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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.

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