Medications for Osteoarthritis

Conventional treatment for osteoarthritis
Acetaminophen
NSAIDs (Non-steroidal anti-inflammatory drugs)
Topical analgesics
Narcotic analgesics
Tramadol

Conventional treatment for osteoarthritis

Conventional treatment for osteoarthritis relies almost entirely upon painkillers, both over-the-counter and prescription. Recommended medications in the treatment of osteoarthritis include acetaminophen, nonsteroidal anti-inflammatory drugs (NSAIDs), narcotic analgesics, tramadol, and corticosteroids. However, these medications are not disease modifying agents, they have only symptom modifying effect. This means that pain relievers do not cure osteoarthritis or decrease the rate of cartilage breakdown, they help to relieve the symptoms of osteoarthritis and allow to continue daily activities.

Acetaminophen

Non-narcotic analgesic acetaminophen (Tylenol) is generally safe and effective in relieving minor pain and discomfort associated with osteoarthritis. The Academy of Rheumatology has suggested this as the first line in treatment of arthritis. Acetaminophen, however, does not reduce the inflammation caused by osteoarthritis. People with liver disease should avoid acetaminophen.

NSAIDs (Non-steroidal anti-inflammatory drugs)

The most frequently prescribed medications for arthritis pain are NSAIDs. NSAIDs work by blocking the production of prostaglandins, which are hormone-like substances that contribute to pain and inflammation. Although these drugs help to reduce the pain of osteoarthritis, some are associated with toxicity and other adverse reactions due to their mechanisms of action, and they do not slow progression of joint destruction. NSAIDs have even been implicated in the worsening of osteoarthritis

Commonly prescribed NSAIDs include:

diclofenac (Voltaren, Cataflam)
etodolac (Lodine)
ibuprofen (Motrin, Advil, Nuprin)
indomethacin (Indocin)
ketoprofen (Orudis)
ketorolac (Toradol)
meclofenamate (Meclomen)
naproxen (Naprosyn, Anaprox)
piroxicam (Feldene)

Possible side effects of NSAIDs include constipation or diarrhea, dizziness, drowsiness, gas or heartburn, headache, nausea, vomiting, and insomnia. NSAIDs, in the process of blocking the inflammatory processes, also block beneficial chemical functions that protect the stomach lining and help to maintain kidney function. Thus, NSAIDs may cause potentially serious reactions, such as bleeding, peptic ulcers, kidney damage.

COX-2 inhibitors

COX-2 inhibitors work in a way similar to NSAIDs, helping to decrease inflammation, swelling, and joint pain. COX-2 inhibitors block an inflammation promoting enzyme called COX-2. This class of drugs was initially believed to work as well as traditional NSAIDs, but with fewer stomach problems. However, numerous reports of heart attacks and stroke have prompted the FDA to re-evaluate the risks and benefits of the COX-2s. Rofecoxib (Vioxx) and valdecoxib (Bextra) have been withdrawn from the U.S. market, Celecoxib (Celebrex) is still available.

Topical Analgesics
Topical analgesics include creams or rubs that are applied directly over the painful area. They can provide relief of minor arthritis pain. Because they work only on the areas of the body where they are applied, they minimize the risk of side effects associated with pills, although you can burn or irritate your skin if you do not adhere to the label instructions or if you have sensitive skin.

Some of topical analgesics are made from capsaicin, an ingredient found in cayenne peppers. Others are made from menthol, oil of wintergreen, camphor, eucalyptus oil and turpentine oil, which stimulate or irritate the nerve endings, distracting the brain's attention from the arthritis pain.

Common topical analgesics available over the counter include capsaicin (Arthricare, Zostrix), salycin (Aspercreme), methyl salicylate (Bengay, Icy Hot), and menthol (Flexall).

Narcotic Analgesics
Stronger pain medications, such as narcotic analgesics, are sometimes prescribed if over-the-counter pain relievers and NSAIDs fail to relieve osteoarthritis symptoms. Over time, a dependency to these drugs may develop. Other possible side effects of narcotic analgesics are constipation, dizziness, drowsiness, nausea and vomiting. Some medications combine a narcotic with other drugs such as acetaminophen or aspirin.

Commonly prescribed narcotic analgesics include:

Acetaminophen with codeine (Fioricet, Phenaphen with Codeine, Tylenol with Codeine)
Oxycodone (OxyContin, Roxicodone)
Hydrocodone with acetaminophen (Vicodin, Dolacet)
Propoxyphene hydrochloride (PP-Cap, Darvon)
Meperidine hydrochloride (Demerol)

Non-narcotic analgesic (Tramadol)

Tramadol hydrochloride is a synthetic drug, similar to narcotics in the way that it functions, but may have a reduced risk of dependency. Reported side effects of tramadol include agitation, anxiety, bloating and gas, constipation, convulsive movements, diarrhea, dizziness, drowsiness, dry mouth, headache, indigestion, nausea, nervousness, sweating, vomiting, weakness, confusion. In contrast to narcotic analgesics, tramadol does not induce significant respiratory depression, constipation, or have significant abuse potential.

The efficacy and safety profile of tramadol make it suitable as a long-term treatment for moderate to severe osteoarthritis pain in people for whom acetaminophen or NSAIDs are not effective or in whom treatment with NSAIDs is contraindicated.

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