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Arthritis pain
If you have osteoarthritis and have pain, you are by no means alone. More than 40 million Americans suffer from some form of arthritis, and many have chronic pain that limits daily activity. Osteoarthritis is by far the most common form of arthritis, affecting more than 20.7 million Americans.
How is arthritis pain treated?
No single treatment applies to all people with arthritis. Instead, your doctor will develop a management plan designed to minimize your pain and improve your joint function. Both self-care strategies and medication can help relieve pain.
Acetaminophen
Acetaminophen, available as Tylenol® and generic preparations, is one of the medications your doctor may prescribe for you initially, if you have pain without significant inflammation. Acetaminophen is an analgesic, meaning it relieves pain.
If you are taking acetaminophen, remember not to take more than your doctor recommends. Don't abuse alcohol and be cautious about engaging in prolonged periods of fasting. These circumstances could lead to acetaminophen-induced liver damage.
 A word about NSAIDs
NSAIDs (nonsteroidal anti-inflammatory drugs) are commonly taken to reduce pain and swelling, although they are not for everyone. Ibuprofen, naproxen and aspirin are all NSAIDs. Talk to your doctor about whether taking NSAIDs is safe for you, especially if you:
COX-2 inhibitors
Recent information suggests that the COX-2 inhibitor celecoxib (Celebrex®) may increase the risk of heart attack and stroke. Related drugs, rofecoxib (Vioxx®) and valdecoxib (Bextra®), were removed from the market because of the risks of heart, stomach and skin problems. Ask your doctor if celecoxib is safe for you.
DON'T STOP TAKING YOUR MEDICATIONS WITHOUT FIRST TALKING TO YOUR DOCTOR.
Corticosteroids
Corticosteroids are a type of steroid made by the adrenal gland. They act against inflammation but may cause side effects and must be used carefully. In osteoarthritis, they are only used as injections into the joint. When a joint affected by osteoarthritis is inflamed, doctors may recommend a corticosteroid injection.
The injected corticosteroid can provide significant relief and can improve a person's ability to move the joint, and these benefits may last months or years. After giving the shot, the doctor is likely to advise you to avoid using the joint too much for 24 to 48 hours after the injection, to ensure that the beneficial effect lasts as long as possible.
Frequent injections of corticosteroids can lead to faster joint breakdown and eventual failure of the joint. For this reason, doctors don't give a corticosteroid injection more often than two to three times a year. Other potential problems associated with corticosteroid injections into a joint include pain related to the procedure, infection (on rare occasions) and worsened arthritis caused by crystals derived from the injected corticosteroid.
Hyaluronan
Hyaluronan, a drug formulated for injection and known by the brand name of Synervisc®, when injected into a joint appears to restore the joint fluid to a level of viscosity that is closer to normal. This helps relieve pain by cushioning the joint as it moves. Studies of hyaluronan show it is at least as effective as a single injection of corticosteroid in relieving joint pain. Possible side effects of this drug include pain related to the injection, joint swelling and, rarely, infection or allergic reactions.
Topical analgesics
A topical analgesic is a drug put on the skin (such as a cream) to relieve pain. Capsaicin cream is one such agent that has been approved by the Food and Drug Administration to help relieve osteoarthritis symptoms. The effects of these compounds appear to add to the effects of NSAIDs. It may take a few weeks of daily application, two to four times a day, before pain relief is noticed.
If you use capsaicin cream, thoroughly wash your hands afterwards, and to be careful not to accidentally transfer traces of the cream to areas such as your eyes or mouth, by touching them before washing. The reason for this is an initial burning sensation caused by the application of capsaicin cream. For most people, this sensation is temporary and moderate, but others experience it as severe and prolonged.
Chondroprotective agents
Chondroprotective agents are also known as disease-modifying osteoarthritis drugs. A number of drugs are being studies their chondroprotective effect, which means the extent to which they protect joint cartilage from further damage and halt the progression of osteoarthritic damage to a joint. However, no drugs are approved by the FDA as effective for this purpose.
Low-dose tetracycline derivatives, low-dose corticosteroids, tamoxifen and chloroquin are all compounds that are being investigated for possible chondroprotective effects. Glucosamine and chondroitin sulfate are two other drugs being studied. These last two drugs are apparently well tolerated, except for causing occasional stomach irritation, but their onset of action in relieving pain is slow.
Although these and other drugs under investigation hold promise, they have not yet been fully studied and current data is varied. Follow your doctor's recommendations for all medications you are using for your arthritic pain.
The management of pain in osteoarthritis is a dynamic process that changes according to your needs. If you are not getting enough pain relief from your medications, tell your doctor. Write down your questions before your visit. You must be forthcoming with information and ready to work with your doctor to optimize your medications and reduce the risks of side effects.
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External Sources
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National Institutes of Health
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The Food and Drug Administration
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The American Academy of Orthopaedic Surgeons
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This article was reviewed and updated June 2007.
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