Analgesics are a class of drugs used to relieve pain. Analgesics induce pain relief by blocking pain signals going to the brain or by interfering with the brain's interpretation of the signals, without producing anesthesia or loss of consciousness. There are basically two kinds of analgesics: non-narcotics and narcotics.
Acetaminophen is the initial therapy recommended by the American College of Rheumatology for the treatment of osteoarthritis, especially of the hips and knees. Some patients, however, may find nonsteroidal anti-inflammatory drugs (NSAIDs) to be more effective for pain relief than acetaminophen. There have been studies and debates over which is more effective - acetaminophen or NSAIDs? The conclusion is that medication options must be individualized.
Narcotic analgesics are sometimes prescribed for patients with severe osteoarthritis who have failed other treatment options. Ultram (tramadol) is non-narcotic but the drug has narcotic-like action as well as pain relieving properties. Ultram has been reported to reduce NSAID use and effectively treat breakthrough pain for osteoarthritis patients.
Topical analgesics are creams or other formulated rubs applied to the affected joint externally. They are sold over-the-counter. Active ingredients include:
- Counterirritants - wintergreen oil, camphor, eucalyptus
Nonsteroidal anti-inflammatory drugs (NSAIDs)
NSAIDs have been shown to be effective for osteoarthritis in various studies. Since most NSAIDs are of equal effectiveness for pain relief, the decision of which NSAID to use may be based on cost, dosage schedule, and risk of side effects. The risk of gastrointestinal and renal toxicity as well as heart risks must be considered with NSAID use.
- Ansaid (Flurbiprofen)
- Arthrotec (Diclofenac/Misoprostol)
- Cataflam (Diclofenac potassium)
- Clinoril (Sulindac)
- Daypro (Oxaprozin)
- Dolobid (Diflunisal)
- Feldene (Piroxicam)
- Ibuprofen (Motrin, Advil)
- Indocin (Indomethacin)
- Ketoprofen (Orudis, Oruvail)
- Lodine (Etodolac)
- Meclomen (Meclofenamate)
- Mobic (Meloxicam)
- Nalfon (Fenoprofen)
- Naproxen (Naprosyn, Aleve)
- Ponstel (Mefanamic Acid)
- Relafen (Nabumetone)
- Tolectin (Tolmetin)
- Voltaren (Dicolfenac Sodium)
COX-2 selective inhibitors
COX-2 selective inhibitors have less potential for gastrointestinal toxicity than traditional NSAIDs. Your doctor should consider benefits versus risks and also consider cost when selecting the best NSAID or COX-2 inhibitor for you.
NSAIDs work by blocking the activity of the enzyme, cyclooxygenase, also known as COX. Research has revealed that there are two forms, known as COX-1 and COX-2. NSAIDs affect both forms. COX-1 is involved in maintaining healthy tissue, while COX-2 is involved in the inflammation pathway. COX-2 selective inhibitors became are a subset of NSAIDs, and a better choice for patients at risk for gastrointestinal toxicity.
At one time, there were three COX-2 selective inhibitors on the market: Celebrex, Vioxx, and Bextra. While the last two have been removed from the market, Celebrex is the only COX-2 selective inhibitor available.
Osteoarthritis patients with joint effusion or localized inflammation may benefit from intra-articular corticosteroid injections.
Another localized injection which may benefit knee osteoarthritis patients involves intra-articular injection of hyaluronan or derivatives (e.g., Synvisc, Orthovisc, Hyalgan, Euflexxa, Supartz). The process is known as viscosupplementation.
Primer on the Rheumatic Diseases. Edition 12. Published by the Arthritis Foundation
Osteoarthritis Treatment Options. Arthritis Foundation. 7/23/2007. <http://www.arthritis.org/disease-center.php?disease_id=32&df=treatments>.