Complexities in the pharmacologic management of osteoarthritis pain

Abstract

Objective:

To discuss challenges in the pharmacologic management of osteoarthritis (OA) pain.

Scope:

Literature searches through MEDLINE and Cochrane databases were used to identify relevant journal articles. The search was limited to articles published from January 1982 to January 2013. Additional references were obtained from articles extracted during the database search.

Findings:

Pharmacologic management of OA is aimed at alleviating pain and reducing functional impairment. Limitations of the most commonly prescribed agents (non-steroidal anti-inflammatory drugs [NSAIDs], acetaminophen, and opioids) and conflicting practice guidelines have led to physician and patient dissatisfaction. OA management guidelines advocate the use of acetaminophen, NSAIDs, serotonin-norepinephrine reuptake inhibitors (SNRIs) and opioids; however, these agents are associated with serious adverse events (AEs) and, in some cases, efficacy concerns. Acetaminophen, particularly at higher dosages, may lead to acute liver failure and gastrointestinal (GI) bleeding. NSAIDs present a significant GI bleeding risk and are also associated with a variety of renal complications, myocardial infarction and other serious cardiovascular complications. SNRIs can cause AEs such as hepatotoxicity and drug/drug interactions that can lead to serotonin syndrome. Opioids exhibit abuse potential and tramadol may demonstrate limited efficacy.

Conclusions:

The safety and efficacy concerns associated with currently available OA treatment options establish a need to develop new treatment strategies. Disease-modifying agents and novel drug formulations are currently under investigation. As these new pharmacologic options evolve, their adoption may lower risk and improve clinical outcomes.

Keywords::

• Acetaminophen
• Musculoskeletal
• NSAIDs
• Opioids
• Osteoarthritis
• Practice guidelines

Transparency

Declaration of funding

Editorial support was sponsored by Iroko Pharmaceuticals LLC.

Declaration of financial/other relationships

B.M. is an advisor for Pfizer Inc., NeurogesX Inc., INSYS Therapeutics Inc., Teva Pharmaceutical Industries Ltd., Sucampo Pharmaceuticals Inc., and Zogenix Inc. P.T. has disclosed that she has no significant relationships with or financial interests in any commercial companies related to this study or article. The authors had full control in the development of this manuscript and did not receive honoraria.

CMRO peer reviewers may have received honoraria for their review work. The peer reviewers on this manuscript have disclosed that they have no relevant financial relationships.

Acknowledgments

Editorial assistance was provided by Colville Brown, MD, of AlphaBioCom LLC.