PMID- 23489409
OWN - NLM
STAT- MEDLINE
DCOM- 20131101
LR  - 20130416
IS  - 1473-4877 (Electronic)
IS  - 0300-7995 (Linking)
VI  - 29
IP  - 5
DP  - 2013 May
TI  - Complexities in the pharmacologic management of osteoarthritis pain.
PG  - 539-48
LID - 10.1185/03007995.2013.785391 [doi]
AB  - 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.
FAU - McCarberg, Bill
AU  - McCarberg B
AD  - University of California San Diego, San Diego, CA 92127, USA. 
      rundrbillrun@cox.net
FAU - Tenzer, Penny
AU  - Tenzer P
LA  - eng
PT  - Journal Article
PT  - Review
DEP - 20130403
PL  - England
TA  - Curr Med Res Opin
JT  - Current medical research and opinion
JID - 0351014
RN  - 0 (Analgesics)
RN  - 0 (Anti-Inflammatory Agents, Non-Steroidal)
SB  - IM
MH  - Analgesics/adverse effects/*therapeutic use
MH  - Anti-Inflammatory Agents, Non-Steroidal/adverse effects/*therapeutic use
MH  - Female
MH  - Gastrointestinal Hemorrhage/chemically induced/prevention & control
MH  - Humans
MH  - Male
MH  - Osteoarthritis/*drug therapy/physiopathology
MH  - Pain/*drug therapy/physiopathology
MH  - Pain Management/*methods
EDAT- 2013/03/16 06:00
MHDA- 2013/11/02 06:00
CRDT- 2013/03/16 06:00
PHST- 2013/03/16 06:00 [entrez]
PHST- 2013/03/16 06:00 [pubmed]
PHST- 2013/11/02 06:00 [medline]
AID - 10.1185/03007995.2013.785391 [doi]
PST - ppublish
SO  - Curr Med Res Opin. 2013 May;29(5):539-48. doi: 10.1185/03007995.2013.785391. Epub 
      2013 Apr 3.