Mini Review
Volume 6 Issue 2 - 2020
Important Considerations in the Pharmacological Management of Osteoarthritis-Related Pain
Flaminia Coluzzi1* and Stefano Gumina2
1Department Medical and Surgical Sciences and Biotechnologies, Sapienza University of Rome, Polo Pontino, Latina, Italy
2Department of Anatomy, Histology, Legal Medicine and Orthopaedics, Sapienza University of Rome, Rome, Italy
*Corresponding Author: Flaminia Coluzzi, Professor, Department Medical and Surgical Sciences and Biotechnologies, Unit Anesthesia, Intensive Care and Pain Medicine, Sapienza University of Rome, Polo Pontino, Latina, Italy.
Received: December 17, 2019; Published: January 30, 2020




Abstract

In the last years, the approach to chronic osteoarthritis pain has moved from a joint-centred viewpoint towards a whole body-based approach, where the central nervous system seems to play a key role in maintaining and amplifying pain pathways. Current therapeutic strategies and future perspectives are discussed in the light of the last clinical evidence. Three targets of treatment must be considered: a) peripheral mechanisms of pain and inflammation; b) central sensitization; and c) joint degeneration. Non-pharmacological strategies are currently the first step of treatment. Among analgesics anti-inflammatory drugs and paracetamol should be preferred, and tramadol added in non-responder. Opioids, despite their efficacy, are currently not recommended for the fear of their abuse potential. Viscosupplementation via intra-articular hyaluronic acid, platelet rich plasma, and mesenchymal stem cells play a role in targeting joint pathology and prevent further damage. Targeted therapy with monoclonal antibodies may represent a viable future option for osteoarthritis and chronic low back pain, but regardless to their efficacy, further clinical studies are evaluating their safety profile before introduction on the market. Similarly, preliminary promising results coming from other biological intra-articular therapies, targeting cartilage anabolism, prevention of cartilage degradation, and subchondral bone changes, need further clinical investigations to be confirmed.

Keywords: Neuroplasticity; Chronic Pain; Monoclonal Antibodies; Osteoarthritis; Low Back Pain; Opioids

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Citation: Flaminia Coluzzi and Stefano Gumina. “Important Considerations in the Pharmacological Management of Osteoarthritis-Related Pain”. EC Anaesthesia 6.2 (2020): 01-06.

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