*  What are NSAIDs and why are they called pain killers?

NSAIDs have a unique pharmacological ability to block chemical mediators that cause inflammation called prostaglandins.  The fact is that when inflammation is relieved, so is its associated pain.  For inflammatory conditions such as gouty arthritis and rheumatoid arthritis, NSAIDs are an important and popular medication.  However, because not all related pain is due to inflammation, other safe and effective analgesic can be used.

*  I have osteoarthritis in my knees, but I don’t want to take NSAIDs.  What else can I take?

Most cases of osteoarthritis create little or no inflammation, therefore, Tylenol, glucosamine or even mild opiod analgesics can be used, particularly elderly patients with GI or cardiovascular risk factors.  Furthermore, joint injections with corticosteroids or viscosupplementation such as Hyalgan or Synvisc may be helpful.

*  Do I really need to take NSAIDs for my generalized aching due to fibromyalgia?

Not really.  Because fibromyalgia is a type non-inflammatory muscular pain NSAIDs are generally ineffective and is typically not recommended.

*  With the worry about Celebrex causing cardiac problems, I don’t know whether to stop or continue taking it, even though it really helps.

While the inhibition of prostaglandins can prevent pain and inflammation, it can also decrease the protection it offers to the lining of our blood vessels. Therefore excessive blocking of prostaglandins can create an imbalance and may in fact increase cardiovascular events.  So, to be on the safe side, if you have a history of stroke, heart attack, angina or uncontrolled hypertension, you should stop taking Celebrex and switch to traditional NSAIDs, such as Voltaren or Motrin.  But be aware that even traditional NSAIDs have possible cardiovascular side effects.  For now, people without a history of heart problems who cannot take traditional NSAIDs, Celebrex 200 mg daily is a good choice.

*  Three years ago, I had angioplasty and last year a gastric ulcer. What can I take for my RA?

Traditional NSAIDs can cause gastric irritation, while Celebrex has less GI side effects. However, because of your cardiac history, Celebrex is not recommended.  Your safest option may be Arthrotec, which is a combination of Voltaren, a traditional NSAID, and Cytotec, an agent that protects the lining of the stomach wall. Another combination medication is NapraPAC which includes Naproxen, a traditional NSAID, and Prevacid, a proton pump inhibitor (PPI).

*  I have chronic renal problems, but no heart or stomach problems. Which medication can I take, for my gout?