A patient reports having persistent mild to moderate pain in both knees usually associated with standing.The patient reports knee stiffness for 15 to 20 minutes each morning.The primary care nurse practitioner (NP)learns that the patient has used heating pads and acetaminophen,which no longer relieve the pain.The NP orders an erythrocyte sedimentation rate,which is normal.The NP should consider prescribing:

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Topical NSAIDs,acupuncture,and tramadol are effective for pain relief in knee osteoarthritis.Treatment for osteoarthritis should begin with nonpharmacologic treatment,and acetaminophen should be first-line pharmacologic treatment.NSAIDs should be used when these two measures are no longer effective.COX-2 inhibitors are more expensive and should be used in the presence of gastrointestinal (GI)side effects or for moderate to severe pain.Glucosamine and chondroitin do not relieve most osteoarthritis pain.

A Patient Reports Having Persistent Mild to Moderate Pain in Both