Arthritis Pain Relievers

Navigate your way to joint-pain relief.

Written by Suzy Cohen, R. Ph.

Q: I live with chronic pain in my knees, hands, shoulders and hips, and it’s keeping me from activities that I love, such as gardening. I really feel like I’m missing out. What do you suggest?

A: Joint pain can sneak up on you, with just a minor ache in your finger, for example. Before you know it, the pain has crept into your knees, your back and your neck. The term for this condition is arthritis, which literally means “joint inflammation.” Arthritis doesn’t evoke the same fear as heart disease, yet it is the nation’s leading cause of disability, resulting in about 750,000 hospitalizations and 36 million outpatient visits every year. You may feel like you’re stuck in a body riddled with pain, but you’re wrong. With a little more information, you can become proactive and start enjoying your life again.
 
Think Heat and Humidity
Before you start taking medications or supplements, think about the weather. Cold air increases stiffness in your swollen joints. Think hot and humid. If you can’t move to St. Maarten, then take a nice hot bath. That’s right, a good soak can ease the pain in your achy joints in minutes. Add 1 cup of Epsom salts to your bath. These salts work by imparting magnesium to the bath water. Magnesium goes into your body through your skin and relieves pain, loosens up tight muscles and boosts mood. Kick it up a notch and add a few drops of oil of wintergreen. Light a candle and breathe deeply. This may be the only quiet time you get all day! When you get out, you will feel more flexible and relaxed. You can also get a quick fix-me-up by buying yourself a moist heating pad or one of those new heat wraps that you can apply and wear for eight to 12 hours. This provides instant relief to one area.

Creams, Gels and Lotions
You’ll find dozens of topical products at your local pharmacy, and you will find that each brand works a little bit differently.

• Counterirritants temporarily distract you from the pain by causing your skin to feel hot or cold. They contain ingredients such as menthol, eucalyptus oil or oil of wintergreen.
• Aspirin rubs contain salicylates, the same ingredient in aspirin. These help with the pain and swelling, but if you take blood thinners, aspirin rubs aren’t safe for you.
• Try hot pepper cream. Don’t worry, I’m not advocating a swig of Tabasco, but the ingredient that puts the “hot” in hot pepper sauce does, in fact, relieve joint pain. Products that contain capsaicin (pronounced cap-SAY-sin) work by numbing your nerve endings so you don’t feel the pain. This works great for arthritis in your fingers, elbows or knees. Repeated applications give you even more relief as long as you massage the cream into your joints very well. If you are applying it to your hands, leave it on for 30 minutes (wear gloves), and be careful not to touch your eyes. Then wash with soap and water at least twice to remove all residues. Normal sensations include burning or stinging, but it goes away with continued use.

Capsaicin products numb nerve endings, which works great for arthritis in your fingers, elbows or knees.

Suzy’s Secret From Behind the Counter: Get into those medicine bottles. If those child-resistant caps on your medicine bottles are giving you grief, ask your pharmacist for easy-open caps that just pop off. I assure you, it’s quick and simple to remedy. There are laws designed to protect children and minimize household poisonings, which is why child-resistant caps are used in the first place. If you sign a little waiver at your pharmacy, we’ll put a note in the computer to remind us to use easy-open caps every time you refill your prescription.

 

Pills that Provide Powerful Relief
Your doctor may prescribe an anti-inflammatory drug. One of the most popular meds today is Celebrex, which reduces inflammatory chemicals that cause pain. Celebrex is very popular, but its infamous sister drug Vioxx was recalled in 2004. The FDA insists that Celebrex should remain on the market. It is widely prescribed and works within several days. Cousins of Celebrex include a different class of medications called the nonsteroidal anti-inflammatory drugs (NSAIDs).  Some popular NSAIDs include Voltaren, Mobic, Motrin and Naprosyn; these pose less risk to the heart, but more GI upset. Your doctor can figure out which is best for you.

Pineapple Puts More Pep in Your Step. Bromelain is a powerful enzyme in pineapple that reduces inflammation in your body without any side effects. Eating just a cup of fresh pineapple quells production of inflammation-causing chemicals, or you can buy it as a supplement. If you do, take 500 to 750 mg three times a day on an empty stomach.

 

If you have moderate pain, your doctor may prescribe a painkiller like Ultram (tramadol). This drug relieves pain and improves mood by increasing a happy brain chemical called serotonin.  Side effects include drowsiness, diz-ziness, headache, stomach upset and possible addiction. Using this medication while taking antidepressants (either prescribed or natural) may pose a problem.

If you are in severe pain, your doctor may bring out the big guns and prescribe a narcotic painkiller such as Darvocet (contains propoxy­phene/acetaminophen) or Vicodin/Lortab (contains hydro­codone and acetaminophen). These medications are addictive, so stick to the lowest effective dose and use it only when you really need to. While taking these medications, you should avoid driving or operating machinery.

Sometimes What You Eat Can Hurt You. Foods such as tomatoes, eggplants, peppers, cherries, pimentos, tomatillos and potatoes may cause a flare-up in pain. Spices such as paprika and cayenne pepper can be offenders, too. These all belong to the nightshade family. If you’ve noticed pain after eating any of these foods, avoid them. Hopefully, you’ll soon see signs of improvement.

Options in OTC Meds
Some of you would rather try an over-the-counter (OTC) pain reliever before going to your doctor. Tylenol or store brand aceta­minophen should be your first choice for treating minor joint pain because they do not typically cause stomach discomfort, nor do they produce edema or swelling in the hands and feet. It’s OK to combine this with natural remedies. Because acetaminophen is a common ingredient in cough/cold products and sleep meds, it’s easy to get too much (more than 4,000 mg in one day). Take 500 to 1,000 mg two or three times a day. Prescription Motrin is sold in a lower dosage OTC under the brand names Advil and Motrin IB, along with a store-brand generic version called Ibuprofen. Prescription Naprosyn is also sold OTC as Aleve and generic naproxen. Store brand generics are great because they save you money. 

NSAIDs in general have to be avoided in people with heartburn, GERD or ulcers. They may upset the stomach, causing nausea, diarrhea or constipation. NSAIDs also increase edema, so I cannot recommend these to people with high blood pressure or heart disease. Finally, NSAIDs (including aspirin) can thin the blood, so they should be avoided by people who take blood-thinning medications, such as Coumadin (warfarin), Plavix and the herbs ginkgo and ginger. Stick to lower dosages, such as 500 to 1,000 mg two or three times a day with meals. Avoid these meds if you have liver disease, or a history of alcoholism or pancreatic problems.

Build Up Your Cushy Zone One of the reasons you have so much pain is the grinding between your joints. There is little or no cartilage left, so instead of a cushy zone between your joints, they grind against one another. Glucosamine can help. This substance comes from crushed shells of crabs, lobster, crawfish and shrimp. We also make it in our bodies, but we make  less with age. Taking glucosa­mine as a supplement gives you a boost to build up the cartilage—your cushy zone. The famous GAIT study found that glucosamine (with chondroitin) relieved joint pain better than Celebrex. Plus, glucosamine won’t make pinholes in your gut the way NSAID drugs can. Take 500 to 1,000 mg of glucosamine twice a day with meals.