This protocol addresses pain management in hand osteoarthritis for patients in whom oral NSAIDs are not a viable option — whether due to contraindications, intolerance, or an inadequate analgesic response — and no other suitable alternatives remain.
In this specific situation, a centrally-acting analgesic agent may be considered for pain relief. Its use in hand osteoarthritis is conditionally supported in selected cases where standard anti-inflammatory therapy has failed or cannot be used.
DOI: 10.1016/j.rdc.2022.03.009.
Recommendations on the use of tramadol were mixed, either conditionally/weakly against or conditionally/weakly for; this variation was primarily related to the recognition that some patients require an option for pain management when oral NSAIDs are not an option (contraindicated, not tolerated, or ineffective), particularly when considering input from patient panels.
Opioids, including tramadol, are generally not recommended, though guidelines did acknowledge that in some cases, such as in instances of contraindications, intolerance to, or inadequate response to NSAIDs, tramadol can be considered for pain relief in the absence of other viable options.
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