Understanding Arthritis Painkillers
Weighing the Risks and Benefits
Common Medicines for Arthritis Pain continued...
Prescription narcotic painkillers -- such as codeine, fentanyl, morphine,
and oxycodone -- are used for severe pain that is not relieved with other
medications. The drugs work on the nerve cells' pain receptors and are very
effective in controlling severe pain.
In rare cases, White prescribes a narcotic for arthritis pain relief, she
says. "If the only way to get someone up and out of bed is a mild narcotic,
then I'll do it. I do it only to help people get over a hump, and only rarely.
There are a lot of side effects."
Narcotics are particularly dangerous for elderly patients, because of the
risk of falls, White adds. "Most people don't want to take narcotics. I
don't think it's the dependency issue as much as it clouds their thinking, and
they get constipated. There are a lot of issues that people don't want to put
DMARDs (Disease-Modifying Anti-Rheumatic Drugs)
In rheumatoid arthritis, DMARDs such as methotrexate can help prevent the
serious joint damage that is caused by inflammation (they are not used to treat
osteoarthritis). Because DMARDs take weeks to really start working, steroids or
painkillers are sometimes used until they kick in.
"These drugs are revolutionizing the field of rheumatology," White
tells WebMD. "They really have something important to offer people, a
chance to not be disabled and out of work. They also offer a chance to do basic
lifestyle changes that relieve pain."
There is a downside to many DMARDs: They work by suppressing the immune
system, so there is greater susceptibility to infection while taking these
drugs. Also, there is risk for liver problems, low blood count, and a slightly
increased risk of cancer.
White says she advises her patients to weigh the benefits versus the risks.
A person with painful progressive rheumatoid arthritis could face serious
disability without treatment.
Biologics (Biological Response Modifiers)
If DMARDs like methotrexate don't help stop rheumatoid arthritis, biologics
are the next course of action, says Hadler.
Biologics are a more aggressive, targeted therapy that can actually
significantly slow progression of rheumatoid arthritis within a few weeks --
rather than just treating the symptoms. However, biologics can cause flare-ups
of other chronic diseases that are in remission, particularly infections like
tuberculosis. Biologics may also cause an increased risk of cancer.
"It's something we have to consider," says White. As always, White asks
her patients to weigh the risks and benefits given the stage and severity of
their rheumatoid arthritis.
Hadler calls biologics "impressive drugs," but usually waits a few
months before prescribing them, and is wary about prescribing them for patients
in their 20s, 30s, 40s.
"We have had the drugs for a decade, so we know about toxicities for
that time frame," Hadler tells WebMD. "But we don't know what these
drugs will do if you're taking them for longer than 10 years or for five years
and stop for awhile."