Table 8.

Conventional therapeutics for OA.

Category	Drugs	Mechanism of Action	Analgesic Action Level
NSAIDs	Aspirin, naproxen, ibuprofen, diclofenac, celecoxib, piroxicam, indomethacin, meloxicam, ketoprofen, sulindac, diflunisal, nabumetone, oxaprozin, tolmetin, salsalate, etodolac, fenoprofen, flurbiprofen, ketorolac, meclofenamate, mefenamic acid, etoricoxib, and rofecoxib.	inhibit COX enzymes leading to decreased prostaglandin synthesis. increasing serotonin in central sites	Peripheral and central effects
Analgesics	Acetaminophen	Peripheral: COX1 and 2 inhibition Central: descending serotonergic neuronal pathways, inhibition of L-arginine/NO pathway, stimulation of endocannabinoid system, and anti-nociception mechanisms	Peripheral and central effects
	Duloxetine	Serotonin and nonrepinephrine reuptake inhibitor	Central effects
Opioids and opioid receptor ligands	Morphine, codeine, acetaminophen with codeine, fentanyl, hydrocodone, acetaminophen with hydrocodone, hydromorphone, meperidine, oxycodone	Activate opioids receptors to hyperpolarizes sensory neurons and attenuate nerve hyperexcitability	Peripheral and central effects
Corticosteroids	Prednisone, betamethasone, cortisone, dexamethasone, hydrocortisone, methylprednisolone, prednisolone, triamcinolone acetonide	Immunosuppressive and anti-inflammatory by interrupting the inflammatory cascade	Peripheral
Joint modifying treatments	Chondroitin and glucosamine	Increase proteoglycan synthesis in articular cartilage	Peripheral/local
	Hyaluronic acid	Enhance chondrocyte synthesis of endogenous hyaluronic acid and proteoglycans	Peripheral/local