Chronic pain guideline for primary care

This is the work of a Canadian panel that filtered 74,000 papers to get a summary for chronic pain management of osteoarthritis, low back pain, and neuropathic pain.¹

Figure 1 in the guideline provides a simple summary (the authors suggest this is how guidelines should be reported):

• Placebo is fairly effective 29% to 40%.
• Physical activity is essential for OA and back pain.
• For OA (NZ available drugs) - steroid injections, oral and topical NSAIDs.
• Glucosamine and chondroitin are of uncertain benefit as the publicly funded trials found no benefit while the industry-sponsored ones did show benefit.
• For low back pain - spinal manipulation, oral NSAIDs, and TCAs.
• For neuropathic pain - gabapentinoids and rubefacients, e.g. capsaicin.  

The authors felt cannabinoids and opiates showed that harms exceeded benefits.