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© 2014 Balmaceda. This work is published by Dove Medical Press Limited, and licensed under Creative Commons Attribution – Non Commercial (unported, v3.0) License. The full terms of the License are available at http://creativecommons.org/licenses/by-nc/3.0/. Non-commercial uses of the work are permitted without any further permission from Dove Medical Press Limited, provided the work is properly attributed. Permissions beyond the scope of the License are administered by Dove Medical Press Limited. Information on how to request permission may be found at: http://www.dovepress.com/permissions.php Journal of Pain Research 2014 :7 211–218 Journal of Pain Research Dovepress submit your manuscript | www.dovep ress.com Dovepress 211 COMMENTARY open access to scientific and medical research Open Access Full Text Article http://dx.doi.org/10.2147/JPR.S45321 Clinical trial data in support of changing guidelines in osteoarthritis treatment Casilda M Balmaceda New Y ork Neurological Consultants, New York, NY, USA Correspondence: Casilda M Balmaceda New York Neurological Consultants, PC, 385 Fort Washington Avenue, Suite 1, New York, NY 10032, USA Tel +1 212 927 3327 Fax +1 212 305 1470 Email [email protected] Abstract: Goals for the management of osteoarthritis (OA) emphasize pain relief, reduction of inflammation, and improveme nt in functioning. Among pharmacological pain management interventions, nonsteroidal anti-inflammatory drugs (NSAIDs) are frequently recommended as the most effective treatment option for OA. Howe ver, the use of traditional oral NSAIDs is associated with risk of serious adverse events involving the gastrointestinal, cardiov ascular, and renal systems. Topi cal NSAIDs are an alternative with well-established tolerability and efficacy in the treatment of OA of the knee or hand. While the management of OA pain is evolving toward the more widespread use of topical NSAIDs, some OA management guidelines have yet to incorporate these agents in their recommendations. This review examines the efficacy and tolerability of topical NSAIDs, their current placement in OA management guidelines, and their potential role in enabling pain specialists to provide individualize d care for their patients with OA. Keywords: topical NSAIDs, diclofenac, practice guidelines, chronic pain, osteoarthritis Introduction Osteoarthritis (OA), the most common form of arthritis, conservatively affects 27 million adults in the USA based on 2005 population data. 1 As many as one in two adults may develop symptomatic OA of the knee by age 85; however, among obese adults, the lifetime risk of developing OA increases to two in three. 2 OA of the knee is one of the top five causes of disability , with 80% of patients with the condi- tion experiencing some degree of movement limitation affecting activities of daily living. 3 T reatment options for OA include both pharmacol ogic and non-pharmac ologic modalities. Non-pharmacologic modalities, such as exercise and weight-management programs, ha ve been sho wn to be ef fective for ov erweigh t and obese patient s experiencing OA in weight-bea ring joints and should be utilized in conjunction with other therapies if possible. 4–7 Pharmacologic options, including orally administered acet- aminophen and nonsteroidal anti-inflammatory drugs (NSAIDs), are the most com- monly utilized pharmacological options for OA. However, the risk of adverse events (AEs) with the administration of higher doses or prolonged treatment with these drugs can limit their use in some patients, particularly the elderly and those with existing hepatic, gastrointestinal, cardiova scular, and renal conditions. 8,9 There are multiple approaches that can help in mitigating these risks while providing safe and effectiv e treatment. One option is to combine analgesics with different mechanisms of action to allow for the utilization of lower doses of each Number of times this article has been viewed This article was published in the following Dove Press j ournal: Journal of Pain Research 12 April 2014

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