Hold Off Spending Money on OA Pain Control

If you have osteoarthritis (OA), you may be able to manage your pain without costly, potent prescription drugs. The American College of Rheumatology says people should first try:

  • Exercise to strengthen surrounding muscles
  • Bracing joints
  • Ice and heat packs for flare-ups
  • Taking over-the-counter medications such as acetaminophen every day
  • Losing weight.

“You can get a lot of pain relief with something as cheap and simple as acetaminophen,” says Deborah S. Litman, M.D., assistant clinical professor of rheumatology at Georgetown University School of Medicine and a rheumatologist in private practice in Bethesda, Md. “Many people with osteoarthritis are fine on acetaminophen if they take it on a regular basis, particularly if you combine it with exercise, weight loss if needed and local treatments.”

Many may not know cheaper choices for OA exist. A survey from the Alliance for Aging Research shows about half of American adults know they should start arthritis treatment with over-the-counter pain relievers. However, the alliance says, as many as one-third think experts recommend going immediately to more expensive drugs.

Some recent studies indicate acetaminophen relieves arthritis pain, even severe pain, as effectively as nonsteroidal anti-inflammatory (NSAIDS).

“People figure if it costs 10 times as much that it must be 10 times better for you. That is not always the case,” says Daniel Perry, executive director for the alliance. He estimates over-the-counter drugs may cost a person $200 a year, compared to $2,000 for prescriptions.

Stronger drugs may mean more side effects. Each class of drug, even over-the-counter, carries some risks, including gastrointestinal bleeding, problems fighting infections, and the development of osteoporosis, diabetes, cataracts and neurological problems. Rheumatologists generally start with as mild a treatment as possible to prevent complications.

Acetaminophen usually does not cause side effects, though taking too much, or taking it with alcohol, can cause liver problems.

However, acetaminophen may not help all kinds of pain, says John Clough, M.D., a rheumatologist at the Cleveland Clinic.

“It is probably more effective in situations where the pain is due to the mechanical effects of joint damage rather than to inflammation,” he says.

Other over-the-counter medications that work for relieving OA pain include aspirin, ibuprofen and naproxen.

See your doctor

“If an over-the-counter drug works, then it’s fine,” Clough says. “But the correct diagnosis should be made by a doctor before undertaking a chronic treatment program.”

“These drugs need to be monitored with complete blood count and serum creatinine levels every six months and an occasional set of liver function tests,” Clough says. That’s because you could have problems with kidney or liver functioning, or gastrointestinal bleeding.

“If you aren’t taking acetaminophen on a regular basis, it may take a few doses to get to a steady level in the blood. You are usually better off treating mild to moderate osteoarthritis by taking acetaminophen on a regular basis,” Clough says.

The other inexpensive ways to manage your pain is exercise and weight loss.

“You have to keep the muscle strong,” Litman says. “If pain is limiting your movement, you may not want to exercise. And many people gain weight because of that. The more weight they gain, the more weight on that joint. If you want to break the cycle, you are going to have to exercise.”

Studies show losing only about 11 pounds can reduce the risk of developing OA in a healthy knee, even if a person already has OA in the other knee.

Osteoarthritis is the most common form of arthritis, which is caused by the breakdown of cartilage. Cartilage is a flexible tissue in the joints that normally cushions the ends of bone that make up a joint and helps the joint move more easily. Damage, usually caused by wear and tear or an injury, impairs its function and leads to joint pain and stiffness.

At least 21 million Americans have OA, which often involves weight-bearing joints. Nearly everyone older than 70 has OA in at least one joint but not all develop symptoms. However, as baby boomers age, the number of Americans with the disease will rise. The disease is often diagnosed in people older than 40.

The type of exercise you do depends on the severity of the disease and your age, Litman says. If your disease is advanced, you shouldn’t do repetitive high-impact activities such as running, which may complicate the condition.

Whether your OA is advanced or not, you need to build the muscles surrounding the arthritic area. Litman sends older patients, particularly ones who are not used to exercise, to a physical therapist to help them do water workouts or use elliptical machines.

Arthritis is the leading cause of disability and limits the activity of more than 7 million people. The disease is second to heart problems as a cause of work disability.

“People think that part of getting old is that they have to buck up and get on with it. This isn’t a useful attitude,” says Daniel Perry of the Alliance for Aging Research. “We have the medicine and the nonpharmacological therapies. The knowledge is out there, and people should take advantage of it and enjoy life to its absolute fullest.”