QuestionSBA
QuestionChoice
Normally, the second-line management would be to add an NSAID; however, this patient has contraindications to NSAID by way of his peptic ulcers and impaired renal function. Hence, a weak opioid such as tramadol should be opted for instead.
10003646
a
Tramadol
QuestionChoice
This is a strong opioid which can be given to arthritis patients if they experience severe pain, but this is not the most appropriate analgesic to add at this stage because a weaker opioid has not been trialled yet.
10003650
e
Morphine
QuestionChoice
This is a disease-modifying antirheumatic drug (DMARD) which is commonly used in the management of rheumatoid arthritis. It has no place in the pain management of osteoarthritis.
10003648
c
Methotrexate
QuestionChoice
This is an NSAID which can be used to manage pain caused by osteoarthritis, but not in this patient as they have peptic ulcers and impaired kidney function.
10003647
b
Diclofenac
QuestionChoice
This is a tricyclic antidepressant which can be used for neuropathic pain and chronic pain associated with osteoarthritis. However, tramadol should be trialled before neuropathic agents.
10003649
d
Amitriptyline
Concept
Chapter
2693
3766
Osteoarthritis
Topic
145
Orthopaedics
13276
A 79-year-old man presents to the GP as he has continued to have joint pain even whilst on the maximum paracetamol dose and after applying topical capsaicin. He has a past medical history of peptic ulcers and
chronic kidney disease.

What is the most appropriate additional analgesic?
a