Which oral nonopioid agents are most effective for OA pain?
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Q Which oral nonopioid agents are most effective for OA pain? Evidence-based answer: nonsteroidal anti-inflammatory drugs (nsaids), when used at the maximum clinically effective dose, reduce osteoarthritis (OA) pain in large joints more effectively than either placebo or acetaminophen (strength of recommendation [SOR]: A, network meta-analysis of randomized controlled trials [RCTs]). When ranked for efficacy, diclofenac 150 mg/d was the most effective (SOR: A, network meta-analysis of RCTs). The selective COX-2 inhibitors, such as celecoxib, are not more effective at reducing pain than the nonselective NSAIDs (SOR: A, metaanalysis of RCTs). Meloxicam is superior to placebo but marginally inferior to other NSAIDs (SOR: A, systematic review of RCTs). Acetaminophen is no more effective than placebo (SOR: A, meta-analysis of RCTs).
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