Table 6.
Guideline recommendations for medication
| AAOS [10] | EULAR [6] | ICSI [9] | Schnitzer/ACR [7] | CCC [8] | |
| Nonselective NSAID | Recommended (A) | Recommended (A) | Recommended if acetaminophen not effective | Recommended | Recommended (A) |
| Recommended with PPI if gastrointestinal risk factors | Recommended with PPI or misoprol if gastrointestinal risk factors | Recommended (A) with PPI if gastrointestinal risk factors | |||
| Use with caution for patients with high risk factors for congestive heart failure or renal problems | Use with caution with elderly patients (C) or patients with renal problems (D) | ||||
| Not recommended for patients on anticoagulation therapy or preoperative period | |||||
| Topical NSAID | Recommended (A) | Recommended (A) | |||
| Acetaminophen | Recommended (A) | Recommended (A) as initial pain treatment | Recommended as initial pain treatment | Recommended as initial pain treatment | Recommended (A) as initial pain treatment |
| Coxibs | Recommended (B) if renal or gastrointestinal risk factors | Recommended (A) if gastrointestinal risk factors | Recommended if gastrointestinal risk factors | Recommended for patients not responding to acetaminophen or nonpharmacologic modalities | Recommended (A) if gastrointestinal risk factors, depending on cardiovascular risks |
| Recommended for patients with severe pain or signs of inflammation | Use with caution with elderly patients (C) or patients with renal problems (D) | ||||
| Recommended for patients with high gastrointestinal risks. | |||||
| Use with caution for patients with high risk factors for congestive heart failure or renal problems | |||||
| Tramadol | Recommended for patients with contraindication to NSAIDs/coxibs or who have not responded to oral therapy | ||||
| Opioids | Recommended (B) if NSAIDs are contraindicated | Recommended if NSAIDs contraindicated and if nonpharmacologic treatments not effective | Recommended for patients who have not responded to tramadol or have side effects | ||
| Capsaicin | Recommended (A) | Recommended as an adjunct treatment to oral therapy, for patients with contraindication to NSAIDs/coxibs or for patients who have not responded to oral therapy | |||
| Nonacetylated salicylates | Recommended | ||||
| Methylsalicylate | Recommended as an adjunct treatment to oral therapy, for patients with contraindication to NSAIDs/coxibs or for patients who have not responded to oral therapy |
AAOS, American Academy of Orthopaedic Surgeons; ACR, American College of Rheumatology; CCC, Canadian Consensus Conference; EULAR, European League Against Rheumatism; ICSI, Institute for Clinical Systems Improvement; NSAID, nonsteroidal anti-inflammatory drug; PPI, proton pump inhibitor.