Pain Management Strategies in Osteoarthritis

Osteoarthritis is a prevalent degenerative joint disorder marked by chronic pain and functional impairment. Pain arises from a combination of nociceptive signals generated by cartilage wear, subchondral bone changes and synovial inflammation, and from alterations in central pain processing. Management encompasses non-pharmacological interventions—such as structured exercise programmes, weight optimisation, physiotherapy and assistive devices—alongside pharmacological therapies. First-line agents include paracetamol and topical non-steroidal anti-inflammatory drugs (NSAIDs); systemic NSAIDs remain a mainstay when tolerated. Opioids are reserved for refractory cases given safety concerns. Emerging strategies target central mechanisms with antidepressants (for example duloxetine or tricyclics) and anticonvulsants (such as pregabalin and gabapentin), while intra-articular injections of corticosteroids or hyaluronic acid may provide localized relief. A multimodal approach tailored to symptom severity, comorbidities and patient preference is essential. Novel areas of research include nerve growth factor inhibitors, neuromodulation and personalised rehabilitation, reflecting a shift towards integrating peripheral and central targets for improved outcomes.

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Pain Management Strategies in Osteoarthritis publication trend

The graph below shows the total number of articles in pain management strategies in osteoarthritis across all publications each year (not limited to Nature Index journals).

Technical terms

Central sensitization: Heightened responsiveness of central nervous system neurons to input, leading to amplified pain perception beyond peripheral tissue injury.

Nociceptor: A specialised sensory neuron that detects noxious thermal, mechanical or chemical stimuli and transmits pain signals.

Neuropathic pain: Pain arising as a direct consequence of a lesion or disease affecting the somatosensory nervous system, often characterised by burning or shooting sensations.

Gamma-aminobutyric acid (GABA) derivatives: Medications that enhance the inhibitory neurotransmitter GABA in the nervous system, used to modulate central pain pathways.

References

1. The efficacy of duloxetine, non-steroidal anti-inflammatory drugs, and opioids in osteoarthritis: a systematic literature review and meta-analysis. BMC Musculoskeletal Disorders (2014).
2. Duloxetine in OsteoArthritis (DOA) study: effects of duloxetine on pain and function in end-stage hip and knee OA – a pragmatic enriched randomized controlled trial. BMC Musculoskeletal Disorders (2022).
3. Nortriptyline for pain in knee osteoarthritis in general practice: a double blind randomised controlled trial. British Journal of General Practice (2021).
4. Comparison of the effects of duloxetine and pregabalin on pain and associated factors in patients with knee osteoarthritis. Revista da Associação Médica Brasileira (2022).
5. Pharmacological use of gamma-aminobutyric acid derivatives in osteoarthritis pain management: a systematic review. BMC Rheumatology (2022).