|Step 7: Pain medication|
Medicines to control osteoarthritis pain must be pain-specific, since osteoarthritis can cause both sudden and chronic pain.
- If a person experiences unexpected, severe pain from a damaged joint, he or she might benefit from strong pain relievers and muscle relaxants.
- By contrast, such medications usually are not useful or appropriate for chronic pain, which is more effectively treated by self-management techniques such as proper joint use, joint protection, exercise, medication scheduling, and weight control.
Many medications are used to treat arthritis. Some must be prescribed by a physician, whereas other "over-the-counter" (OTC) products can be bought without a prescription. Consult a physician before taking any new medications, including OTC products. Some OTC products have the same ingredients as prescription medications, so one runs the risk of overdose unless all medications are discussed with a physician.
Over-the-counter pain relievers
Pain relievers like acetaminophen (Tylenol) and aspirin are familiar choices for the treatment of osteoarthritis.
- Acetaminophen generally is considered safe, although it may pose risks to some individuals with liver disease or when taken in excessive doses.
- Aspirin is a popular medicine for many arthritic disorders because of its ability to relieve pain as well as inflammation (swelling, redness). However, aspirin is not suitable for people who have had a stomach ulcer or aspirin allergy.
Nonsteroidal anti-inflammatory drugs (NSAIDs)
NSAIDS relieve pain as well as inflammation. There are a wide variety of NSAIDs to choose from. Over-the-counter forms include:
- Ibuprofen (Advil, Motrin)
- Naproxen (Aleve)
Prescription NSAIDs include:
- Diclofenac (Cataflam, Voltaren)
- Ibuprofen (Motrin)
- Indomethacin (Indocin)
- Tolmetin (Tolectin)
- Nabumetone (Relafen)
- Naproxen (Anaprox, Naprosyn)
- Sulindac (Clinoril)
Unfortunately, NSAIDs have been characterized as having a "double-edged sword," since gastrointestinal (GI) complaints -- which range from stomach upset to ulceration and bleeding -- are common side effects of these medicines.
- Such complaints sometimes can be controlled by taking the NSAID with food or by using antacids between meals.
- However, if GI problems are more than mild or are long-lasting, the physician may prescribe an NSAID that causes fewer GI side effects (for example, salsalate).
- Note that NSAIDs also may cause kidney damage, worsen blood pressure (with salt and fluid retention), and contribute to bleeding by affecting the platelets (clotting elements in the blood).
The following drugs may be prescribed by a physician to reduce the side effects of NSAIDs:
- Proton-pump inhibitors -- such as esomeprazole (Nexium), lansoprazole (Prevacid), omeprazole (Prilosec, Zegerid), pantroprazole (Protonix), and andrabeprazole (Aceiphex) --are used to relieve gastrointestinal symptoms, and have some ability to reduce the risk of NSAID-related ulcers.
- Antacids help relieve upset stomach and other minor gastrointestinal symptoms (such as nausea, heartburn, indigestion).
- Misoprostol (Arthrotec) is used to reduce the risk of NSAID-related ulcers.
- H2-blockers such as ranitidine (Zantac), famotidine (Pepcid), or cimetidine (Tagamet) are used to relieve gastrointestinal symptoms, and may have some ability to reduce the risk of NSAID-related ulcers.
These medications reduce the pain of arthritis without causing ulcer disease, and they at least partially prevent the GI complaints associated with NSAIDs. Just one of these medicines, available by prescription only, is still on the market:
- Celecoxib (Celebrex)
Two other COX-2 inhibitors, valdecoxib (Bextra) and rofecoxib (Vioxx), are no longer available due to increased heart and stroke risks. Celebrex is also not without side effects and risks. Celecoxib may raise blood pressure, and long-term use might increase your risk for heart attack or stroke.
These are sometimes prescribed for osteoarthritis if muscle spasms contribute to a person's discomfort. They include:
- Cyclobenzaprine (Flexeril)
- Carisoprodol (Soma)
- Methocarbamol (Robaxin)
Other prescription drugs
Sleep medications and antidepressants may be beneficial in certain individuals.
Over-the-counter (OTC) creams, rubs, and sprays
These can be applied topically (to the skin) for temporary relief of pain in a sore muscle or joint. They work in various ways, depending upon their ingredients. Some products contain:
- Salicylates (aspirin-related compounds that relieve pain)
- Skin irritants (chemicals that cause cold, warm, or other sensations, thereby reducing feelings of pain)
- Capsaicin (a "hot" substance found in chili peppers that blocks pain signals to the brain). Most creams, such as those containing capsaicin, must be reapplied three to four times daily and may require 2 to 4 weeks of use before effects are noticeable.
Q: My stomach is easily upset. Will arthritis medicine upset my stomach or give me an ulcer?
A: Make sure that your doctor knows about your stomach problems so that they can prescribe a pain reliever that does not irritate the stomach or cause bleeding from or ulcers in the stomach, which these medications can sometimes do.
Suitable choices may be an aspirin-free pain reliever, such as acetaminophen, or an NSAID that causes fewer GI symptoms. As an alternative, the physician may prescribe an additional medication to lessen the side effects of NSAIDs. It also may be beneficial to switch to the COX-2 inhibitor Celebrex, which can significantly lessen the chance of stomach problems.
Injections into the joint
These are medications a doctor can inject directly into the joint when you go in for an office visit:
- Injectable corticosteroids -- are medications that lessen inflammation, swelling, and pain.
- Injectable hyaluronic acid -- currently is marketed under the brand names Synvisc, Hyalgan, and Orthovisc
Reviewed By: Ariel D. Teitel, MD, MBA, Clinical Associate Professor of Medicine, Division of Rheumatology, NYU Langone Medical Center. Review provided by VeriMed Healthcare Network.