The Most Effective Medications for Arthritis Pain Relief
For many people, the symptoms of arthritis can be debilitating. Whether it’s rheumatoid arthritis or osteoarthritis, pain is pain, and any form of arthritis can be excruciating. I, myself, suffer from osteoarthritis and have a lifelong battle with chronic pain.
My battle started 13 years ago. I was left with a neck injury due to a car accident, and this injury gave me not only chronic neck pain but migraines as well. For 13 years, I have searched for the one medication or herb that would cure my pain. I did find one thing that alleviated all of my pain, but unfortunately, the government won’t let me or anyone else have it.
Arthritis is a result of inflammation in the joints (for example the knees, elbows, neck etc). There are over 100 different types of arthritis, the most common being osteoarthritis, also known as degenerative joint disease. It is typically a result of the aging process and normal wear and tear on the body’s joints, but it can also be a result of an injury like a car accident.
Rheumatoid arthritis is an autoimmune disease in which the body starts to attack its own tissue. It causes deformities in the hands and feet if not diagnosed and treated in the early stages of the disease. Although not painkillers, steroids, such as prednisone, are often used to control the inflammation caused by this disease.
There are several different types of prescription medications on the market for chronic pain caused by arthritis. Most of them only mask some of the pain, however.
The efficacy of the medication depends mainly on the type of arthritis the patient has and their body chemistry.
Painkillers (primarily opiates such as Vicodin or Ultram) usually only work well when coupled with another type of medication, either an anti-inflammatory or a muscle relaxant.
To better understand how pain medication works, let’s take a look at how pain sensations are transmitted to the brain.
How Pain Signals Travel Through the Brain
How the Body Feels Pain
Pain works in mysterious ways. Actually, pain works in a couple different ways when it comes to the signals received by the brain, but I’m sure you don’t want a biochemistry 101 course, so this is the simplified version.
There are two types of pain receptors. One receptor reports injuries to the brain, and the other reports everything else. Because of these two types of receptors, pain also comes in two types (and their names are so original):
- First Pain: This pain sensation is quickly transmitted. It is a sharp pain, similar to a pinprick. It is usually a localized pain as well meaning it comes from a specific area of the body, like your finger, or lip (both of which are densely packed with these “first pain” receptors).
- Second Pain: As its name suggests, second pain typically follows first pain. It has a slower onset but is longer lasting. Typically diffusely localized, it is usually a dull, throbbing, or burning sensation and continues after the stimulus that caused the pain is removed.
Our central nervous system has the ability to modify its perception of pain. This is why when you are working out, you don’t feel the back injury you just inflicted on yourself. You feel it the next day instead. This is also the brain’s “gateway” mechanism for pain. For example, if you have chronic pain in your leg, and you smash your hand with a bust of George Washington, your brain will register the pain in your hand, but your leg won’t hurt anymore.
Now that we know a little bit about the different pain receptors, let’s look at the different types of pain medications.
As their name suggests, these medications are meant to kill pain. They work primarily by binding to the opiate receptors in the brain which decreases the efficiency of the synapses to transmit the pain signals.
Most of the opiate painkillers are considered narcotics, but there are a few that are not. Some of the most well-known narcotic painkillers (with generic names in parenthesis) are:
- Duragesic (fentanyl)
- Vicodin (Hydrocodone/Acetaminophen)
- Oxycontin (Oxycodone)
- Percocet (Oxycodone/Acetaminophen)
- Darvocet (Propoxyphene/Acetaminophen)
- Codeine (Methylmorphine)
These medications work best on moderate to severe pain. For those who suffer chronic pain, these medications may not be the answer. After continued use over a long period of time, the body tends to develop a tolerance to the opiate painkillers. This leads to the need for higher dosages to gain relief. They also have the potential for abuse.
There is an opiate that is non-narcotic and has very little abuse potential. Ultram, also known by the generic name tramadol (my hubby calls it my damn-it-all), is surprisingly effective at alleviating pain. It works quite well on dental pain as well as moderate to severe chronic pain. This is the medication I take, but it does have side effects. In my case, the side effect is anorgasmia (yes, it’s what you think it is).
Nonsteroidal anti-inflammatory drugs, or NSAIDs, are probably the most common painkillers. They include over-the-counter medications such as aspirin, ibuprofen and naproxen sodium (Aleve). These medications relieve pain by decreasing inflammation that causes the pain, and they actually work in about three different ways.
- Reducing prostaglandin synthesis
- Reduces the production of leukocyte-derived inflammatory mediators
- NSAIDs that cross the blood-brain barrier inhibit the production of prostaglandins that produce pain in the grey matter of the spinal cord
Did your eyes glaze over yet? Essentially, all of the above means that NSAID medications decrease prostaglandin synthesis, or the creation of the locally acting messenger molecules, which prevents the pain signal from reaching the brain. They also decrease the immune system’s inflammatory response to injury and infection.
Some of the most common prescription NSAID medications are:
- Voltaren (diclofenac)
- Voltaren Gel
- Celebrex (Celecoxib)
- Vioxx (rofecoxib) this drug was taken off the market due to its side effects
- Bextra (valdecoxib)
- Tylenol (Acetaminophen) usually used in combination with opiate painkillers
- Feldene (piroxicam)
The NSAIDs work well on chronic pain because of their mechanism of action (how they work). They provide long term pain relief when taken consistently by continually preventing the production of the prostaglandins.
Antidepressants have become a popular treatment for chronic pain management. Granted, most patients suffering from chronic pain are usually depressed, but this isn’t the reason they are prescribed for pain relief.
They are usually used in tandem with other pain medication such as an opiate or NSAID, and provide an overall desensitization effect. The most common drugs prescribed for this purpose are the tricyclic antidepressants such as:
- Elavil (amitriptyline)
- Norpress (nortriptyline)
- Imipramil (imipramine)
These medications are used to decrease the excitability of neurons that cause seizures which in turn decreases the excitability of the pain receptors in the brain. Some of these medications are already used to treat chronic pain caused by diabetic neuropathy. These medications are:
- Neurontin (gabapentin)
- Lyrica (pregabalin)
- Lamictal (lamotrigine)
- Tegretol (carbamazepine)
- Trileptal (oxcarbazepine)
You may have noticed I left out muscle relaxants. This is because when it comes to arthritis the muscles usually aren’t the problem (although sometimes they are as in my case). So, I’m limiting this article to the most common pain medications for arthritic sufferers.
Choosing the Right Medication for Your Arthritis and Chronic Pain
Choosing the right medication for you can be a process of trial and error. Prescribing medication is partly science and mostly an art form. Everyone’s body chemistry is different, and what works well for one person, may not work at all for someone else. While studies indicate a drug works for a certain demographic, results in a controlled study environment are far from results that would be found in clinical practice.
The most effective medications are the ones that work on your pain. If you try a medication and you feel it’s not working, tell your doctor. If you have side effects from a medication, make sure you make your doctor aware.
Sometimes a medication may help with the pain, but have side effects that you can’t tolerate. This is when it becomes an art form; you may have to give up some pain relief to get rid of the side effects. Personally, I deal with the side effects to the Ultram because the relief I get from the drug allows me to live a fairly normal life. Not everyone can say the same about their medication.
Your lifestyle also plays a role in how pain medication affects you. If you eat junk and never exercise, you can’t expect one little pill to get rid of all your pain.
For those who suffer from chronic pain, exercise can be very beneficial in alleviating some of it (although for many it’s painful to exercise).
It is imperative that you eat right, exercise, take your vitamins (vitamin C can be especially effective), and your medications as directed. Pain medications can’t help you if you don’t help yourself first.
Questions & Answers
© 2012 Melissa Flagg OSC