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Table 1 Topical analgesics in osteoarthritis (OA) guidelines

From: Evolving guidelines in the use of topical nonsteroidal anti-inflammatory drugs in the treatment of osteoarthritis

Guideline Recommendation
American Association of Orthopaedic Surgeons (AAOS) 2013 [33] • Knee OA: Strongly recommend oral or topical NSAIDs or tramadol for the pharmacologic management of patients with symptomatic OA of the knee
American College of Rheumatology (ACR) 2012 [9] • Hand OA: Initial management of hand OA should include one
• or more of the following:
o topical capsaicin
o topical NSAIDs, including trolamine salicylate
o oral NSAIDs, including COX-2 inhibitors
o tramadol
• Knee OA: Initial management of knee OA should include one
• of the following:
o acetaminophen
o oral NSAIDs
o topical NSAIDs
o tramadol
o intra-articular corticosteroid injections
• Topical rather than oral NSAIDs should be used in patients with hand or knee OA aged ≥75 years
American Geriatric Society (AGS) 2009 [35] • Localized, non-neuropathic persistent pain: Patients with localized, non-neuropathic persistent pain may be candidates for topical NSAIDs
American Pain Society (APS) 2002 [34] • Guidelines were published prior to FDA approval of topical NSAIDs
European League Against Rheumatism (EULAR) 2003, 2007 [10, 36] • Hand OA: Topical treatments are recommended over systemic treatments, especially for mild to moderate pain and when only a few joints are affected
• Hand or Knee OA: Topical NSAIDs and capsaicin have clinical efficacy and are safe in the treatment of hand or knee OA
National Institute for Health and Clinical Excellence (NICE, United Kingdom) 2008 [11] • Hand or Knee OA:
o Topical NSAIDs should be considered for pain relief in addition to nonpharmacologic treatment
o Topical NSAIDs and/or acetaminophen should be considered ahead of oral NSAIDs, COX-2 inhibitors, or opioids
Osteoarthritis Research Society International (OARSI) 2008 [12] • Knee OA: Topical NSAIDs and capsaicin may be effective as adjunctives and alternatives to oral analgesics/anti-inflammatory agents in patients with knee OA
  1. AAOS = American Association of Orthopaedic Surgeons; ACR = American College of Rheumatology; AGS = American Geriatric Society; APS = American Pain Society; COX = cyclo-oxygenase; EULAR = European League Against Rheumatism; FDA = US Food and Drug Administration; GI = gastrointestinal; NICE = National Institute for Health and Clinical Excellence; NSAID = nonsteroidal anti-inflammatory drug; OA = osteoarthritis; OARSI = Osteoarthritis Research Society International.
  2. Adapted from Hochberg MC et al. Arthritis Care Res (Hoboken) 2012, 64:465-474; Jordan KM et al. Ann Rheum Dis 2003, 62:1145-1155; National Collaborating Centre for Chronic Conditions. Osteoarthritis: National Clinical Guideline for Care and Management in Adults. London: Royal College of Physicians; 2008; Zhang W et al. Osteoarthritis Cartilage 2008, 16:137-162; Treatment of Osteoarthritis of the Knee Evidence-Based Guideline 2nd Edition. Rosemont, IL: American Academy of Orthopaedic Surgeons; May 2013; Simon LS et al. Guideline for the Management of Pain in Osteoarthritis, Rheumatoid Arthritis, and Juvenile Chronic Arthritis, 2nd edition. Clinical Practice Guidelines no. 2. Glenview, IL: American Pain Society; 2002; American Geriatrics Society Panel on the Pharmacological Management of Persistent Pain in Older Persons. J Am Geriatr Soc 2009, 57:1331-1346; Zhang W et al. Ann Rheum Dis 2007, 66:377-388.]
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BMC Musculoskeletal Disorders

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