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Medication and Pain Management

For people with arthritis, pain management is more complex than just taking aspirin. Arthritis is a chronic disease that can cause significant pain and discomfort. It requires a careful approach to medication, including a combined effort involving you and your doctor.

Pain management can provide day-to-day relief from one of the worst aspects of arthritis. But you also need a plan for the future—a plan that may go beyond medication. Many new surgical procedures are now available that can help restore function and reduce the pain of arthritis.

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The following section provides a general overview of medications and other approaches to pain management. It will help you gain additional insight into pain management, but remember, it is very important that you discuss this subject with your doctor to determine what specific pain management course is right for you.

There's a great deal of information—and misinformation—available about medications. One helpful source is your pharmacist. The package insert and other labeling provided by the drug manufacturer is another. No matter where you start, it's important to talk with your doctor about using, changing, or discontinuing medications.

Here are a few basic considerations about the use of pain medications:

  • Not every drug is right for every patient.
  • Most drugs have some type of side effect.
  • A combination of drugs may be appropriate for some conditions if recommended by your doctor. Make sure your doctor and your pharmacist know all the medications you are taking—including non-prescription medications and dietary supplements.

Other questions you may have about pain management:

What are analgesics (pain relievers) prescribed for?

The primary purpose of an analgesic is to relieve pain. Some patients use aspirin, an analgesic that also reduces joint inflammation. The most commonly used analgesic, acetaminophen, is relatively effective and has few side effects. Acetaminophen does not contain aspirin, however, so it doesn't relieve joint inflammation. For this reason, acetaminophen is less likely to be used with rheumatoid arthritis and other types of arthritis that cause inflammation, and more likely to be used to treat osteoarthritis and fibromyalgia.

The main side effect of analgesics is a slight risk of dependency that can occur if the drugs are used for long periods of time.

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What are NSAIDs?

Nonsteroidal anti-inflammatory drugs (NSAIDS) are the most frequently used medications for arthritis. They are often used to treat osteoarthritis, rheumatoid arthritis, gout, juvenile arthritis, and bursitis. Some are available by prescription only, while others (such as aspirin, ibuprofen, and naproxen) can be purchased over the counter.

NSAIDs help reduce redness and swelling and relieve pain. The type of NSAID that your doctor recommends for you will depend on several factors:

  • The type of arthritis you have
  • The degree of pain and inflammation
  • How your body reacts to the NSAID
  • Other medications you are taking

As with all medications, there are side effects that can occur with NSAIDs. The most common side effects include constipation and stomach irritation (ranging from indigestion and heartburn to development of stomach ulcers if symptoms are left untreated). For this reason, your doctor will monitor you carefully, and you should report any symptoms immediately.

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When would a doctor prescribe corticosteroids?

Corticosteroids are similar to the hormone, cortisol, which occurs naturally in the body. Corticosteroids reduce painful inflammation in joints, but because of potentially serious side effects, they are rarely used as a first choice for long-term treatment.

Corticosteroids are almost never used to treat osteoarthritis, and when they are prescribed for rheumatoid arthritis, it is generally to relieve severe symptoms while waiting for another drug, such as an NSAID, to reach an effective level. If they are used for a longer period of time, they are generally used in lower doses.

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Do I have to take drugs to relieve arthritis pain?

Arthritis patients have found that they may benefit from a number of pain management techniques that do not involve medication. Ask your doctor about alternatives to medication, or ideas you can try in addition to medication. The most popular are:

  • Sleep
  • Exercise
  • Stress Management
  • Massage Therapy
  • Relaxation Therapy
  • Biofeedback
  • Hot/Cold Treatment

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Is it true that sleep can be a factor in arthritis pain?

Not getting a good night's sleep is a problem for many people with arthritis. If your pain continually awakens you, you may never reach Stage 3 sleep - the deep sleep that's needed for true rest. And your fatigue can worsen your pain.

There are many sources of information about getting a better night's sleep—magazines, articles, books, web sites, etc., and you should consult with your doctor, nurse, or therapist.

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What can I do if medications don't relieve enough of my pain?

If you have worked with your doctor but pain medications don't allow you to do the things you want—to live the life you want—you may need another solution. Joint replacement may allow you to resume many of your usual activities and reduce the amount of pain medication you take. New surgical procedures use minimally invasive technology to allow smaller incisions, less pain, and faster recoveries for many people. Read more.

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