Pain medicine for arthritis
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
There are multiple drugs available for pain control in arthritis.
Analgesics are drugs that help relieve pain, but do not have an effect on inflammation. They are helpful if you need relief from pain only, are allergic to aspirin or have had an ulcer. Acetaminophen is one example of an analgesic that give temporary relief of common arthritis pain, but does not reduce swelling. It is available without a prescription. Tramadol (Ultram) is another analgesic pain medicine. Narcotic pain relievers are sometimes used for patients with severe arthritis pain when all other therapies have failed.
Non-steroidal anti-inflammatory drugs (NSAIDs) help reduce joint pain, stiffness and swelling. NSAIDs cut down on the production of prostaglandins, which are substances that provoke inflammation. Examples of NSAIDs include aspirin, ibuprofen and naproxen sodium. Other NSAIDs are available by prescription only. NSAIDs can cause problems with gastrointestinal damage including peptic ulcer disease and gastrointestinal bleeding. Concerns regarding the potential for cardiovascular side-effects such as heart attack and stroke are also present.
Glucocorticoids are drugs related to the natural hormone produced in the body called cortisol. Scientists have developed synthetic forms of cortisone that can be taken in pill form or injected directly into joints or other tissues. These drugs help relieve pain by reducing swelling and inflammation in the area. Glucocorticoid injections must be monitored carefully; side effects can occur if you receive injections too frequently.
Disease-modifying anti-rheumatic drugs (DMARDs) often are used to control inflammatory conditions such as rheumatoid arthritis. While their main function is to reduce inflammation, slow down and/or suppress the immune system, these drugs also can help relieve pain. The drugs may take several weeks or months to begin working. Examples of DMARDs include methotrexate, hydroxychloroquine, azathioprine, azulfidine and leflunomide.
Biologic response modifiers (BRMs), also called biologic agents, are used to suppress arthritis inflammation. Multiple BRMs have been approved by the Food and Drug Administration for the treatment of rheumatoid arthritis: Enbrel, Humira, Kineretm, Remicade, Cimzia, Simponi, Actemra, Orencia, Rituxan, and most recently, Xeljanz.
Antidepressants, in addition to relieving depression, also can help relieve chronic pain. They are typically prescribed for the chronic pain of fibromyalgia rather than for arthritis. These drugs work by blocking pain messengers in the brain.
Antidepressants are sometimes used to help people with arthritis break out of the pain and depression cycle. These drugs also can help improve sleep quality, which in turn may help reduce pain. The doses used to treat pain and sleep problems are usually lower than those used for depression. Three major groups are the tricyclics, the selective serotonin re-uptake inhibitors, and the selective serotonin and nor-epinephrine re-uptake inhibitors.
GABA stimulators are also being used for chronic pain. These include drugs such as Neurontin and Lyrica.
Topical pain relievers can temporarily relieve the pain of arthritis. They include creams, rubs and sprays that are applied to the skin over a painful muscle or joint. Some topical pain relievers may contain combinations of salicylates, skin irritants and local anesthetics that relieve pain in one area.
Other over-the-counter topical creams containing capsaicin (the chemical that makes chili peppers taste "hot") may be used alone or with other medications to temporarily relieve pain. When applied as directed to joints affected by arthritis, the medication usually begins to work within one to two weeks. It works by decreasing a substance in the nerves called "substance P," which sends pain signals to the brain.
Muscle relaxants, such as cyclobenzaprine or carisoprodol, may relieve pain by decreasing muscle spasms that often trigger pain signals. Like tranquilizers, however, they should only be used for brief periods of time.
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