General advice
Osteoarthritis and soft-tissue disorders
- Refer to NICE NG226 and NICE CKS.
- Non-drug measures, such as education, weight reduction and exercise, are core treatments in osteoarthritis (OA) and should be offered to everyone. See Versus Arthritis for patient information, musculoskeletal decision support tools and the Surgery Toolkit.
- There has been a move away from the use of medication to treat chronic pain. Consider signposting/referral to:
- Physical Activity Referral Scheme (PARS). GP practices and other relevant HSC staff can refer using PARS specific protocols generated through CCG.
- Relevant support groups, e.g. Versus Arthritis (VA) NI provide face to face, telephone and virtual support and pain management courses across NI. Note Face to face VA courses are not held in WHSCT area.
- Action Mental Health deliver pain management courses across the WHSCT area.
- Better Days Pain Support Programmes run by Healthy Living Centres. Some centres provide pain support programmes. Refer to the HLC website to find out about the services they offer.
- Online resources such as Live Well with Pain and the Pain Toolkit provide self-management advice for people living with persistent pain.
- Do not offer glucosamine, strong opioids or intra-articular hyaluronan injections to manage osteoarthritis.
Low back pain and sciatica
- See NICE NG59 on the management of low back pain and sciatica.
- Consider oral NSAIDs for managing low back pain. Be aware of the risk of harms and limited evidence of benefit from the use of NSAIDs in sciatica.
Rheumatoid arthritis and other inflammatory disorders
- If rheumatoid arthritis is suspected the patient should be referred to Rheumatology for assessment, management and initiation of DMARDs. Patients should not be managed by non-specialists.
- Refer to the following websites for further information and guidelines: NICE NG100 Rheumatoid arthritis and British Society for Rheumatology.
- Risks/benefits of treatments should be discussed with patients before commencing. Some charitable/voluntary sector organisations have developed tools for patient communication, e.g. Versus Arthritis and NRAS.