OR2.3 | Joint Pain Medication Selection — Summary & Reflection

KEY TAKEAWAYS

Joint pain medication selection requires classifying the pain type (traumatic, inflammatory, degenerative, peri-operative) and matching the drug class to the mechanism. Paracetamol is the safest first-line analgesic across most musculoskeletal conditions. NSAIDs are effective but require contraindication screening: avoid in renal impairment (eGFR <30), co-prescribe a PPI in high-GI-risk patients (peptic ulcer history, elderly, concomitant aspirin), use the lowest dose for the shortest duration. Selective COX-2 inhibitors have lower GI toxicity but increased cardiovascular risk. Intra-articular corticosteroids provide rapid relief for inflammatory and degenerative flares; never inject a potentially infected joint. Strong opioids are not appropriate for chronic degenerative joint pain. Communication skills -- explaining indication, dose, side effects, and monitoring in lay language -- are an assessable component of OR2.3 and an ethical obligation in shared prescribing.

REFLECT

Consider the patient in the hook scenario: a 58-year-old with peptic ulcer disease and CKD who was prescribed ibuprofen without gastroprotection or renal function monitoring. He returns with GI symptoms and ankle oedema. You need to: stop the ibuprofen, start a PPI, reassess renal function, and find an alternative analgesic plan. How would you explain to the patient why the previous prescription was changed without undermining his trust in the medical team? What would you document in the medical record? Reflect on the professional responsibility to prescribe safely and to acknowledge and correct a prescribing error.