Non-NSAID pharmacologic treatment options for the management of chronic pain

  • Thomas J Schnitzer
    Requests for reprints should be addressed to Thomas J. Schnitzer, MD, PhD, Office of Clinical Research and Training, Northwestern University, Abbott Hall, 5th Floor, 710 N. Lakeshore Drive, Chicago, Illinois 60611
    Office of Clinical Research and Training, Northwestern University, Chicago, Illinois, USA
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      Chronic pain affects 75 million US citizens. A number of pharmacologic treatments are available for chronic pain that does not respond adequately to nonpharmacologic methods. Long the mainstay of chronic pain management, nonsteroidal anti-inflammatory drugs (NSAIDs) are known to be associated with gastrointestinal (GI) and renal toxicities, a particular problem for the elderly population, which commonly experiences chronic pain, such as that associated with osteoarthritis (OA). Several non-NSAID, non-narcotic therapies are available for noninflammatory pain. Acetaminophen is as effective as NSAIDs for the management of mild-to-moderate OA pain and is the recommended first-line therapy by the American College of Rheumatology (ACR). Propoxyphene, widely believed to be safe and effective, may, in fact, be no more effective—and perhaps less effective—than acetaminophen or ibuprofen. A relatively new analgesic, tramadol, appears to be a useful therapy for patients who do not receive adequate pain relief with acetaminophen and are at risk for NSAID-related side effects. For localized chronic pain associated with OA, topical capsaicin is also an effective analgesic.
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