What are the recommended first-line pharmacological treatments for managing pain in patients with osteoarthritis?

Recommended first-line pharmacological treatments for managing pain in patients with osteoarthritis include:

• Offer a topical non-steroidal anti-inflammatory drug (NSAID) for people with knee osteoarthritis as the first-line pharmacological option.
• Consider a topical NSAID for osteoarthritis affecting other joints if appropriate.
• If topical NSAIDs are ineffective or unsuitable, consider an oral NSAID, taking into account the patient's gastrointestinal, renal, liver, and cardiovascular risk factors.
• When prescribing oral NSAIDs, offer gastroprotective treatment such as a proton pump inhibitor to reduce gastrointestinal risks.
• Paracetamol and weak opioids should not be routinely offered and only considered for infrequent, short-term pain relief when other treatments are contraindicated, not tolerated, or ineffective.
• Do not offer glucosamine or strong opioids for osteoarthritis management due to lack of evidence of benefit and unfavorable risk-benefit profile.

These pharmacological treatments should be used alongside non-pharmacological approaches and at the lowest effective dose for the shortest possible time.

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