Eric Murray – What To Take for Arthritis Pain?
March 8, 2010
The best thing you can do for your arthritis, your doctor says, is to lose a few pounds. And don’t forget your exercise program. But what about the pain you’re feeling right now?
The pain of arthritis can be substantial, often requiring pain medication. And the disease is chronic, meaning that many patients end up popping pills every day for several decades. As a result, the question of what to take for pain relief is a complex and difficult problem.
Long before they seek the help of a doctor, arthritis patients are likely to become familiar with over-the-counter remedies, sometimes failing to recognize that these pills, like prescription medications, have side effects and must be taken with care.
Aspirin is an old stand-by, effective for treating headaches, lowering fevers and relieving various aches and pains. As a nonsteroidal antiinflammatory drug (NSAID), it works by inhibiting chemicals that are released as part of any inflammatory reaction.
Other NSAIDs sold without a prescription include ibuprofen (Advil, Motrin), naproxen (Aleve) and ketoprofen. All carry a potentially serious side effect of causing stomach irritation, ulcers and gastrointestinal bleeding.
With occasional use to treat a headache, this may not pose a problem, but for arthritis patients, who need relatively high doses for extended periods of time, the danger is substantial.
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Acetaminophen (Tylenol) is the other old stand-by and usually preferred by doctors for the initial treatment of mild to moderate osteoarthritis. Acetaminophen does not fight inflammation, but, in most situations, it does relieve pain as effectively as NSAIDs. And it is not associated with gastrointestinal bleeding.
Whereas NSAIDs are cleared from the body through the kidneys, acetaminophen is cleared through the liver. And that is a potential problem for persons who have three drinks or more of alcohol a day.
Any of these drugs-or comparable ones-are also available by prescription in stronger formulations. But the stronger the formulation, the greater the danger of side effects.
Guidelines recommend that patients take pain-killing medications on a fairly regular, pre-emptive basis, but studies show that patients frequently take prescribed pain medications at lower doses and less frequently than their doctors recommend-perhaps in part because of concern about side effects.
The introduction of COX-2 inhibitors (Celebrex, Vioxx and Bextra) was intended to give arthritis patients the advantages of an NSAID without the risk of gastrointestinal bleeding. When studies showed a high risk of heart attacks associated with Vioxx and Bextra, however, these drugs were withdrawn from the market in 2005.
Other studies revealed that the risk of a heart attack is also elevated for persons taking Celebrex and even for those taking high doses of traditional NSAIDs such as ibuprofen and diclofenac. Naproxen does not increase the risk of a heart attack, and aspirin is often prescribed to guard against a heart attack.
All NSAIDs and even acetaminophen have a tendency to increase blood pressure and worsen kidney problems, often leading to fluid retention, an enlarged heart and congestive heart failure.
Since arthritis, heart disease, high blood pressure and chronic kidney disease all occur with high frequency in persons age 50 and over, there are clearly no easy answers.
Alternative solutions include cortisone injections; stronger pain killers such as codeine, hydrocodone, tramadol and propoxyphene (Darvon); and topical analgesics such as capsaicin (Theragen, Zostrix) and salicylate (Aspercreme, Bengay Arthritis) creams.
A doctor will look at a patient’s complete medical profile before deciding on a pain medication. If you have swelling or inflammation, you may need an NSAID. But if you’ve ever had stomach bleeding or have been told you are at risk of bleeding, NSAIDs, including aspirin, are not in order.
American Heart Association guidelines issued in 2007 advised doctors not to prescribe COX-2 inhibitors or traditional NSAIDs to any patient with established heart disease or with risk factors for a heart attack, including hypertension.
Despite all the possible problems, pain relief is important to helping you remain more active, which in turn is crucial to good health. Popping a pill or using a capsaicin skin cream may be what it takes to keep you moving. But talk to your doctor first and make sure what you’re taking is safe.