This is an excellent example of how to deal with the patient in a holistic manner.....we shouldn't simply prescribe but should think about other issues, lifestyle, shared decision making etc etc. Remember a good doctor treats the disease a great doctor treats the patient with the disease (with apologies to Osler).....
Answer: see NICE guideline
Answer; Holistic approach with education, advice, particularly with reference to dual purposes of diet/diabetes and weight loss if patient obese, as weight loss proven to reduce pain in OA. Also biomechanics assessment may be useful.
Drugs: Consider topical NSAID, consider re introducing low dose codeine perhaps once daily initally, gain patient confidence.
Questions: Renal function, previous history of gastritis/ulcer.
Dr Andrea Clarke GP
In order to get some prescribing resources out there we intend to publish a series of prescribing problems on the website. The problems will appear at least weekly with the "answers" appearing a couple of days later. We'll use the standard exam stationery available on the LSE, but also available below in case you haven't got access to the LSE.