Moving towards a 2-step approach
The 2-step approach to chronic pain management in the NICE clinical guideline for osteoarthritis has recommended that pain relief following core treatment (education, advice, information access; strength exercise, aerobic fitness training; and weight loss if overweight) should be structured as below:7
- Step 1: Paracetamol or topical non-steroidal anti-inflammatory drugs (NSAIDs) to be considered for as first option for pain relief in addition to core treatment.
- Step 2: If paracetamol or topical NSAIDs are insufficient, then consider oral NSAID/COX-2 inhibitors or opioid analgesics (depending on risk:benefit).