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Clinical Guideline For Treatment Of Arthritis Pain
from the American Pain Society

Among the major recommendations in the APS Arthritis Pain Management Guideline are:

    1.All treatment for arthritis should begin with a comprehensive assessment of pain and function

    2.For mild to moderate arthritis pain, acetaminophen is the drug of choice for its mild side effects, over-the-counter availability and low cost

    3.For moderate to severe pain from both osteoarthritis and rheumatoid arthritis, COX-2 non-steroidal anti-inflammatory drugs (NSAIDS), such as Celebrex and Vioxx, are the drugs of choice for their pain-relieving potency and absence of gastrointestinal side effects. Use of non-selective NSAIDs should only be considered if the patient is non-responsive to acetaminophen and COX-2 drugs and is not at risk for NSAID-induced GI side effects. Due to the high cost of the COX-2 agents, some patients might benefit from taking non-specific NSAIDS and a medication to moderate GI distress.

    4.Opioid medications, such as oxycodone and morphine, are recommended for treating severe arthritis pain for which COX-2 drugs and non-specific NSAIDs do not provide substantial relief.

    5.Unless there are medical contraindications, most people with arthritis, including the obese and elderly, should be referred for surgical treatment when drug therapy is ineffective and function is severely impaired to prevent minimal physical activity. It is advised that surgery be recommended before the onset of severe deformity and advanced muscular deterioration.

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