For example, cognitive behavioral therapy (CBT) had small positive effects on disability and catastrophic thinking.66 Exercise therapy reduced pain and improved function in chronic low back pain54; improved function and reduced pain in osteoarthritis of the knee51 and hip52; and improved well - being, fibromyalgia symptoms, and physical function in fibromyalgia.48 Multimodal and multidisciplinary therapies helped reduce pain and improve function more
effectively than single modalities.55, 67 Multiple guidelines recommended acetaminophen
as first - line pharmacotherapy for osteoarthritis68 - 73 or for low back pain74 and nonsteroidal anti-inflammatory drugs (NSAIDs)
as first - line treatment for osteoarthritis or low back pain70, 74; first - and second - line drugs for neuropathic pain include anticonvulsants (gabapentin or pregabalin), tricyclic
antidepressants, and serotonin - norepinephrine reuptake inhibitors (SNRIs).75 - 78 Nonsteroidal anti-inflammatory drugs have been associated with hepatic, gastrointestinal, renal, and cardiovascular risks.63, 73,79