Prescription arthritis pain relief
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.
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There are multiple drugs available for the pain control of arthritis.
While over-the-counter (OTC) medicines help to a certain extent, more severe arthritis pain is best managed using prescription medicines.
Analgesics are drugs that help relieve pain, but not 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.
A non-narcotic patch is Lidoderm which is a patch that dispenses lidocaine, a local anesthetic for mild to moderate regional pain.
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. Narcotics are available in pill form and also as patches. Examples of the latter are the Duragesic patch which dispenses fentanyl over 72 hours and Butrans which dispenses bupropion over a one week period.
Narcotics and other strong painkillers have been prescribed mainly for short-term and intense pain. But some physicians believe that with careful monitoring these types of drugs can be effective in treating chronic pain. Narcotics such as morphine and codeine reduce pain by blocking pain signals that are traveling to the brain.
Non-steroidal anti-inflammatory drugs (NSAIDs) help reduce joint pain, stiffness and swelling. NSAIDs cut down on the production of prostaglandins, which are substances in the body that help send pain messages to the brain. Examples of NSAIDs include aspirin, ibuprofen and naproxen sodium. Other NSAIDs are available by prescription only. Examples are Celebrex, Mobic, Voltaren, Daypro, Relafen, and Lodine. NSAIDs can cause the side effect of stomach upset. Concern regarding the potential for cardiovascular side-effects is also present.
NSAID topical agents such as Pennsaid and Voltaren gel are useful in that they apply NSAID locally and appear to have many fewer systemic side effects.
Glucocorticoids are drugs related to the natural hormone 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 injections are administered too frequently.
Disease-modifying antirheumatic 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 lefunomide.
Biologic agents are used to target the immunologic abnormalities that cause arthritis inflammation. Multiple biologics have been approved by the Food and Drug Administration for the treatment of rheumatoid arthritis.
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 reuptake 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.
Non-prescription 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. Most topicals are available without prescription.
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. Some people may at first feel a burning or stinging sensation where capsaicin is applied, but this usually goes away with repeated applications.The medicines should be used cautiously since they can cause severe skin burns.
Tranquilizers can help reduce painful muscle tension and spasms in some types of arthritis or related conditions. However, these drugs can be addictive if they are used for a long period of time.
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. Both tranquilizers and muscle relaxants require prescription.
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