Many causes of arthritic pain are encountered in clinical practice. Osteoarthritis is the most common form of arthritis in the United States, afflicting tens of millions of people. The authors review current literature on the treatment of patients with osteoarthritis. They discuss nonpharmacologic therapy such as physical therapy, weight reduction, and osteopathic manipulative treatment. Pharmacologic treatment of patients with osteoarthritis includes acetaminophen, nonsteroidal anti-inflammatory drugs, tramadol hydrochloride, and opiate analgesics in patients who failed all other treatment modalities. Patients who failed medical management should be referred for consideration for surgery.