• T J Schnitzer.
• Office of Clinical Research and Training, Northwestern University, Chicago, Illinois 60611, USA.
• Am. J. Med. 1998 Jul 27;105(1B):45S-52S.

AbstractChronic pain affects 75 million US citizens. A number of pharmacologic treatments are available for chronic pain that does not respond adequately to nonpharmacologic methods. Long the mainstay of chronic pain management, nonsteroidal anti-inflammatory drugs (NSAIDs) are known to be associated with gastrointestinal (GI) and renal toxicities, a particular problem for the elderly population, which commonly experiences chronic pain, such as that associated with osteoarthritis (OA). Several non-NSAID, non-narcotic therapies are available for noninflammatory pain. Acetaminophen is as effective as NSAIDs for the management of mild-to-moderate OA pain and is the recommended first-line therapy by the American College of Rheumatology (ACR). Propoxyphene, widely believed to be safe and effective, may, in fact, be no more effective-and perhaps less effective-than acetaminophen or ibuprofen. A relatively new analgesic, tramadol, appears to be a useful therapy for patients who do not receive adequate pain relief with acetaminophen and are at risk for NSAID-related side effects. For localized chronic pain associated with OA, topical capsaicin is also an effective analgesic.

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