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Medication Options for Arthritis Pain Relief
Last time, we explored lifestyle options to help manage arthritis pain of osteoarthritis. In this article, we’ll discuss medication options for the treatment of osteoarthritis. If you missed the first article in this two part series, you can find it here.
The choice of which medications to use to treat arthritis symptoms depends on the severity of the arthritis and which joints are affected. Regardless of the medication used to treat the pain and inflammation of arthritis, it is very important to monitor the treatment’s effectiveness. Starting a symptom diary is a useful way to compare symptoms before and after a treatment, and evaluate the benefits provided.
Topical Medications
If only a limited number of joints are affected by arthritis, a topical treatment may be the best option. Topical treatments are medications in cream or ointment form which are applied directly to the affected joints. These medications can also be relied upon when oral treatments are not working optimally, or when oral treatments need to be avoided because of risks or side effects. Two ingredients to look for in a topical treatment are diclofenac and capsaicin.
Diclofenac is a non-steroidal anti-inflammatory (NSAID) medication which is available orally as a prescription anti-inflammatory, or in creams available over the counter. This medication works to treat pain and inflammation where it is applied, but avoids many of the unwanted effects elsewhere in the body. One brand name cream that contains diclofenac is called Voltaren, and it is available in two strengths without a prescription. Your doctor may also prescribe for you a diclofenac cream that is stronger and compounded by a pharmacist.
Capsaicin cream is also available without a prescription, and can be found in the brand name product Zostrix. Capsaicin is an ingredient derived from hot peppers, and it can be effective in relieving arthritis pain for some people, especially in the hands. Because capsaicin is made from hot peppers, it should not be applied to raw, irritated, or broken skin, and care should be taken not to get any of the cream in your eyes.
Oral Medications
Acetaminophen is the most common and generally the safest oral medication used to treat arthritis. Most people will be familiar with it as the brand name product Tylenol. Many generic versions of acetaminophen are also available. Patients should be on the lookout for Tylenol products which combine acetaminophen with other medicines that may not be appropriate to treat arthritis. Acetaminophen works to relieve the pain associated with arthritis, but does not treat inflammation. Tablets or capsules usually contain between 325 mg – 650 mg of acetaminophen per tablet. Your pharmacist can help you select the right acetaminophen product as well as recommend the best dose and schedule for you.
NSAIDs (Non-Steroidal Anti-Inflammatory Drugs) are a group of medications that can be taken orally to treat pain and inflammation. Some NSAIDs are available without a prescription, like ibuprofen (Advil, Motrin, etc.) or naproxen (Aleve, etc.) Other, stronger NSAIDs are only available with a doctor’s prescription.
When selecting a NSAID to treat arthritis, it is best to consult with a pharmacist or doctor beforehand. NSAIDs may not be a good choice for people with significant risk factors for heart attack or stroke, for those with kidney or liver disease, heart failure, or a history of stomach ulcers. NSAIDs might interact with other prescription medications that you may take, so be sure to check with a health care professional if these options are right for you.
Duloxetine is a prescription medication that might be an option for people with chronic osteoarthritis pain if acetaminophen or an NSAID alone is not effective. Duloxetine can be added-on to an existing treatment with acetaminophen or an NSAID and may provide additional pain relief benefit.
Opioid medications such as morphine, hydromorphone, and codeine are not generally recommended for osteoarthritis because of the adverse effects of these medications. However, they may be useful treatments for short periods of time to relieve arthritis pain, or may be an option for elderly people who cannot take NSAIDs. If tramadol or an opioid medication is prescribed for arthritis, great care should be taken to manage side effects and ensure that these medications are used safely.
Going beyond the pharmacy
Some osteoarthritis sufferers may explore treatment options that take them outside the pharmacy. In some instances, your doctor may recommend and provide corticosteroid injections directly into affected joints. This treatment may be a short term solution for osteoarthritis in selected joints, as directed by your medical doctor.
There has been growing interest in the role that cannabis products might play in providing relief to those dealing with arthritis issues. Unfortunately, there is not much solid evidence to recommend the use of cannabis, or to designate to it a specific role in the management of the disease. Some patients do report benefits from using CBD (cannabidiol) products to treat inflammation, chronic pain, anxiety and sleep issues, which might occur with osteoarthritis.
Any patient curious about trying a CBD product should consult both with a healthcare professional to make sure that it is safe for them, and also consult with a person familiar with the CBD products to ensure that they are getting a product that matches what they are looking for. With the sale of these cannabis products now removed from healthcare settings, there is even more responsibility put on the patient to make sure that they are getting the expertise of people in both the healthcare setting and the ever changing world of cannabis products. CBD products in oil, capsule, topical or edible form may be investigated, but any cannabis product that is meant to be smoked or vaped should be avoided completely.
For those patients with severe osteoarthritis who do not benefit adequately from medication or other treatments, surgery may become an option to be discussed with a doctor. Arthritic hips and knees are the joints most frequently considered for surgical options. The decision of whether to undergo surgery for a joint damaged by arthritis needs to weigh the risks and benefits. Fortunately, you can reduce your risk of having your arthritis progress to the point of surgery by actively managing the disease with proper use of medications and the appropriate non-drug measures.
Mark Mercure is certified by the Board of Pharmacy Specialties in Geriatric Pharmacy and is the owner/manager of Home Health Care Pharmacy. He specializes in providing comprehensive medication reviews which help patients optimize medication use and avoid drug-related issues.