This protocol applies to patients with shoulder osteoarthritis who have a contraindication to NSAIDs or who cannot tolerate them. In these cases the standard first-line analgesic pathway is closed, requiring an alternative evidence-based approach.
Guidelines note that acetaminophen is no longer considered first-line for osteoarthritis due to limited efficacy, though it remains an option for patients who have contraindications or intolerances to NSAIDs. When neither agent is appropriate, a separate treatment path is indicated.
For patients in this situation, guidelines acknowledge that a specific oral analgesic agent — not an NSAID or acetaminophen — may be considered for pain relief when no other viable option is available. The full structured regimen, including sequencing and clinical criteria, is available below.
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.
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