More and more of us are trying to maintain our active lifestyles as we enter “middle age” and beyond. As we do so, we have to learn how to take care of our aching joints. Most joint pain remedies work to control the symptoms of arthritis, but don’t really do anything to restore the joints themselves. However, weight control is essential for maintenance of damaged joints, especially in the knees, so maintaining the ability to exercise regularly is important.

Many orthopedic conditions can cause pain of varying degrees, and when you need medication to relieve the pain, it’s good to know all the options. There are a vast array of non-narcotic and non-opioid medications that are available to help provide relief from those painful joints and muscles.

Acetaminophen is commonly used to treat pain. This medication relieves mild pain and reduces fever, but does not reduce inflammation. However, in cases of chronic pain, no inflammation is present at the site of the pain, so acetaminophen can be a suitable treatment choice. Acetaminophen is safe when used appropriately, but can be dangerous when used excessively. Patients should be aware that acetaminophen is mixed in with many prescription painkillers so using plain acetaminophen at the same time will increase your risk of overdose.

The non-steroidal anti-inflammatory drugs (NSAIDs) are most useful in cases of acute pain, or for flare-ups in patients with chronic pain. NSAIDs are excellent for treating inflammatory conditions including tendonitis, bursitis and arthritis. In fact, almost anything that ends in “itis.”  NSAIDs are available in over the counter and prescription dosages. In general, NSAID use is limited for patients with chronic pain because of concerns about the development to side effects. Long term and/or regular use of NSAIDs should be avoided, if possible. Both NSAIDs and acetaminophen in high doses, or taken for a long time, can cause serious side effects. If you are taking pain relievers on most days, tell your doctor. You may need to be watched for side effects. Your doctor may want to check certain blood tests.

As with NSAIDs, corticosteroids are powerful anti-inflammatory medications and best used for acute pain or for flare-ups of a chronic inflammatory problem. Corticosteroids can either be taken orally or injected into the soft tissues or joints.

Narcotics should be considered if pain couldn’t be otherwise controlled. Although these medications can be dangerous and habit forming, they can also be extremely effective. Narcotics can become addictive when they are used for lengthy times without gradual reduction in the dose, or if the medications are taken for reasons other than pain.

Topical pain relievers are also available without a doctor’s prescription. These products include creams, lotions or sprays that are applied to the skin in order to relieve pain from sore muscles and arthritis. Corticosteroids, NSAIDs and local anesthetics are all available in topical preparations. When used in the setting of chronic pain, local anesthetics are often applied as a patch to the area of pain. Several anti-inflammatories are also available as topical creams and patches.

Analgesics should be used strictly as directed, read and follow the instructions on the label exactly. Taking more than the recommended will not increase the positive effects, and may cause unpleasant side effects such as vomiting, diarrhea or dizziness and even bleeding or organ damage. Analgesics should only be used when in date (the expiration date can be found on the packet).

If the pain persists, visit your doctor.

Chronic pain is a problem that is seldom resolved quickly, or with one treatment. The best way to treat chronic pain is by working with your doctor and trying to attack the pain with different types of treatments. Other treatments effective for chronic pain include acupuncture, ice and heat application, massage and other alternative treatments.

Steroid Shots for Arthritis

Corticosteroids injected (steroid shot) right into the joint can also be used to help with swelling and pain. However, relief lasts only for a short time. More than two or three injections a year may indicate that the injections aren’t really working.  Steroid injections are sort of like a car wash. Eventually, your car gets dirty again. The car wash doesn’t “wear off.” If your car is constantly getting dirty after a short time, you may need to change your driving habits. If your knee pain quickly returns after only temporary relief, life style changes may be in order. These injections can be performed at your health care provider’s office or with the guidance of ultrasound or X-rays.

When the pain seems to go away after these injections, it may be tempting to go back to activities that may have caused your pain. When you receive these injections, ask your doctor or physical therapist to give you exercises and stretching that will decrease the chance of your pain returning.

Other Injections for Knee Arthritis

Hyaluronic acid is a substance already in the fluid of your knee. It helps protect the joint. When you have arthritis, the hyaluronic acid becomes thinner.

Your doctor can inject a form of hyaluronic acid into your joint to help protect it. This is sometimes called artificial joint fluid, or viscosupplementation. These injections cannot help everyone, but if they do help, the relief may last 3-6 months. Hyaluronic acid is used mostly for knee arthritis.

Other popular joint injections include platelets and stem cells. While these appear promising, there are few conclusive studies documenting their effectiveness. Many exaggerated claims appear as advertisements for stem cell injections in particular. There also seems to be an increasing number of complications, such as infections reported after these injections. Care should be taken in choosing a provider for them. A qualified health care provider in a safe environment should only do them.

Supplements

A mounting body of research is showing that certain widely available supplements, such as fish oil and glucosamine, may have a beneficial effect in relieving pain and facilitating range of motion in patients who have osteoarthritis of the knee.

Before buying supplements for your osteoarthritis, you need to understand that the FDA does not regulate dietary supplements. Despite label and marketing claims, supplements do not undergo the rigorous manufacturing and regulatory processes that help to guarantee the potency, consistency and composition of prescription drugs. Supplements are prone to wide fluctuations in batch-to-batch (or even pill-to-pill) consistency. This lack of regulation has stymied attempts to flesh out the benefits – or lack thereof – attributed to nutritional supplements and has also contributed to the inconclusive results of many clinical trials.

That said, the naturally occurring chemicals in certain dietary supplements might have an effect on the body’s inflammatory mechanisms. Inflammation is the body’s natural way of protecting itself. Inflammation helps to fight infections, increase blood flow to areas that need healing and generate pain signals. However, these same inflammatory chemicals can also contribute to osteoarthritis. A collection of some widely available supplements that may benefit people with osteoarthritis follows. Always check first with your doctor or pharmacist before starting any supplement. There may be unintended side effects if you’re already taking other medications.

Curcumin (in turmeric) and resveratrol (in grapes, wine, berries, peanuts and chocolate) are two nutritional supplements that have a variety of anti-inflammatory actions. Turmeric, and thus curcumin, has been used in traditional Hindu medicine for at least a thousand years for various ailments, including joint disorders and arthritis. However, it has been only in the past 20-30 years that resveratrol has been studied in laboratories and humans for its effects on inflammation and arthritis, which have been promising but not conclusive.

Omega-3 fatty acids also show a spectrum of anti-inflammatory activities that appear to account for much of their cardioprotective effects. A few studies have shown that rheumatoid subjects who consumed large doses of DHA and EPA omega-3 fatty acids (upwards of 2-4 grams daily in some studies) were able to cut back on their nonsteroidal anti-inflammatory use. The American diet is often high in omega-6 fatty acids, considered pro-inflammatory and weak in anti-inflammatory omega-3 fatty acids. In addition to increasing consumption of cold-water and fatty fish (tuna, sardines, salmon, etc.), people with osteoarthritis might also benefit from choosing canola and olive oils over corn and coconut oils (and foods processed with them), and including foods such as walnuts and foods rich in anti-inflammatory ALA (a major plant source of omega-3s), such as soybeans, flaxseed, pumpkin seeds and tofu.

Glucosamine is another supplement that has shown inconsistent results in human trials of people with osteoarthritis, despite its high ranking in dietary supplement sales. Glucosamine is often combined with chondroitin sulfate in popular supplements. They are necessary for health and maintenance of cartilage as well as other joint structures, such as the synovial lining and supportive ligaments. Taken as a dietary supplement, glucosamine has anti-inflammatory properties as well as effects on the integrity of joint cartilage.

These supplements may help control pain. However, they do not seem to help your joint grow new cartilage or keep your arthritis from getting worse. Some doctors recommend a trial period of 3 months to see whether glucosamine and chondroitin help.

All of these are useful for controlling joint and muscle pain and helping to maintain an active lifestyle. However, several things should be kept in mind. Pain is your body’s signal that there might be a problem. Covering up the pain will make the problem worse. If you have to continue the medication consistently, you should consult a sports medicine specialist for evaluation. Also, even over the counter medications and even “natural” products can have side effects or interact with other medications you are taking, so medical advice is a good idea. Finally, different things work best for different people; it’s always best to start with a sport medicine specialist who can help figure out what’s best for you rather than a clinic that only provides on type of treatment and hopes that “one size fits all.”

By Dr. Michael L. Gross

Dr. Michael Gross, the founder and director of Active Orthopedic and Sports Medicine, is the section chief of sports medicine and the orthopedic director of the Center for Sports Medicine at Hackensack University Medical Center, as well as medical director of Active Center for Health and Wellness.

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