Pharmacological Treatment of Pain in Hallux Valgus

Pharmacological Approach

The American Geriatrics Society recommends NSAIDs as the primary pharmacological treatment for pain associated with hallux valgus, addressing the inflammatory component of the metatarsophalangeal joint 1, 2
Topical formulations of NSAIDs or capsaicin can be beneficial for mild to moderate pain, especially in specific joints like hallux valgus 3, 2
NSAIDs should be used with caution in elderly patients due to the high risk of gastrointestinal, platelet, and nephrotoxic side effects, avoiding high doses for prolonged periods 3, 4

The American College of Rheumatology recommends paracetamol as a first-line treatment for mild to moderate pain due to its favorable safety profile 2, 4
It can be used as an alternative or in combination with NSAIDs depending on patient tolerance 1, 2

In patients with a history of gastroduodenal ulcers or gastrointestinal bleeding, consider selective COX-2 inhibitors (celecoxib, rofecoxib) 3
Caution: rofecoxib may cause fluid retention in older adults and increase cardiovascular risk if taken without aspirin 3

Intra-articular injections of glucocorticoids can be beneficial for acute episodes of pain, especially when there is evidence of inflammation and joint effusion 3, 2
Hyaluronic acid intra-articular preparations have shown efficacy for pain not adequately relieved by non-invasive therapies 3

Physicians should obtain detailed medication histories, including over-the-counter medications, as NSAIDs have frequent interactions with other conditions (congestive heart failure, hypertension, liver and kidney disease) 3, 4

The oral route is preferred for convenience, ease of use, and cost 4
Fixed-interval dosing is superior to as-needed administration for more consistent pain relief 4