Osteoarthritis Pain Medications: Part 2

This is the second part of my survey of your osteoarthritis medication options.

Read part 1 here.

Part 2 focuses more on potent medications.  Always check with your rheumatologist before beginning any medication regimen.

Tramadol

This is a medium potency analgesic with low risk of dependency.

It has no effect on inflammation.

Nausea is a possible side effect, which can be minimized by starting at low doses, and sedation may occur in some patients.

The use of higher than recommended doses can increase risk of seizures.

On the plus side, combining it with acetaminophen can improve pain relief.

Narcotics

Narcotic agents are the most potent pain medications available. These work in the brain in the same manner as morphine, and they do pose a risk of dependency.

Sedation and constipation are possible, especially at higher doses.

These medications have been abused and obtained due to their significant abuse potential.  Physicians prescribe narcotics only to selected patients that use them exactly as prescribed and maintain regular follow-up.

Nerve blocking agents

Medications originally developed to treat seizure disorders have been shown to dampen sensitivity of nerves and ease pain levels in people with chronic arthritis pain.  Gabapentin (Neurontin^®) and pregabalin (Lyrica^®) are two options that can be used alone or in conjunction with other medications.

They can be sedating, and for some patients a bedtime dose will improve sleep disorders or restless leg symptoms, but make sure to ask what your limitations will be.

Response to these medications varies between patients, so initially small doses are used with gradual increase to obtain the best effect.  At high doses, these options have a risk of excessive sedation or loss of mental clarity.

Muscle relaxers

Muscle spasm and muscle pain are common in patients with arthritis.  Bedtime dosing of muscle relaxers such as cyclobenzaprine or tizanidine can lower pain levels and also improve sleep quality.  Due to possible sedation, daytime dosing is less useful for most patients.

Serotonin medications

Medications used for the treatment of anxiety and depression can also help arthritis discomfort, including chronic pain due to osteoarthritis.  In chronic pain, brain serotonin levels are reduced–similar to people with depression symptoms.

Duloxetine (Cymbalta^®) received FDA approval for both Fibromyalgia and chronic musculoskeletal pain.  Your response to specific agents will vary, so a trial of more than one option is advised even if one of these is not helpful.

Sleep medications

If you have osteoarthritis, you know that your arthritis pain can disrupt sleep, leading to fatigue and greater pain sensitivity.  Medications that improve sleep quality- nerve blocking agents, muscle relaxers, serotonin medications (above)- often improve both your pain and energy levels.

Joint injections

Cortisone is an anti-inflammatory medication that is injected directly into painful joints to provide temporary relief of pain.  Knees and shoulders are most commonly injected, but other  joints can be injected by an experienced physician.  Pain relief can vary from several days to several months following injection.

Most people tolerate cortisone fairly well, but it may cause temporary flushing and can cause increased blood sugar in diabetic patients.

Viscosupplements are newer medications that are approved only for osteoarthritis of the knee.  They are all forms of Hyaluran, a protein found in normal, healthy joint fluid.  Compared to cortisone, pain reduction can last longer- up to 6 months.  However, as with other medications, there is no evidence that Hyaluran injections result in repair of damaged cartilage.