Analgesics, or painkillers, are commonly used to manage the pain of osteoarthritis. Analgesics include paracetamol, non-steroidal anti-inflammatory drugs (NSAIDs) and opioid analgesics.
In Australia, the US and the UK, the clinical practice guidelines for management of osteoarthritis recommend regular use of paracetamol as the first choice. When paracetamol provides insufficient pain relief, regular use of NSAIDs is recommended [1].
Australian guidelines recommend intra-articular corticosteroid injections for short-term treatment of hip and knee osteoarthritis. Oral opioids are used to relieve moderate to severe pain [2].
The most common medications prescribed, advised or supplied by general practitioners (GPs) for osteoarthritis [3] were:
- paracetamol (non-opioid analgesic) (26% per osteoarthritis problems managed)
- Meloxicam (NSAID COX-2) (11%)
- Celecoxib (NSAID COX-2) (7%)
Table 1: Top 10 medications prescribed, advised or supplied by GPs for osteoarthritis, 2010–11
| Type of medication |
Class |
Rate per 100 osteoarthritis
problems managed |
| Paracetamol |
Non-opioid analgesic |
25.6 |
| Meloxicam |
NSAID (COX-2) |
11.2 |
| Celecoxib |
NSAID (COX-2) |
6.5 |
| Paracetamol/Codeine |
Opioid analgesic |
5.0 |
| Tramadol |
Opioid analgesic |
4.8 |
| Buprenorphine |
Opioid analgesic |
4.0 |
| Oxycodone |
Opioid analgesic |
3.7 |
| Diclofenac sodium systemic |
NSAID |
2.8 |
| Naproxen |
NSAID |
2.1 |
| Fentanyl |
NSAID |
1.2 |
Notes:
1. The data in the Bettering the Evaluation and Care of Health (BEACH) survey relating to the period 2010-11 contained in this report were collected by the Family Medicine Centre of the University of Sydney under a previous collaboration with the AIHW. In BEACH surveys, problems managed in general practices are classified according to the second edition of the International Classification of Primary Care (ICPC-2). The ICPC-2 codes used for osteoarthritis were L83011, L84004, L84009, L84010, L84011, L84012, L89001, L90001, L91001, L91003, L91015, L91017 and L92007. Refer to Britt et al. (2011) for more information about the BEACH Survey.
2. Multiple medications may be prescribed for osteoarthritis in one GP-patient encounter.
Source: The BEACH program, Family Medicine Research Centre, University of Sydney.
References
- Stitik T, Altschuler E & Foye P 2006. Pharmacotherapy of osteoarthritis. American Journal of Physical Medicine and Rehabilitation 85:S15-S28.
- RACGP (The Royal Australian College of General Practitioners) 2009. Guideline for the non-surgical management of hip and knee osteoarthritis. Melbourne: RACGP.
- Bettering the Evaluation and Care of Health (BEACH) Survey, in 2010-11, Britt H, Miller GC, Charles J, Henderson J, Bayram C, Pan Y, Valenti L, Harrison C, O'Halloran J, Zhang C, Fahridin S 2011. General practice activity in Australia 2010-11. General practice series no.29. Sydney: Sydney University Press.