible deleterious effect on articular cartilage metabolism, led change in strategy. Contemporary thinking nonpharmacologic measures should be tried first, pharmacologic intervention an adjunct. Nonpharmacologic therapy includes things patient education, weight loss, physical therapy, occupational exercise. Paracetamol, doses high 4000 mg/day, first-line drug choice OA. If does not respond paracetamol, may appropriate alternative, provided they medically contraindicated. Because their GI toxicity, it suggested lowest dose shortest time. intensity varies both during day night, enabling use short half-life as-needed basis. Strategies risk complications include prophylaxis misoprostol. Current developments field also discussed, including emergence specifically inhibit cyclooxygenase 2 (COX-2) disease-modifying treatments.