Managing Osteoarthritis Pain Beyond NSAIDs

Arthritis is an umbrella term for more than 100 different diseases affecting bones and joints. Osteoarthritis is by far the most common; rheumatoid arthritis, an autoimmune disease, trails as a distant second.

Osteoarthritis (OA) is mostly a “wear and tear” problem. Causes include overuse injuries, such as from high-impact sports (running, jumping); repetitive use (assembly line jobs, computer work); misalignment of bones (scoliosis, poor posture); and advancing age.

As we get older, there’s simply more mileage on the body. Areas most affected are knees, hips and fingers. While you can’t stop OA, there are ways to slow progression and ease the pain. It may be tempting to “grin and bear it,” but that’s never a good idea.

“Ignoring a painful joint can lead to further damage,” says orthopedic surgeon Brad Thomas, MD, and Chief of Sports Medicine, UCLA Department of Orthopedic Surgery. “Pain usually means something bad is happening and should be addressed.”

NSAIDs: Common Arthritis Pain Medications

Nonsterodial anti-inflammatory drugs (NSAIDs) are a mainstay for many people with OA pain. They come in many formulations and are available by prescription (Celebrex, Zorvolex), and over-the-counter (Aleve, Motrin, Advil). Aspirin is also an NSAID. They can be useful in reducing inflammation and pain. But they’re not right for everyone, and side effects can be mild or quite alarming.

“Intermittent NSAID use can be helpful, but I don’t recommend chronic use,” says rheumatologist John Dermot Fitzgerald, MD, Ronald Reagan UCLA Medical. “They have side effects such as gastrointestinal bleeding, kidney damage, and there is increasing concern about cardiovascular effects. And never use NSAIDs with any blood thinners.”

Exercise to Ease Joint Pain

Research shows that physical activity decreases pain, improves function and delays disability. Sometimes movement might be a bit uncomfortable at the start, but in a few minutes most people feel better.

“Arthritic joints tend to stiffen. Warming them up with heat, massage and exercise works well to get both the circulation flowing and joint fluid mobilized,” says Dr. Thomas.

Ease into exercise to allow the natural warmth of circulation to occur. Qi Gong is an ancient Chinese form of self-healing using slow, gentle movements and breathing techniques. Yoga can also be helpful, but it’s important to find a gentle class or one that is targeted toward those with joint issues. Many yoga poses can be unfriendly to the joints. So, if you’re unsure, be sure to ask before attending the class. Walking and bicycling are other physical activities that can bring pain-relief through low-impact movement.

Acetaminophen (Tylenol) is not an NSAID. It blocks pain signals but doesn’t reduce inflammation. It, too, comes with precautions. Follow dosages as directed by the label or your physician, and know that long-term use can lead to liver damage.

Rub Out Pain with Topical Treatments

Topical analgesics rarely have side effects and can be applied directly to the area of pain. The products contain various ingredients, including menthol and camphor, which provide a cooling sensation. Salicylate, a main ingredient in aspirin, is also used in topical treatments, offering the same pain-relieving effect when rubbed onto the skin. Capsaicin, which is derived from chili peppers, provides pain-relieving warmth when applied. Some products contain a combination of ingredients. Always read and follow label instructions. If you are taking blood thinners, check with your doctor before using a product that contains salicylates.

More Methods to Consider

According to Dr. Thomas, pain can be managed through natural medications like turmeric, hyaluronic acid and glucosamine sulfate. A multitude of injection therapies are available and effective; hyaluronic acid, platelet-rich plasma (PRP), and amnion therapy all function to reduce pain in arthritic joints. Before trying new medications or supplements, it’s always wise to consult with your doctor as to the best options for your condition.

Modifications and assistance devices can also help mitigate pain and joint damage. Braces and wraps provide compression and stability. “Reducing stress on the joint is good for the joint,” adds Dr. Fitzgerald. “Adaptive devices such as canes, large grip utensils, and fat-grip gel-flow pens are all helpful alternatives.”

Heat and ice packs can also bring relief. Some people prefer heat, others cold. Alternating hot and cold packs is a viable alternative. Whichever method brings you the most relief is fine.

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