Beyond Pain Relievers


Are there other options for joint pains?

Arthritis care is often perceived to be limited to pain relievers. This is not surprising considering how often we encounter advertisements for these products. Many would immediately buy these at the first instance of joint pains.

Pain relievers (or pain killers to some) refer to a broad group of medications that include simple analgesics (i.e. paracetamol), non-steroidal anti-inflammatory drugs (NSAIDs) and opioid analgesics. However, stories abound about the dangerous side effects associated with the use of these medications. But with more than 100 types of arthritis (and an additional 100 forms of soft tissue rheumatism) possibly causing joint pains, it is important to consider other treatment options available when one experiences joint pains.

Yes, there are definitely other treatment options. And the options depend on which condition one has.

Urate lowering therapy

Gout is a common arthritic condition associated with elevated levels of uric acid in the body that causes intermittent joint pain and swelling. While pain relievers are effective in managing attacks of gout, real treatment consists of lowering uric acid in the body through the use of urate lowering therapies (ULT).

Available in the Philippines are allopurinol, febuxostat and some medications used in treating other diseases such as hypertension (e.g. losartan) and elevated cholesterol (e.g. fenofibrate).

When properly used, ULT may lead to fewer, or even completely eliminate, attacks of gout. Thus, leading to less use of pain relievers. They may also reverse some of the complications such as soft tissue deposits (called tophi) and kidney stones caused by excess uric acid in the body.

The key in achieving the best outcomes when treating gout is knowing which medications to start, when to start them and how to adjust the medication dose to achieve target uric acid levels in the blood.

It must be emphasized, though, that uric acid levels in the body are lowered only while taking ULT and this may mean maintaining these meds for life.

Rheumatoid arthritis and spondyloarthritis are chronic conditions that, if not treated properly, may lead to joint deformities and disability.

Spondyloarthritis includes various arthritis types such as those associated with psoriasis (psoriatic arthritis), genitourinary or gastrointestinal infections (reactive arthritis), those beginning in childhood that may persist to adulthood (juvenile idiopathic arthritis), and those predominantly affecting the spine (ankylosing spondylitis).

These arthritic conditions are known to cause joint pain, swelling, and stiffness of the joints following inactivity. They may also affect other organs in the body such as the eyes, lungs, liver and the intestines.

Disease modifying anti-rheumatic drugs

Pain relievers may help reduce joint symptoms but the mainstays of treatment consist of giving disease modifying antirheumatic drugs (DMARDs). DMARDs help reduce inflammation in the body which is a common process in these arthritis types.

More than that, they can delay and slow down joint damage caused by the inflammation. And when DMARDs halt the inflammation and limit the joint damage, the result is less joint pains which may reduce the need for pain relievers.

There are three types of DMARDs – the older (and less expensive) conventional DMARDs and the newer (but more effective) targeted DMARDs and biologic DMARDs. They may come in the form of tablets, injections (similar to how insulin is given) or medication for intravenous use.

Some brands are available in the country but require a doctor’s prescription for purchase. And similar to how ULT is used in gout, DMARDs have to be taken for extended periods to maximize its benefits.

Osteoarthritis is probably the most common cause of arthritis in individuals >45 years of age. Previously, it was believed that osteoarthritis results from overuse or degeneration of the joints. But nowadays, studies show that osteoarthritis results from failure of joint protectors such as the subchondral bone and cartilage caused by factors including overweight, previous joint trauma and even genetics.

Hyaluronic acid, steroids

Pain relievers help reduce symptoms but hyaluronic acid may provide an option for sustained pain relief. Furthermore, hyaluronate may slow down the thinning of cartilage and delay the need for joint replacement surgery.

The product, however, has not been shown to reverse osteoarthritis.

Beyond Pain Relievers 2

Similar to hyaluronate, steroids may also be given to lessen the pain and swelling of a single joint. Both hyaluronic acid and steroids need to be administered into the affected osteoarthritic joint. The procedure for this (called joint injection) may be performed at the doctor’s clinic or in a minor operating room.

Not all options for arthritis entail the use of medications.

Activity modification

Since the problem with osteoarthritis is the failure of joint protectors, treatment also includes maneuvers to aid these protectors as they function. These include activity modification, muscle strengthening exercises to reduce the work of the joint and weight loss and the use of canes and walkers to reduce the pressure on the joints.

Weight loss

Weight loss cannot be overemphasized in the management of osteoarthritis – losing >5 percent of one’s body weight may significantly reduce the pain and the need for pain relievers alone.

Carpal tunnel syndrome, de Quervain’s tenosynovitis and flexor tenosynovitis are forms of soft tissue rheumatism that may coexist with the above arthritic conditions. They may be caused by repeated use of the affected joints (hence, they are referred to as repetitive stress injuries) or as a consequence of endocrine problems such as diabetes and thyroid disorders.

Pain relievers (both taken orally or applied through the skin) are used to treat the pain, swelling and inflammation of the affected structures. But for those hesitating pain relievers, a steroid injection into the affected area have the same benefit. Likewise, splints may also be used to limit use of the joint and hasten its recovery.

Treatment, other than pain relievers, is available for many causes of joint pains. The more important first step in determining which of the above treatments suits you is consulting the proper doctor to correctly diagnose what condition you have.

Your visit to the doctor may include reviewing factors that lead to the condition and discussing the risk and benefits of available treatment options before finally settling on treatment that is best given one’s unique situation.

Furthermore, for many of these diseases, regular follow up is needed in order to maximize benefits of treatment while continuously monitoring for any adverse side effects.

Indeed, the treatment for joint pains is not limited to pain relievers alone. And partnering with the proper health care professional may be your best option for achieving your goals.

“Weight loss cannot be overemphasized in the management of osteoarthritis – losing >5 percent of one’s body weight may significantly reduce the pain and the need for pain relievers alone”

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