Non Surgical Priority 7 from the Early Hip and Knee Osteoarthritis PSP

UNCERTAINTY: For people with early OA going to primary care what is the best and most cost effective and appropriate pain relief strategy? (JLA PSP Non Surgical Priority 7)
Overall ranking amongst non surgical questions 7
JLA question ID 0041/17
Extra explanatory note Many people want to avoid taking lots of pain killers and explore alternatives and need a combination of approaches that are personal to their stage of OA, lifestyle etc. This question could be considered as a sub set of Q 2
Intervention; packages of care (so not just analgesia), include frequency of treatment.
Population; people with identifiable pain symptoms presenting in primary care (not necessarily just GP)
Outcomes; relief of or improvement in pain, adherence to strategy
Evidence

2012 OUT OF DATE Topical NSAIDs for chronic musculoskeletal pain in adults DOI: 10.1002/14651858.CD007400.pub2 http://onlinelibrary.wiley.com/doi/10.1002/14651858.CD007400.pub2/abstract

Topical NSAIDs can provide good levels of pain relief; topical diclofenac solution is equivalent to that of oral NSAIDs in knee and hand osteoarthritis, but there is no evidence for other chronic painful conditions. Formulation can influence efficacy. The incidence of local adverse events is increased with topical NSAIDs, but gastrointestinal adverse events are reduced compared with oral NSAIDs.
Health Research Classification System category Musculoskeletal
Extra information provided by this PSP
Original uncertainty examples I have been looking into more pain relief. My doctor just says I am maxed out on what I can take but I atill get pain.  ~  If long term use of paracetamol is not recommended what safe pain relief can I use?  ~  My pain is intermittent - do I need treatment all the time?
Submitted by 22 patient/carers, 10 clinicians, 1 carer & clinician, 4 H&K PSP (2 clinicians and 2 professional focus groups)
PSP information
PSP unique ID 0041
PSP name Early Hip and Knee Osteoarthritis
Total number of uncertainties identified by this PSP. 52  (To see a full list of all uncertainties identified, please see the detailed spreadsheet held on the JLA website)
Date of priority setting workshop 26 February 2016