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.
As published in NZ Doctor and Research Review