Osteoarthritis Medications

Many different medications are used to control the pain associated with spinal arthritis. Two important factors that must be considered in medications are the level of the patient's pain and the potential side effects of the medication. Even nonprescription drugs should be checked for side effects.

Acetaminophen

For mild pain and discomfort without inflammation, over-the-counter acetaminophen (such as Tylenol) may be sufficient treatment. Acetaminophen does not reduce inflammation, but is an effective pain reliever and is less likely to cause stomach problems than NSAIDs (such as ibuprofen or aspirin), especially among elderly patients or people prone to stomach problems.

For these reasons, acetaminophen is generally the preferred initial drug given to patients with osteoarthritis. People with liver disease, people who drink alcohol heavily, and those taking blood- thinning medicines or NSAIDs, and people taking acetaminophen for more than 10 days in a row should use acetaminophen with caution and only under a doctor's care.

Pain-Relieving Creams, Rubs, Sprays

Pain-relieving creams, also called topical analgesics, applied to the skin over the joints can provide relief of minor arthritis pain. They are available over the counter and can often be used in conjunction with oral medications.

Examples include capsaicin (such as Arthricare, Zostrix), salicin (such as Aspercreme), methyl salicylate (such as Bengay, Icy Hot), and menthol (Flexall). Topical analgesics should not be used with other heat treatments, as the combination can cause too much heat and even burns.

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Nonsteroidal Anti-Inflammatory Drugs (NSAIDs)

NSAIDs are medications that are used to reduce both osteoarthritic pain and the inflammation associated with the pain in the joints. Examples of non-prescription NSAIDs include aspirin (e.g., Bayer, Ecotrin), ibuprofen (e.g., Advil, Motrin, Nuprin), and naproxen (e.g., Aleve, Naprosyn, Anaprox, Naprelan). It is sometimes possible to use NSAIDs for a while and then discontinue them for periods of time without recurrent symptoms, thereby decreasing side effect risks.

The most common side effects of NSAIDs involve gastrointestinal distress, such as stomach upset, cramping, diarrhea, ulcers and even bleeding. NSAIDs are also believed to increase the risk of serious cardiovascular conditions (such as heart attack or stroke), especially for those patients at risk for these conditions. The risk of these and other side effects increases in the elderly, when taken at higher doses, and with long term use.

Many other drugs cannot be taken when a patient is being treated with NSAIDs because NSAIDs alter the way the body uses or eliminates these other drugs. It is recommended that patients check with their health care provider or pharmacist before starting or altering an NSAIDs regimen for osteoarthritis.

Another type of NSAIDs, called COX-2 inhibitors, are available by prescription only and are designed to have fewer side effects related to the stomach and bowels than other NSAIDs. However, studies suggest that COX-2 inhibitors carry a greater risk of serious cardiovascular conditions than other NSAIDs.

As of April 2005, following recommendations by the FDA, the only COX-2 inhibitor available to consumers is celecoxib (brand name Celebrex). Both valdecoxib (Bextra) and rofecoxib (Vioxx), COX-2 inhibitors used by millions of arthritis sufferers, have been discontinued pending further study on their safety. It is recommended that patients consult with their treating physician to evaluate the relative benefits and risks of COX-2 inhibitors in order to come up with the best treatment plan for their individual clinical situation.

Cortisone Injections

While oral cortisone is generally not used in treating osteoarthritis, when injected directly into the osteoarthritic spinal joints, cortisone can rapidly decrease pain and restore function.

Injected glucocorticoids (also called corticosteroids, which are powerful anti-inflammatory hormones) may be used for inflammation and pain that is not responsive to NSAIDs. This type of injection is designed to reduce the inflammation, and is generally combined with an anesthetic, which in turn should help reduce the patient’s pain. Since repetitive cortisone injections can be harmful to the tissue and bones, they are reserved for patients with more pronounced symptoms and are generally not recommended for more than three treatments per year.

Other Medications for Spinal Arthritis

Mild narcotic painkillers can also be very effective for additional pain relief for osteoarthritis. Due to their potential for addiction, they are not used for extended periods and are not commonly prescribed.

Medications to relax muscle spasms may also be given temporarily.

Nutritional Supplements

Nutritional supplements are a relatively recent alternative treatment for osteoarthritis sufferers in the U.S., although they have been used since the 1960s in Europe. It should be noted that very little scientific information exists on nutritional supplements in relation to diseases of the spine. More study is needed on their safety and effectiveness.

Recently, the food supplements glucosamine and chondroitin have been shown to relieve symptoms of pain and stiffness for some persons with osteoarthritis. Glucosamine and chondroitin, similar to NSAIDs, have been shown to have anti-inflammatory effects. They may also inhibit the breakdown of cartilage associated with osteoarthritis and even spur cartilage growth.

These supplements are available in capsule form at pharmacies and health food stores without a prescription (like vitamins), although there is no certainty about the purity of the products or the dose of the active ingredients because they are not monitored by the FDA. They are gaining in popularity as more people use them and report improvements in their osteoarthritis symptoms and relatively few negative side effects.

Glucosamine and chondroitin sulfate may not provide sufficient pain relief for all osteoarthritis patients. Many patients find it is best to use glucosamine and chondroitin sulfate nutritional supplements in conjunction with other nonsurgical treatments (under the guidance of their treating physician).

Upset stomach, nausea, heartburn, and diarrhea are the most commonly reported side effects. Taking glucosamine and/or chondroitin sulfate with food seems to reduce the incidence of the above side effects. Patients taking blood-thinners or daily aspirin therapy should be careful taking chondroitin as it can increase blood-thinning and cause excessive bleeding. Women who are or may become pregnant should not take glucosamine or chondroitin, as the affects on unborn children are not yet known. Those with diabetes or shellfish allergies will need to take extra precautions and may need to avoid both supplements altogether. In all cases, a doctor should first be consulted.

Fish oil supplements have also been shown to have some anti-inflammation properties and increasing dietary fish intake and/or taking fish oil capsules (omega 3 capsules) can sometimes reduce inflammation due to arthritis. Additionally, antioxidants in certain vitamins, such as vitamins C, D, and E, may also help, either via supplements or emphasized within the patient's diet.

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Written by Vert Mooney, MD