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What Can I Take For My Arthritic Pain?
Because osteoarthritis has no known cure, treating it consists mainly of pain and symptom relief. From Acetaminophen to opiods, the choice of drug therapy largely depends upon the severity of pain and underlying medical conditions. Let’s take a look at a few.
The first case, Chuck, who has mild osteoarthritis and a history of gastritis and kidney problems, complains of knee discomfort after working all day. Acetaminophen (Tylenol) is recommended because it can relieve mild pain, without affecting gastrointestinal tract and kidneys. Tylenol is relatively safe for your liver when taken in less than 4 grams a day.
The second case, Irene, who has moderate osteoarthritis in her hips, has been doing well with Aleve (Narpoxen), a non-steroidal anti-inflammatory drug (NSAID) supplemented by the occasional Tylenol for additional relief. From recent studies, NSAIDs have proven to be more effective in relieving moderate arthritic pain than Tylenol.
Because NSAIDs inhibit the production of “bad”, inflammation producing prostaglandins, the “good”, stomach and kidney protecting, fluid balancing prostaglandins are decreased as well. Recently, a study involving Naproxen has shown increased cardiovascular side effects, but a final determination has not been made at this point.
For Irene, however, taking Aleve daily has not caused stomach irritation, kidney problems, or fluid retention. Irene does need to keep in mind that over-the-counter NSAIDs can frequently cause GI side effects even without warning.
Our third case, Tara, who complains of knee and hand pain due to osteoarthritis, has a history of peptic ulcer disease. Because COX-2 inhibitors can block only the pro-inflammatory “bad” prostaglandins, while unaffecting the “good” prostaglandins, thus preventing stomach ulcers and bleeding, Tara was started on Celebrex 200 mg once a day. Unlike rheumatoid arthritis, osteoarthritis rarely has severe inflammation, therefore, low dose NSAIDs is recommended.
One popular Cox-2, Vioxx, was pulled from market due to proven increased cardiovascular side effects. Also, one study showed that Celebrex, when given in higher than 400 mg doses, can increase cardiovascular problems. However, several other studies of daily doses of less than 400 mg of Celebrex have shown no increase in CV side effects.
In Tara’s case, Celebrex offers her pain relief without GI irritation. If Tara still has pain, she can add Tylenol or another analgesic, but not Aleve or Advil. Taking two types of NSAIDs together increases your chances of GI and kidney side effects without necessarily offering increased pain relief.
Our final case is Tim, who has both cardiovascular and gastrointestinal problems with fairly advanced osteoarthritis. Tylenol was simply too mild, NSAIDs caused GI irritation, and Celebrex was stopped because of his history of angina. His next option: narcotic analgesic treatment.
Despite the recent media hype about analgesic side effects, finding the right treatment and taking it correctly is the way to find relief from osteoarthritis, regardless of your case. With common sense and the guidance of your physician, you can find the right analgesic treatment.
By Dr. Yong H. Tsai
Published in The Daytona Beach News-Journal
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