Treating the Pain of Osteoarthritis — Where Do We Go from Here?

Mandl, Lisa A.

doi:10.3899/jrheum.110671

Cited by 6 publications

(6 citation statements)

References 21 publications

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“…Pain is the overriding clinical issue [90]. Complex underlying pain mechanisms [91] might require the administration of pain medications from different medication classes to achieve sufficient analgesia.…”

Section: Pain Indications Frequently Encountered By the Family Pramentioning

confidence: 99%

Tramadol/Paracetamol Fixed-Dose Combination for Chronic Pain Management in Family Practice: A Clinical Review

Merchante¹,

Pergolizzi

Laar³

et al. 2013

ISRN Family Medicine

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The family practitioner plays an important role in the prevention, diagnosis, and early management of chronic pain. He/she is generally the first to be consulted, the one most familiar with the patients and their medical history, and is likely the first to be alerted in case of inadequate pain control or safety and tolerability issues. The family practitioner should therefore be at the center of the multidisciplinary team involved in a patient's pain management. The most frequent indications associated with chronic pain in family practice are of musculoskeletal origin, and the pain is often multimechanistic. Fixed-dose combination analgesics combine compounds with different mechanisms of action; their broader analgesic spectrum and potentially synergistic analgesic efficacy and improved benefit/risk ratio might thus be useful. A pain specialist meeting held in November 2010 agreed that the fixed-dose combination tramadol/paracetamol might be a useful pharmacological option for chronic pain management in family practice. The combination is effective in a variety of pain conditions with generally good tolerability. Particularly in elderly patients, it might be considered as an alternative to conventional analgesics such as NSAIDs, which should be used rarely with caution in this population.

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Section: Pain Indications Frequently Encountered By the Family Pramentioning

confidence: 99%

Tramadol/Paracetamol Fixed-Dose Combination for Chronic Pain Management in Family Practice: A Clinical Review

Merchante¹,

Pergolizzi

Laar³

et al. 2013

ISRN Family Medicine

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“…Occasionally, some patients reported increased pain with movement, cold weather, high humidity, and/or a drop in barometric pressure (19) . The pain of OA includes both nociceptive and nonnociceptive components and is associated with abnormally excitable pain pathways in the peripheral and central nervous systems (20,21) . Furthermore; unrelieved pain leads to serious negative consequences, like those observed with poor pain score belong to OA patients before treatment (table 1), with many other physiological effects associated with increased catabolic demands (22) .…”

Section: Discussionmentioning

confidence: 99%

Evaluation of the Clinical use of Metformin or Pioglitazone in Combination with Meloxicam in Patients with Knee Osteoarthritis; using Knee Injury and Osteoarthritis outcome Score

Mohammed¹,

Al-Shamma²,

Jassim³

2017

IJPS

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Osteoarthritis is the most prevalent arthritic disease and a leading cause of disability. The pathogenesis of osteoarthritis involves multiple etiologies, including variable degree of synovial inflammation. Metformin and pioglitazone could potentially reduce the levels and activity of inflammatory mediators. This may consider as a new therapeutic approach added to the current used drugs in an attempt to decrease the pain, inflammation, and improve daily activity and quality of life in patients with knee osteoarthritis. This study designed to evaluate the clinical utility of using metformin or pioglitazone as anti-inflammatory agents in combination with non-steroidal anti-inflammatory drugs (NSAID) of selective type of cyclooxygenase-2 (COX-2) inhibitor, meloxicam, in the treatment of knee osteoarthritis (OA). Randomized, double blinded clinical study was performed on 98 patients who have symptomatic and radiologic evidence of painful OA of the knee (57 patients only completed the study). Patients were allocated into three groups, group (A); 20 patients treated with meloxicam (15mg/day) alone, group (B); 20 patients treated with metformin (1000mg/day) + meloxicam (15mg/day) and group (C); 17 patients treated with pioglitazone (15mg/day) + meloxicam (15mg/day). The treatment was followed for 12 weeks through measurement of the clinical effects of drugs each 7 days, using the Knee Injury and Osteoarthritis Outcome Score (KOOS) system. The results showed that metformin or pioglitazone, when used in combination with NSAID resulted in significant improvement in the components of KOOS, higher than that produced by meloxicam when used alone. In conclusion, administration of metformin or pioglitazone as adjuvant therapy to NSAID, meloxicam, in OA patients produced very well characterized analgesic and anti-inflammatory activities, and improves the therapeutic profile of meloxicam. Keywords: Metformin, Pioglitazone, Osteoarthritis, Knee injury, KOOS.

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“…Innervation of the joint tissue and angiogenesis have been described as main pathophysiological pathways causing the deep joint pain described by some OA patients [13, 14]. The pain of OA includes both nociceptive and non-nociceptive components and is associated with abnormally excitable pain pathways in the peripheral and central nervous systems [15, 16]. Quantitative sensory testing in OA patients reveals that OA patients have lower thresholds for mechanical and thermal pain than healthy controls [1, 17] and increased sensitivity to pressure, ischemia, and innocuous stimuli [18].…”

Section: Issues In Oa Painmentioning

confidence: 99%

Pain Treatment in Arthritis-Related Pain: Beyond NSAIDs

Laar¹,

Pergolizzi²,

Mellinghoff³

et al. 2012

TORJ

124

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Managing pain from chronic conditions, such as, but not limited to, osteoarthritis and rheumatoid arthritis, requires the clinician to balance the need for effective analgesia against safety risks associated with analgesic agents. Osteoarthritis and rheumatoid arthritis pain is incompletely understood but involves both nociceptive and non-nociceptive mechanisms, including neuropathic mechanisms. Prevailing guidelines for arthritis-related pain do not differentiate between nociceptive and non-nociceptive pain, sometimes leading to recommendations that do not fully address the nature of pain. NSAIDs are effective in treating the nociceptive arthritis-related pain. However, safety concerns of NSAIDs may cause clinicians to undertreat arthritis-related pain. In this context, combination therapy may be more appropriate to manage the different pain mechanisms involved. A panel convened in November 2010 found that among the currently recommended analgesic products for arthritis-related pain, fixed-low-dose combination products hold promise for pain control because such products allow lower doses of individual agents resulting in decreased toxicity and acceptable efficacy due to synergy between the individual drugs. Better evidence and recommendations are required to improve treatment of chronic arthritis-related pain.

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Treating the Pain of Osteoarthritis — Where Do We Go from Here?

Cited by 6 publications

References 21 publications

Tramadol/Paracetamol Fixed-Dose Combination for Chronic Pain Management in Family Practice: A Clinical Review

Tramadol/Paracetamol Fixed-Dose Combination for Chronic Pain Management in Family Practice: A Clinical Review

Evaluation of the Clinical use of Metformin or Pioglitazone in Combination with Meloxicam in Patients with Knee Osteoarthritis; using Knee Injury and Osteoarthritis outcome Score

Pain Treatment in Arthritis-Related Pain: Beyond NSAIDs

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