Treatment of Shoulder Osteoarthritis with Contraindications or Intolerances to NSAIDs
When shoulder osteoarthritis patients cannot use non-steroidal anti-inflammatory drugs — due to a medical contraindication or intolerance — standard first-line analgesic options are off the table. This scenario calls for a clearly defined alternative approach.
Clinical Situation
This protocol is for patients with shoulder osteoarthritis who have contraindications or intolerances to NSAIDs. Acetaminophen and opioids carry their own limitations in this setting, and guidelines reflect only conditional support for their use under these circumstances.
Treatment Approach — Partial Overview
The structured regimen for this scenario centres on an oral pharmacological agent outside the NSAID and opioid classes. Full eligibility criteria, clinical rationale, and sequencing are available via the protocol link below.
Complete regimen not shown here — access it below.
References
DOI: 10.1016/j.rdc.2022.03.009.
- Acetaminophen is no longer considered "first-line" for OA due to its relative poor efficacy, though it is still an option for those who have contraindications or intolerances to NSAIDs.
- 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.
- Though duloxetine is approved for OA in some countries, there were only conditional or weak recommendations for its use across all guidelines, reflecting general concerns about efficacy and tolerability.
View source ↗