title: Complexities in the pharmacologic management of osteoarthritis pain.
abstract: OBJECTIVE
  To discuss challenges in the pharmacologic management of osteoarthritis (OA) pain.
  
  
  METHODS
  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.
  
  
  RESULTS
  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.
authors.affiliation: University of California San Diego, San Diego, CA 92127, USA. rundrbillrun@cox.net
authors.forename: Bill
authors.initials: B
authors.lastname: McCarberg
authors.forename: Penny
authors.initials: P
authors.lastname: Tenzer
mesh_terms: D000700:Analgesics / Q000009:adverse effects / Q000627:therapeutic use*; D000894:Anti-Inflammatory Agents, Non-Steroidal / Q000009:adverse effects / Q000627:therapeutic use*; D005260:Female; D006471:Gastrointestinal Hemorrhage / Q000139:chemically induced / Q000517:prevention & control; D006801:Humans; D008297:Male; D010003:Osteoarthritis / Q000188:drug therapy* / Q000503:physiopathology; D010146:Pain / Q000188:drug therapy* / Q000503:physiopathology; D059408:Pain Management / Q000379:methods*
chemical_list: D000700:Analgesics; D000894:Anti-Inflammatory Agents, Non-Steroidal