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Arthritis Treatments Need Not Be Risky, Experts Say, and There Are Plenty of Alternatives to Prescription Drugs

Posted on: Monday, 24 January 2005, 15:00 CST

As if the pain of sore and swollen joints isn't bad enough, now arthritis sufferers have to endure the confusion and frustration of having some of their most effective pain relievers declared risky.

The arthritis medication Vioxx was pulled from the market Sept. 30 after studies indicated it increased the chance of heart attack and stroke. The other shoe fell when Celebrex, another arthritis drug in the same class of Cox-2 inhibitors, was linked to serious cardiovascular side effects.

A short time later, similar problems were seen with the popular painkiller naproxen (sold over the counter as Aleve). So, what's an arthritis sufferer or ailing weekend warrior to do?

Plenty, say arthritis experts.

People need to take control of their symptoms by trying various things and seeing what works for them, says Veronica Braun, president of the San Diego chapter of the Arthritis Foundation.

"We live in a culture where we just want to take a pill and feel better. But, that's not always possible," she said. "People should look at (the recent medical findings) as an opportunity to search out other things -- everything from exercise to stress reduction, to acupuncture -- to help relieve their pain."

Arthritis experts offer the following pain-management recommendations to prove there is life after Vioxx. Just be sure to consult your doctor before taking any medications or beginning any exercise, weight-loss or pain-relief treatments.

Some ways to manage your pain:

Acupuncture

By helping to release pain-relieving chemical substances such as endorphins in the central nervous system, acupuncture shows promise for pain relief associated with osteoarthritis.

A recent study sponsored by the National Institutes of Health found that acupuncture treatment significantly reduced pain and eased movement for patients with arthritic knees who were taking pain medicine. The study involved 570 knee patients who experienced a 40 percent improvement in function with acupuncture after 14 weeks.

"Acupuncture seems to help some people, and it appears to be safe," said Dr. Gary Firestein, director of the University of California, San Diego's division of rheumatology, allergy and immunology. "If you're uncomfortable and in pain and you don't want to take medication, acupuncture may be a reasonable approach."

Over-the-counter painkillers

Until recently, nonsteroidal anti-inflammatory drugs (NSAIDs), including naproxen (Naprosyn and Aleve) and ibuprofen (Advil and Motrin), were used quite successfully by people with joint and muscle pain.

However, after recent studies indicated that high doses and long- term use of naproxen may cause cardiovascular problems, doctors are cautioning people to use the drug only as recommended -- 220 milligrams twice a day and for not more than 10 days.

"We need to remember that this stuff isn't candy. Medicines, including over-the-counter medicines, are serious business and all have potential risks," Firestein says.

Ibuprofen hasn't been found to cause cardiac problems, but people still need to be cautious: Gastrointestinal bleeding and ulcers can occur with high doses and prolonged use of the painkiller. Additionally, when taken along with a low-dose aspirin regimen for cardiac protection, it's been found that ibuprofen interferes with aspirin's protective effect.

"If you take aspirin for your heart, it's important to talk to your doctor about what you should do (for arthritis pain)," said Dr. Gary Williams, a rheumatologist and chairman of Scripps Clinic's department of medicine in San Diego. "And, if you're taking ibuprofen, be sure to follow the package directions."

Although acetaminophen (Tylenol) doesn't have any gastrointestinal side effects, it lacks the anti-inflammatory effects of an NSAID. It might help a bit with the pain, but it won't do anything for inflammation that causes arthritis pain.

Low-dose Celebrex

If you've had good results with Celebrex, check with your doctor to see if you should continue its use. If you've had no history of cardiovascular problems or risks, ask if it's possible to safely lower the dosage and still get pain relief.

"If you've been taking 400 milligrams of Celebrex, you may want to reduce it to 100 or 200 milligrams since it's not been demonstrated to be a problem at lower dosage," Firestein said.

Exercise

"The muscle-skeletal system is at its best when it moves. It's not designed to be immobile. In fact, you can induce arthritis by immobilizing some joints," Firestein says.

Stretching and nonweight-bearing exercise such as swimming and cycling can increase the range of movement, reduce fatigue and generally make patients feel better.

"Becoming as fit as you can and strengthening the muscles around the joint can have a dramatic effect," Williams says.

Chiropractic care

"Chiropractors can be helpful for neck and back pain," Firestein says. "It's not been established (as a remedy) for osteoarthritis because the damage is already there. But, for muscle spasms and inflammation, chiropractors can break that cycle with physical manipulation."

Heat/ice

Using heat and cold treatments can reduce the pain and stiffness of arthritis and ailing joints. Ice packs numb the sore area and reduce inflammation and swelling when there's damage to a joint, such as a sprained ankle.

Heat relaxes muscles and stimulates blood circulation and often works best for achy joints or a stiff back.

Drugstores carry a wide range of helpful products, including freezer gelpacks and eight-hour heat wraps. Even a package of frozen peas can be used as an ice pack in a pinch.

Dietary supplements

Although there's no substantive scientific evidence that nutritional supplements can ease arthritis and muscle/joint pain, some people swear by them.

One of the most popular is glucosamine-chondroitin, lauded by some for relieving achy joints and rebuilding cartilage. It's the focus of a large study by the National Institutes of Health.

"Some studies on fish oil and other omega-3 fatty acids suggest that in high doses, they may have some anti-inflammatory and analgesic effects, Firestein said.

Other supplements such as methyl sulfonyl methane (MSM) and S- adenosylmethionine (SAM-e) are touted by some alternative-medicine practitioners as being helpful for joint pain sufferers, however there's insufficient data to prove their effectiveness.

Massage

Massage can bring warmth and relaxation to painful areas, according to the Arthritis Foundation, which recommends self- massage and professional treatments.

Weight loss

People who are overweight have a greater risk of developing osteoarthritis in the joints. Every extra pound you carry around translates to added stress on your knees, back and hips.

"Drop 10 or 15 pounds and your hips and knees will say 'thank you,' " Firestein said.

Surgery

Going under the knife for back, hip or knee pain should be a last resort and reserved "only for people who are unable to perform daily living activities or are waking in the middle of the night with pain," Firestein said.

Source: Daily Breeze

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