. 2021 Apr 19;10(2):783–808. doi: 10.1007/s40122-021-00260-1

Table 2.

Considerations driving the choice of therapy according to the general practitioner, the pharmacologist and the pain therapist

The pharmacologist’s point of view	The GP’s point of view	The pain therapist’s point of view
1. The main indication for NSAIDs is inflammatory nociceptive pain, while their use is not appropriate in other forms of pain. 2. In some OA patients, central sensitization may play an important part in pain persistence. Thus, it is often useful to combine NSAIDs with paracetamol or opioids, as they are active on central synapses. When opioids are given, it is important to know the modalities of discontinuation and to monitor patients during both opioid and NSAID therapy. 3. Frequently, a pharmacological treatment is more effective if associated to rehabilitation and minimally invasive techniques, which should not be considered as the last step in the process of care.	Once the patient characteristics have been defined, there are 4 fundamental drug features that drive the choice toward a particular NSAID therapy: 1. The efficacy profile in OA 2. The safety profile in terms of risk of CV events, GI bleeding and nephrotoxicity 3. The interference with concomitant therapies, particularly ASA and oral anticoagulants 4. The formulation (e.g. extended release), which is a key determinant of patient compliance However, it must be stressed that the choice is not straightforward because of the lack of clear-cut evidence (see section on safety)	Drug efficacy is defined according to the available data on established efficacy and safety outcomes (see section Patient Evaluation) In particular, when evaluating the efficacy of NSAID therapy, use scales for both pain and function

The pharmacologist’s point of view

The GP’s point of view

The pain therapist’s point of view

1. The main indication for NSAIDs is inflammatory nociceptive pain, while their use is not appropriate in other forms of pain.

2. In some OA patients, central sensitization may play an important part in pain persistence. Thus, it is often useful to combine NSAIDs with paracetamol or opioids, as they are active on central synapses. When opioids are given, it is important to know the modalities of discontinuation and to monitor patients during both opioid and NSAID therapy.

3. Frequently, a pharmacological treatment is more effective if associated to rehabilitation and minimally invasive techniques, which should not be considered as the last step in the process of care.

Once the patient characteristics have been defined, there are 4 fundamental drug features that drive the choice toward a particular NSAID therapy:

1. The efficacy profile in OA

2. The safety profile in terms of risk of CV events, GI bleeding and nephrotoxicity

3. The interference with concomitant therapies, particularly ASA and oral anticoagulants

4. The formulation (e.g. extended release), which is a key determinant of patient compliance

However, it must be stressed that the choice is not straightforward because of the lack of clear-cut evidence (see section on safety)

Drug efficacy is defined according to the available data on established efficacy and safety outcomes (see section Patient Evaluation)

In particular, when evaluating the efficacy of NSAID therapy, use scales for both pain and function

GP General practitioner, OA osteoarthritis