Many different medications are used to control the pain associated with
spinal arthritis. Two important factors that must be considered
in medications are the level of the patient’s pain and the potential
side effects of the medication. Even nonprescription drugs should
be checked for side effects.
Acetaminophen
For mild pain and discomfort without inflammation,
over-the-counter acetaminophen (such as Tylenol) may be sufficient treatment. Acetaminophen
does not reduce inflammation, but is an effective pain reliever and is
less likely to cause stomach problems than NSAID’s (such as ibuprofen
or aspirin), especially among elderly patients or people prone to stomach
problems. For these reasons, acetaminophen is generally the preferred
initial drug given to patients with osteoarthritis. People with
liver disease, people who drink alcohol heavily, and those taking blood-
thinning medicines or NSAIDs, and people taking acetaminophen for more
than 10 days in a row should use acetaminophen with caution and only
under a doctor’s care.
Pain-relieving creams, rubs, sprays
Pain-relieving creams, also
called topical analgesics, applied to the skin over the joints can provide
relief of minor arthritis pain. They
are available over the counter and can often be used in conjunction with
oral medications. Examples include capsaicin (such as Arthricare,
Zostrix), salycin (such as Aspercreme), methyl salicylate (such as Bengay,
Icy Hot), and menthol (Flexall). Topical analgesics should not
be used with other heat treatments, as the combination
can cause too much heat and even burns.
Nonsteroidal anti-inflammatory drugs (NSAIDs)
NSAIDS are
medications that are used to reduce both osteoarthritic
pain and the inflammation associated with the pain in the joints. Examples
of non-prescription NSAIDs include aspirin (e.g., Bayer, Ecotrin), ibuprofen
(e.g., Advil, Motrin, Nuprin), and naproxen (e.g., Aleve, Naprosyn, Anaprox,
Naprelan). It is sometimes possible to use NSAIDs for a while and then
discontinue them for periods of time without recurrent symptoms, thereby
decreasing side effect risks. The most common side effects of NSAIDs
involve gastrointestinal distress, such as stomach
upset, cramping, diarrhea, ulcers and even bleeding. NSAIDs are also
believed to increase the risk of serious cardiovascular conditions (such
as heart attack or stroke), especially for those patients at risk for these
conditions. The
risk of these and other side effects increases in the
elderly, when taken at higher doses, and with long term use. Many
other drugs cannot be taken when a patient is being treated with
NSAIDs because NSAIDs alter the way the body uses or
eliminates these other drugs. It is recommended that patients check with
their health care provider or pharmacist before starting or altering an
NSAIDs regimen for osteoarthritis.
Another type of NSAIDs, called
COX-2 inhibitors, are available
by prescription only and are designed to have fewer side effects related
to the stomach and bowels than other NSAIDs. However, studies suggest
that COX-2 inhibitors carry a greater risk of serious cardiovascular
conditions than other NSAIDs. As of April 2005, following recommendations
by the FDA, the only COX-2 inhibitor available to consumers is celecoxib
(brand name Celebrex). Both valdecoxib (Bextra) and rofecoxib (Vioxx),
COX-2 inhibitors used by millions of arthritis sufferers, have been discontinued
pending further study on their safety. It is recommended that patients
consult with their treating physician to evaluate the relative benefits
and risks of Cox-2 inhibitors in order to come up with the best treatment
plan for their individual clinical situation.
Cortisone injections
While oral cortisone is generally not used in treating osteoarthritis,
when injected directly into the osteoarthritic spinal
joints, cortisone can rapidly decrease pain and restore function (facet
injections). Injected
glucocorticoids (also called corticosteroids, which
are powerful anti-inflammatory hormones) may be used for inflammation and
pain that is not responsive to NSAIDS. This type of injection is designed
to reduce the inflammation, and is generally combined with an anesthetic,
which in turn should help reduce the patient’s pain. Since
repetitive cortisone injections can be harmful to the tissue and bones,
they are reserved for patients with more pronounced symptoms and are generally
not recommended for more than three treatments per year.
Other medications for spinal arthritis
Mild narcotic painkillers
can also be very effective for additional pain relief for osteoarthritis. Due to their potential for addiction,
they are not used for extended periods and are not commonly prescribed. Medications
to relax muscle spasms may also be given temporarily.
Nutritional supplements
Nutritional supplements are a relatively
recent alternative treatment for osteoarthritis sufferers in the U.S.,
although they have been used since the 1960s in Europe. It should be noted that very little
scientific information exists on nutritional supplements in relation
to diseases of the spine. More study is needed on their safety
and effectiveness.
Recently, the food supplements glucosamine and chondroitin have been
shown to relieve symptoms of pain and stiffness for some persons with
osteoarthritis. Glucosamine and chondroitin, similar to NSAIDs, have
been shown to have anti-inflammatory effects. They may also inhibit
the breakdown of cartilage associated with osteoarthritis and even spur
cartilage growth. These supplements are available in capsule form
at pharmacies and health food stores without a prescription (like vitamins),
although there is no certainty about the purity of the products or the
dose of the active ingredients because they are not monitored by the
FDA. They are gaining in popularity as more people use them and
report improvements in their osteoarthritis symptoms and relatively few
negative side effects. Glucosamine and chondroitin sulfate may
not provide sufficient pain relief for all osteoarthritis patients. Many
patients find it is best to use glucosamine and chondroitin sulfate nutritional
supplements in conjunction with other conservative treatments (under
the guidance of their treating physician).
Upset stomach, nausea, heartburn and diarrhea are the most commonly
reported side effects. Taking glucosamine and/or chondroitin
sulfate with food seems to reduce the incidence of
the above side effects. Patients taking blood-thinners
or daily aspirin therapy should be careful taking chondroitin as it can
increase blood-thinning and cause excessive bleeding. Women who are or
may become pregnant should not take glucosamine or chondroitin, as the
affects on unborn children are not yet known. Those with diabetes or
shellfish allergies will need to take extra precautions and may need
to avoid both supplements altogether. In all cases, a doctor should first
be consulted. For more, see Safe
use of glucosamine and chondroitin sulfate supplements.
Fish oil supplements have also been shown to have some anti-inflammation
properties and increasing dietary fish intake and/or taking fish oil
capsules (omega 3 capsules) can sometimes reduce inflammation due to
arthritis. Additionally, antioxidants in certain vitamins, such
as vitamins C, D, and E, may also help, either via supplements or emphasized
within the patient’s diet.
