Efficacy of commonly prescribed analgesics in the management of osteoarthritis: a systematic review and meta-analysis



Pain management is a cornerstone of osteoarthritis (OA) management. The aim of this review is to obtain current, literature-based estimates of the effect of common pharmacologic treatments on pain reduction in OA.


A MEDLINE search (2006–2016) was conducted for randomized controlled trials studying acetaminophen, oral NSAIDs, topical NSAIDs, COX-2 inhibitors, and opioids in the treatment of OA pain. Drug effect on pain was estimated using relative change in pain, and expressed as percentage change. An overall effect for each drug category was obtained as a weighted average of study-specific effects, with weights based on each study’s sample size.


Twenty-nine studies were included. The effect on pain was estimated in a total of 43 treatment arms (acetaminophen n = 6, oral NSAIDs n = 9, topical NSAIDs n = 8, COX-2 inhibitors n = 9, and opioids n = 11). Relative (%) changes in pain were found to be as follows: acetaminophen = 32.5, oral NSAIDs = 34.3, topical NSAIDs = 40.9, COX-2 inhibitors = 36.9, and opioids = 35.4.


The effects of 5 major drug categories in the treatment of OA pain were reviewed with data extracted from 29 studies published from 2006 to 2016. Acetaminophen was found to have an RC value close to that of oral NSAIDs. The effects of oral NSAIDs, COX-2 inhibitors, and opioids in controlling pain were similar to what has been demonstrated in previous literature. Topical NSAIDs were found to have a greater RC than oral NSAIDs.

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The authors would like to thank Jordan Stewart, BSc, BSc Pharm, for his assistance with quality assessment of the studies.


No grants or industrial supports were received for the work reported on in this manuscript.

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ICMJE Authorship Criteria: 1a. Substantial contributions to the conception or design of the work; or 1b. The acquisition, analysis, or interpretation of data for the work; and 2. Drafting the work or revising it critically for important intellectual content; and 3. Final approval of the version to be published; and 4. Agreement to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved. MS: 1a, 1b, 2, 3, 4. JC: 1b, 2, 3, 4. ECS: 1b, 2, 3, 4. JAK: 1a, 1b, 2, 3, 4. There is no external editing support to declare.

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Correspondence to Mohan Stewart.

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Stewart, M., Cibere, J., Sayre, E.C. et al. Efficacy of commonly prescribed analgesics in the management of osteoarthritis: a systematic review and meta-analysis. Rheumatol Int 38, 1985–1997 (2018). https://doi.org/10.1007/s00296-018-4132-z

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  • Osteoarthritis
  • Pharmacotherapy
  • Analgesia
  • Pain