Arthritis pain relievers
by Nathan Wei, MD, FACP, FACR
Nathan Wei is a nationally known board-certified rheumatologist and author of the Second Opinion Arthritis Treatment Kit. It's available exclusively at this website... not available in stores.
Click here: Second Opinion Arthritis Treatment Kit
Arthritis pain relievers fall into a number of broad categories.
The first are the non-narcotic analgesics. The second is the narcotic analgesic group. The third category is the non-steroidal anti-inflammatory group. The fourth category are the antidepressants. And the fifth category are the GABA stimulators.
Analgesics relieve pain but have no effect on inflammation. Pain relief from analgesics occurs through a centeral nervous system mechanism. There are basically two kinds of analgesics: non-narcotics and narcotics.
Acetaminophen is the most commonly used over-the-counter, non-narcotic analgesic.
Acetaminophen is a popular pain-reliever because it is both effective for mild to moderate pain relief and relatively inexpensive. However, the safety of acetaminophen is tied to proper use. While it is generally safe and effective, taking too much can cause serious liver damage. The drug is sold under brand names such as Tylenol and Datril, but it is also available in many cough and cold products and sleep aids. It is also an added ingredient in many prescription pain relievers.
Taking more than 4000 mg/day or using it long term can increase the risk of liver damage. The risk of liver damage with acetaminophen use is also increased by ingesting alcohol. Chronic use of acetaminophen also can lead to chronic kidney failure.
Acetaminophen is found in more than 500 over-the-counter drugs. It can be found in combination with other active ingredients in many cold, sinus, and cough medications. The cumulative effect of acetaminophen must be considered if multiple drugs containing acetaminophen are used.
The major class of narcotics used in the United States are the opioids.
Opioids are medications which bind to opioid receptors in the central nervous system or gastointestinal tract. There are four broad classes of opioids:
• Endogenous opioid peptides (produced in the body - endorphins, enkephalins)
• Opium alkaloids (morphine, codeine)
• Semi-synthetic opioids (heroin, oxycodone, hydrocodone, dihydrocodeine, hydromorphone, oxymorphone)
• Fully synthetic opioids (Demerol, methadone, fentanyl, pentazocine, buprenorphine, butorphanol, tramadol, and more)
Opioids are used in medicine as strong analgesics, for relief of severe or chronic pain.
Questions arise over the addictive potential of opioids vs. the benefit of the analgesic properties they provide for treating conditions such chronic arthritis. Some believe opioids can be taken safely for years with minimal risk of addiction or toxic side effects. The enhanced quality of life which opioids may provide the patient must be considered.
Non-steroidal anti-inflammatory drugs (NSAIDs) are a group of drugs commonly used to treat arthritis because of their analgesic (pain-killing), anti-inflammatory, and antipyretic (fever-reducing) properties. The mechanism of action of NSAIDs is the inhibition of the enzyme cyclooxygenase, which catalyzes arachidonic acid to prostaglandins and leukotrienes. Prostaglandins mediate the inflammatory response.
NSAIDs interfere with prostaglandin production by inhibiting cyclooxygenase.
Scientific studies have shown a correlation between concentration of the drug and effect, but don't explain the differences in individual patient responses.
Other things to know about NSAIDs:
•Pain and inflammation occurs in a circadian rhythm (daily rhythmic cycle based on a 24 hour interval). As a result, NSAIDs may be more effective at certain times of the day.
•NSAIDs are divided into two groups: those with short half lives and those with long half lives. Since it takes approximately three to five half-lives to stabilize blood levels, NSAIDs with longer half-lives require a loading dose to be given (large dose given initially). The "half-life" is the time it takes a drug to go down to half of its initial level.
•Prostaglandins function to protect the stomach lining, promote clotting of the blood, regulate salt and fluid balance, and maintain blood flow to the kidneys when kidney function is less than normal. By blocking prostaglandins, NSAIDs can cause stomach irritation, bleeding, fluid retention, and reduced kidney function.
•Synovial fluid (joint fluid) is the target for NSAIDs.
•NSAIDs are 95% albumin (protein) bound. The unbound amount of NSAID is increased in patients with low albumin concentrations such as found in active rheumatoid arthritis and in the elderly.
•Since NSAIDs bind to plasma proteins they may be displaced by or may displace other plasma-bound drugs such as coumadin, methotrexate, digoxin, cyclosporine, oral anti-diabetic agents, and sulfa drugs. This interaction can magnify either the therapeutic or the toxic effects of drugs.
•Due to their different chemical properties some NSAIDs are metabolized by the liver, while a few are excreted in the urine unchanged.
•Antipyretic and anti-inflammatory effects of NSAIDs can mask the signs and symptoms of infection.
•Adverse effects of NSAIDs which can occur at any time include kidney failure, liver dysfunction, bleeding, and stomach ulceration.
•NSAIDs can interfere with control of hypertension and cardiac failure in patients who take beta-adrenergic antagonists, angiotensin-converting enzyme inhibitors, or diuretics.
•Long-term use of NSAIDs may have a damaging effect on chondrocyte (cartilage) function.
Topical anesthetics such as the Lidoderm patch have been used to treat arthritis pain.
Another group of medicines used to treat arthritis are the antidepressants. Cymbalta, a selective nor-epinephrine and serotonin re-uptake inhibitor has been FDA approved to treat osteoarthritis and low back pain.
GABA stimulators (GABA is a central nervous system neurotransmitter) like Neurontin and Lyrica also are helpful for certain conditions such as post-herpetic neuralgia (shingles pain) and fibromyalgia.
Get more information about arthritis pain relievers as well as...
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Click here Second Opinion Arthritis Treatment Kit
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