Antidepressants for Osteoarthritis Pain
Your doctor may recommend the use of antidepressant medication to help treat chronic OA pain whether or not you have depression. The exact way it helps curb pain is not known, but brain chemicals affected by antidepressant medications may play a role.
One antidepressant, duloxetine (Cymbalta), is FDA approved for the treatment of chronic musculoskeletal pain, including chronic osteoarthritis pain. Some common side effects include nausea, dry mouth, sleepiness, and constipation.
Doctors sometimes prescribe a tricyclic antidepressant such as amitriptyline (Elavil), desipramine (Norpramin), and nortriptyline (Aventyl, Pamelor) for chronic pain. These are most often taken near bedtime because of sedative effects. Other side effects include dry mouth, nausea, weight change, and constipation.
All antidepressant drugs carry a boxed warning of increased risk of suicidal thinking and behavior in children, adolescents, and young adults. All patients starting antidepressant drugs should be monitored closely for any unusual behavioral changes, suicidal thinking and behavior, or worsening of a psychiatric disorder.
Injectable Steroids for Osteoarthritis Pain
Injectable corticosteroids (also known as glucocorticoids or “steroids”) are injected directly into a joint to help ease joint inflammation and pain. The benefit of corticosteroids is that they act quickly and can be administered directly to the joints. Side effects may include allergic reaction but are mainly limited to the joint and include infection, bleeding, and skin changes. Because frequent injections to the same joint can cause damage to the joint structures, you generally should not have more than three injections in the same site per year. Injections should not be done if there is an overlying skin infection.
Hyaluronan Injections for Osteoarthritis Pain
In viscosupplementation, the doctor injects the lubricant hyaluronan into the knee joint, which lets the bones glide more smoothly at the joint.
The benefit is that this lubricant may help ease pain and increase function in some people with mild to moderate OA. It may take four to 12 weeks to feel the full effect, and pain relief can last for up to several months in some people.
The risks are potential side effects, which include joint swelling or pain, and allergic reaction. Also, hyaluronan injections cannot be used by people with skin or joint infections. Examples of hyaluronan injections include Euflexxa, Hyalgan, Orthovisc, Supartz, and Synvisc-One.
Topical Pain Relief (Creams) for Osteoarthritis Pain
Arthritis pain relief does not always come in the form of a pill or shot. For people who cannot tolerate pain medications or who do not experience enough pain relief from other treatments, topical pain relievers in the form of creams, gels, and ointments are an important option. People may also use topical treatments in addition to other medications.
Topical treatments can be obtained through prescriptions and over the counter and may include topical NSAIDs, and capsaicin, an ingredient derived from hot peppers. You might experience some skin irritation, so test the medication on a small part of your skin to make sure you’re not sensitive to any of the ingredients.
You should never apply a topical ointment to broken or irritated skin, and keep them away from your eyes and mouth. Never combine a topical ointment with any sort of heat therapy, such as a heating pad or hot towel because the combination could cause severe burns.