The Arthritis Newsletter

Summer 2013

Reducing the Pain of Arthritis: Looking at Over the Counter Drugs

By Gerry Sheanh and Sheila Kerr. Edited by Dr. Carlo Marra, PharmD, PhD

Common Arthritis Medication for Pain Relief

  • Over the counter medication for Arthritis pain reliefTylenol­™ (also called acetaminophen or paracetamol) is a pain reliever or analgesic drug. It can have side effects, especially if you take more that the recommended dosage
  • Ibuprofen (also called Motrin or Advil) is an anti-inflammatory drug that is one of the Non Steroidal Anti-inflammatory Drugs or NSAIDs. Other NSAIDs are aspirin or naproxen (Aleve). These drugs can have side effects on the stomach and heart
  • Exercise is medicine. Exercise can relieve pain and research suggests it can also reduce inflammation
  • Taking ibuprofen within two hours of low dose aspirin will completely stop the heart health benefit from the low dose aspirin.

Arthritis hurts. No matter which of a hundred faces your arthritis presents, you will endure varying levels of pain. Little wonder, then, that the medical community prescribes and the pharmaceutical companies produce medications to combat pain and the inflammation that produces pain and joint damage. Your first stop may be a pharmacy. Faced with numerous over-the-counter options, the first step in choosing what may be right for you is to know what the common brands are, what they do, and what they do not do. Talk to your pharmacist and doctor if you have hot swollen joints or numerous joints with pain, as you may have a form of arthritis that requires early aggressive treatment. The online tool Arthritis ID will give you more information. This is the link to the tool: http://arthritisiscured.org/resources/arthritis_id/ . Delaying proper medical assessment and treatment may be detrimental to your long-term health.

Tylenol­™ is a proprietary brand of acetaminophen and is known outside of Canada and the U.S. as paracetamol. In its standard form, acetaminophen is a mild analgesic (pain killer) used for headaches, minor pain and reducing fevers. It is not intended to reduce inflammation and is intended for relief of pain.  For those with osteoarthritis, a type of arthritis where inflammation plays a minor role, acetaminophen is the first line drug treatment.  Reducing pain can help you maintain an active lifestyle. If you are looking for pain relief in order to stay active, acetaminophen may be helpful.  Looking at the risks- be sure to follow the maximum dosage instructions. Overdose and long-term use may be harmful to the liver and kidneys as well as causing gastrointestinal problems.

Aspirin, or acetylsalicylic acid (ASA) is an anti-inflammation agent. Before the advent of newer medications, aspirin was widely used. Today it is used in low doses as a preventative measure for those at risk of heart issues. Looking at risks- over time, aspirin is very hard on the gastrointestinal tract. It should be noted, though, that “coated” aspirins are available that are less irritating to the gastric system than the regular variety.  Because of this, aspirin as a first choice for treating inflammation and pain has greatly diminished over the years, even though it is still an effective means of managing episodes of pain. Low dose aspirin therapy may be used for heart attack prevention, but you should not start aspirin therapy without first consulting your physician. The one thing that people with arthritis need to know is that if they take ibuprofen within two hours of the low dose aspirin, it will completely stop the benefit from the low dose aspirin.

Ibuprofen is a popular Non-Steroidal Anti-Inflammatory Drug (NSAID) that is prescribed for arthritis. Once available only by prescription, it is sold over the counter under brand names such as Advil, Motrin and generic ibuprofen. While it has the same effect as acetaminophen in reducing pain, it does so by reducing the inflammation in and around swollen, painful joints. Reduced inflammation allows greater ease of movement and greater range of motion as well as reducing pain levels sufficiently to allow exercise. Looking at risks- NSAIDs can cause stomach problems (including bleeding ulcers) kidney problems, can cause problems in those with high blood pressure and heart failure, and increase the risk of heart attacks (aspirin excepted), and strokes. Naproxen (Aleve) is another over the counter NSAID and new research suggests that it is likely easier on the heart.

Exercise is medicine; it, too, is effective in pain relief and research is finding that it also has an anti-inflammatory impact.  Exercise is prescribed for the treatment of many forms of arthritis. Exercise can relieve pain as effectively as over the counter medication in the early management of osteoarthritis. Beneficial effects include: stronger muscles to protect your joints; less fatigue; less anxiety; reduced depression; increased bone density; reduced heart disease; and reduction of some types of cancer. The importance of exercise in the management of inflammatory arthritis is critical. If inflamed joints and tissues remain immobile, the immobility becomes greater over time and, in some forms of arthritis, irreversible. Anti-inflammatory medications can reduce inflammation enough to allow exercise. Such exercises would ideally include low impact aerobic activities such as walking, cycling or swimming, which help with heart-lung health and physical endurance. Range of motion exercises such as yoga or tai-chi are enormously helpful in remaining as flexible and strong as possible, and light strength training will help retain and build muscle mass and, most importantly, strengthen the muscles that support the inflamed joints. There is also a substantial psycho-emotional lift from the knowledge that choosing to exercise regularly means that you are managing your arthritis, it isn’t managing you. To get started seek help from a health professional trained in exercise and arthritis, such as a physiotherapist or specialized kinesiologist.

Whichever prescription or over-the-counter medication you take will depend on close consultation with your pharmacist, family doctor and/or rheumatologist and only after a thorough assessment of your diagnosis, your own tolerance and your specific health concerns. Your arthritis may still hurt, but with the right information allowing you to make informed choices, it won’t hurt so much, so often, or for so long.

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