Barbara
Allan's
Arthritis Pain Medication Guide
by Barbara D. Allan
Author of Conquering Arthritis
Table of Contents
Arthritis Treatments That Didn’t
Work for Me
Why Conventional Treatments
for Arthritis Seldom Work
Good Reasons for Arthritis
Pain Medication
Four Classes of Arthritis Pain
Medications
Which Conventional Arthritis
Pain Medications Can Make Arthritis Worse?
My First Arthritis
Healing Breakthrough
About the Author
Arthritis Treatments That Didn’t
Work for Me
I used an electric scooter for years because of my arthritis.
I am now completely healed. Before I tell you what treatments
worked, I will briefly tell you what treatments didn’t
work for me and what I learned from this.
What didn’t work for me was arthritis pain medication
treatment.
I was initially treated with Non Steroidal
Anti Inflammatory
Drugs, also known by the acronym NSAIDs.
The particular ones I took included Aspirin, ibuprofen,
Voltarin, Indomethacin, Naproxen (Naprosyn, Naprelan*),
Naproxen sodium (Aleve, Anaprox) and Piroxicam (Feldene).
They all caused me severe stomach pain, some worse than
others. Because of the stomach pain I was given an anti
ulcer drug called Cytotec (misoprostol). Unfortunately,
Cytotec can cause uterine contractions. It gave me such
bad menstrual cramps that I eventually stopped taking
it.
When those medications didn’t work, I was told
the only other alternative was to put me on antidepressants.
I didn’t want to go on them but my doctor said
she would stop treating me if I didn’t. The rationalization
was that antidepressants would raise my threshold for
pain, thus allowing me to sleep better. So I first went
on one of the tricyclics, but it gave me such a bad
case of cotton mouth, that my doctor switched me over
to the rather famous serotonin reuptake inhibitor, Prozac.
Unfortunately I didn’t need Prozac and at half
the normal therapeutic dose I started having overdose
symptoms. I would feel fine one moment, and then with
no warning I would suddenly be so exhausted I could
hardly control my arms or legs. If I was standing I
would drop to the ground. If I was driving it was all
I could do not to crash the car in that moment. My doctor
dismissed these symptoms for several months. It wasn’t
until I saw the supervising psychologist that I was
told I was experiencing classic Prozac overdose symptoms.
Within a few weeks of stopping the Prozac, those problems
disappeared. Through our mutual frustration with this
process, I no longer had a workable relationship with
this doctor.
In retrospect, that was an empowering moment for me,
because my doctor really didn’t have anything
more to offer me. It was ultimately much better for
my health to seek out answers that aren’t part
of the training that MDs receive. Their answer just
weren’t working for me.
I did see another doctor a few months later when my
arthritis was so bad I could hardly function. At that
time I was given the corticosteroid prednisone. It helped
me through a hard period, but like all anti-inflammatories,
it only provided temporary relief of my symptoms. It
did nothing to correct the underlying problem.
This doctor also wanted me to try a drug whose brand
name is Plaquenil®. Its chemical name is hydroxychloroquine
and it is an anti-malarial. No one knows why it relieves
arthritis symptoms, but it does. I was reluctant to
take this medication because it can damage the eyes.
I went as far as to have reference pictures of my eyes
taken by an optometrist, so we could stop the medication
if we started seeing damage. I didn’t want to
do anything that would cause permanent damage to my
eyesight.
At the same time my doctor was also suggesting I take
methotrexate, which is a chemotherapy agent.
Luckily, I started finding non-drug alternatives to
eliminate my arthritis, and eliminated the need for
any of these drugs.
Why Conventional Treatments for
Arthritis
Seldom Work
Conventional arthritis pain medications suppress symptoms,
but they do nothing to correct the underlying causes
of arthritis.
Arthritis is caused by certain systems in the body
going out of balance. The digestive system, the elimination
system, and the immune system are the big three that
are involved.
Conventional treatments consist of pain medication
and surgery options that do nothing to bring these systems
back into balance. At best they suppress symptoms. At
worst they also disrupt the immune system or some other
system so badly that it can be hard to know which is
worse: the untreated arthritis or the treatment side
effects.
Good Reasons for Arthritis Pain
Medications
That being said, there are good reasons for using arthritis
pain medications. The first is pain relief. Anyone who
has ever been in pain knows how valuable that is. The
second is to slow or stop ongoing joint damage.
But it is still important to be clear that pain relief
and slowing damage are not the same as a cure.
Four Classes of Arthritis Pain
Medications
There are four classes of medications used to treat
arthritis: NSAIDS, analgesics, corticosteroids, and
DMARDs. I will talk about the advantages and disadvantages
of each.
1. NSAIDS
There are two kinds of NSAIDs: conventional and COX-II
inhibitors. They are the most commonly used medications
to treat arthritis pain. They reduce inflammation and
relieve pain. Some NSAIDs, like aspirin and ibuprofen,
are available over the counter.
Like many medications, however, too much of a good
thing can be bad. When taken over an extended time period,
like over weeks or months, conventional NSAIDs can cause
stomach damage.
In fact, research studies has shown that conventional
NSAIDs almost always cause acute lesions in the mucosal
lining of the stomach and upper part of the small intestine
(called the duodenum). You can even have these stomach
and intestinal lesions without knowing it. According
to one study only 50 percent of patients with these
lesions have upper abdominal discomfort(1) .
If you have been using conventional NSAIDs for a long
time, the biochemical damage, which results in increased
intestinal permeability, may take months to heal even
after you stop taking the drugs (2). In a study at Karolinska
Hospital in Stockholm, Sweden, intestinal permeability
increased in every single rheumatoid arthritis patient
treated with conventional NSAIDs (3).
“So why is that a big deal?” you may ask.
“Who cares about a little stomach damage as long
as my arthritis is under better control?”
The reason to care is that increased intestinal permeability,
also known as leaky gut syndrome, can cause also sorts
of problems, including making arthritis worse.
Let me take a moment to clarify. Leaky gut syndrome
is when a large number of food particles pass either
totally undigested or partially undigested into the
bloodstream. All people, even very healthy people, have
some undigested food that leaks into their bloodstream.
However, when high levels of food start leaking into
the bloodstream, that is when we start seeing problems
like arthritis and food sensitivities (4).
So that is the problem with conventional NSAIDS.
There are also NSAIDs called COX-II inhibitors.
You may remember when COX-II inhibitors first came to
market in 1998. They were promoted for not causing stomach
problems. Unfortunately, the COX-II inhibitor, Vioxx,
was pulled off the market in Sept of 2004. The COX-II
inhibitor, Bextra, was pulled off the market April of
2005. This is because they increase the risk of dying
from a stoke or heart attack.
The one COX-II inhibitor still on the market is Celebrex.
There is some debate over the safety of using Celebrex
long term (18 months or more). One New Zealand study
of actual patient outcomes found it no safer than Vioxx.
Examples of NSAIDs
Aspirin (Anacin, Ascriptin, Bayer, Bufferin, Ecotrin,
Excedrin)
Choline and magnesium salicylates (CMT, Tricosal,
Trilisate)
Choline salicylate (Arthropan)
Celecoxib (Celebrex)
Diclofenac potassium (Cataflam)
Diclofenac sodium (Voltren, Voltaren XR)
Diclofenac sodium with misoprostol (Arthrotec)
Diflunisal (Dolobid)
Etodolac (Lodine, Lodine XL)
Fenoprofen calcium (Nalfon)
Flurbiprofen (Ansaid)
Ibuprofen (Advil, Motrin, Motrin IB, Nuprin)
Indomethacin (Indocin, Indocin SR)
Ketoprofen (Actron, Orudis, Orudis KT, Oruvail)
Magnesium salicylate (Arthritab, Bayer Select, Doan's
Pills, Magan, Mobidin, Mobogesic)
Meclofenamate sodium (Meclomen)
Mefenamic acid (Ponstel)
Meloxicam (Mobic)
Nabumetone (Relafen)
Naproxen (Naprosyn, Naprelan*)
Naproxen sodium (Aleve, Anaprox)
Oxaprozin (Daypro)
Piroxicam (Feldene)
Rofecoxib (Vioxx)
Salsalate (Amigesic, Anaflex 750, Disalcid, Marthritic,
Mono-Gesic, Salflex, Salsitab)
Sodium salicylate (various generics)
Sulindac (Clinoril)
Tolmetin sodium (Tolectin)
Valdecoxib (Bextra)
2.
Analgesics
So what medication choices are left for someone with
arthritis? Many people turn to an analgesic. The most
popular is the old over the counter standby acetaminophen
which is know in some parts of the world as Paracetamol
and is also marketed under the brand name Tylenol.
Unlike the NSAIDS, an analgesic like acetaminophen
does nothing to reduce inflammation. All it will do
for arthritis is block the pain. It will give you short
term pain relief, but will do nothing to heal your arthritis.
In fact, acetaminophen can actually make it harder
for your body to heal joint damage. Sulfate is required
for maintaining the structure of the glycosaminioglycans
within joints. Lack of sulfate can impair joint repair.
The human body processes acetaminophen using a reaction
called sulfation. High doses of acetaminophen saturate
the sulfation pathway, effectively keeping this enzyme
system busy doing something other than repairing your
joints.
So like NSAIDS, it is useful for short term pain relief,
but problematic when used over a long period of time.
The final two classes of arthritis drugs are corticosteroids
and DMARDs.
3.
Corticosteroids
The three most common oral corticosteroids are prednisone
(brand name Orasone), prednisoline (Prelone), and methylprednisolone
(Medrol). They all have similar side effects.
Prednisone is probably the most famous of the cortiosteroidals.
Prednisone is a feel good medication, at least initially.
Often people who get a prednisone injection into a joint,
feel like a miracle has occurred. Unfortunately the
relief tends to be temporary and if you repeat the treatment
to often, it will cause osteoporosis.
It may also decrease your ability to fight infection
and may prevent you from developing symptoms if you
get an infection. It can be a nightmare to be on on-going
oral doses. It can cause swelling, weight gain, redistribution
of fat, thin fragile skin, osteoporosis, loss of contact
with reality and many other serious side effects.
Because of the problems with repeated or ongoing use,
where prednisone is most useful for arthritis is in
disrupting a period of high inflammation and pain.
4. DMARDs
DMARDs stands for disease modifying anti rheumatic drugs.
DMARDs used to not be used for arthritis except as
a last resort. Now they are sometimes used much earlier
because when used aggressively they are effective in
slowing joint damage.
But their effectiveness at stopping joint damage comes
at a price. They are toxic. Some can cause birth defects.
Others can suppress the creation of blood cells. Others
suppress the immune system, increasing the risk of infections.
Some can damage the eye. Some can cause cancer. Some
are hard on the liver or kidneys.
Instead of restoring the body to balance, they throw
the body even further out of balance, but in a way that
can interrupt the on going damage caused by arthritis.
That can be valuable, but it should not be mistaken
for a cure.
DMARDs include methotrexate, sulfasalazine, leflunomide
(Arava™), gold salts, d-penicillamine, the Tumor
necrosis factor (TNF) inhibitors:etanercept (Enbrel™),
infliximab (Remicade™), and adalimumab (Humira™);
anakinra (Kineret™), the antimalarials, and the
cytotoxic agents: cyclosporin A, cyclophosphamide and
azathioprine.
Methotrexate
is a chemotherapy agent. It can cause myelosuppression,
although not usually at the low doses used for arthritis
patients. Myelosuppression which is a reduction in the
ability of the bone marrow to produce blood cells.
Sulfasalazine
can cause mild gastrointestinal problems. Is often used
as an alternative to methotrexate for patients with
liver disease. It mechanism of action against arthritis
is unknown.
Leflunomide (Arava™).
It mechanism of action is not fully understood. It can
cause diarrhea and birth defects.
Gold Salts.
Intramuscular gold salts were, until the 1990's, the
most often used DMARD agents. They are rarely used now
due to side effects and very slow onset of action. Their
mechanism of action is unknown.
D-Penicillamine.
d-Penicillamine is also a relatively toxic drug and
is, like injectable gold, prescribed primarily for patients
with persistent aggressive disease who have failed to
achieve remission with less toxic agents.
Tumor necrosis
factor (TNF) inhibitors.
There are currently three TNF inhibitors FDA approved
in the treatment of RA: Etanercept (Enbrel™)
, Infliximab (Remicade™) and
adalimumab (Humira™).
The long-term safety of these agents is still relatively
unknown. Side effects include increased risk for serious
and opportunistic infections.
Soluble Interleukin–1
(IL–1) Receptor Therapy.
Anakinra (Kineret™) is a human
recombinant IL–1 receptor antagonist (hu rIL-1ra)
is approved by the FDA for the treatment of RA. Anakinra
has no major side effects but it must be injected everyday,
about the same time of day.
AntiMalarials.
Antimalarials such as hydroxychloroquine (brand name
Plaquinil) and chloroquine are often effective remittive
agents for the treatment of rheumatoid arthritis, particularly
mild to moderate disease. Their mechanism of action
is unknown. Both can damage the eyes. Chloroquine is
no longer recommended because of its greater toxicity
to the eye.
Cytotoxic Agents.
The most commonly used cytotoxic drugs are azathioprine
(Imuran), cyclophosphamide (Cytoxan)
and cyclosporin A. These agents have
high potential toxicity, so are used only as a last
resort.
Azathioprine is a purine analog
that can cause severe bone marrow suppression particularly
in patients with renal insufficiency or when used
concomitantly with allopurinol or ACE inhibitors.
Cyclophosphamide is an alkylating
agent with serious toxicities including bone marrow
suppression, hemorrhagic cystitis, premature ovarian
failure, infection and secondary malignancy particularly
an increased risk of bladder cancer.
Cyclosporine is an immunosuppressive
agent approved for use in preventing renal and liver
allograft rejection. Cyclosporine inhibits T cell
function by inhibiting transcription of interleukin-2.
Its main toxicity is increased risk of infection
and renal insufficiency.
Which
Conventional Arthritis Pain Medications
Can Make Arthritis Worse?
There are four classes of medications commonly used
for arthritis: NSAIDs, analgesics, corticosteroids and
DMARDs. Two of these four classes can make arthritis
worse.
When taken over a long period of time, the stomach
damaging effects of conventional NSAIDs can make arthritis
worse. Conventional NSAIDs include over the counter
remedies like aspirin and ibuprofen and many prescription
arthritis drugs. There are about 2 dozen that prescription
arthritis drugs that fall in this category.
The pain killer acetaminophen, which is in Tylenol,
makes it harder for the body to repair joint damage.
Corticosteroids like prednisone, give temporary relief
when injected into a joint, but when used too frequently,
they cause osteoporosis. Same thing with oral doses.
If you stay on them too long or at too high a dose,
it causes osteoporosis. Although osteoporosis is different
than arthritis, when it occurs at a joint, it can cause
structural damage to that joint.
The final class DMARDs are the only class besides the
corticosteroids that don’t seem to make arthritis
worse. However, most of the medications in this class
are toxic. They will suppress arthritis, many through
unknown mechanisms, but they don’t rebuilt health.
They just disrupt joint destruction.
My
First Arthritis Healing Breakthrough
My first breakthrough came in January 1993 during my
first juice fast. Three days into my first fast I was
pain-free for the first time in the 4½ years
since I had developed arthritis. The fatigue vanished.
I could move around freely without bringing on pain
and inflammation. I could think more clearly than I
had in years. It reminded me of the verse in the Bible
where the healed were commanded to pick up their beds
and walk. Suddenly, after years of crippling illness,
I could finally pick up and walk. Fasting had done what
arthritis drugs had not. Fasting stopped the inflammation
and gave me the boost I needed to get well.
For more information on this and the other 8 breakthroughs
(including anti-inflammatory foods and spices) that
allowed me to completely heal my arthritis read my book
Conquering Arthritis.
WEBSITE SPECIAL
The
book Conquering
Arthritis
plus 3 recipes!
Enjoy the anti-inflammatory effects
of ginger and turmeric without the unfortunate side
effects associated with arthritis drugs.
Buy a copy of the book, Conquering
Arthritis, and get a free immediate download
of three recipes you can make yourself: anti-arthritis
ginger ale, anti-arthritis yogurt drink, and anti-arthritis
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About
the Author
Author Barbara Allan completely cured herself of her
arthritis. Now she helps others do the same. To find
out more, visit www.ConqueringArthritis.com.
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| Author, Barbara Allan, before
healing her arthritis |
Author, Barbara Allan, after
healing her arthritis |
Notes
(1) P. Bertschinger, G. F. Zala and M. Fried, “Effect
of Nonsteroidal Antirheumatic Agents on the Gastrointestinal
Tract: Clinical Aspects and Pathophysiology, Schweiz
Med Wochenschr. 126(37) (1996):1566-8.
(2) I. Bjarnason and T. J. Peters, “Influence
of Anti-Rheumatic Drugs on Gut Permeability and on the
Gut Associated Lymphoid Tissue,” Baillieres
Clin. Rheumatol. 10(1) (1996):165-76.
(3) Hans Oman et al., “Increased Intestinal
Permeability to Polysucrose in NSAID-Treated Patients,”
Eur J of Gastroenterol Hepatol 4(3) (1992):235-240.
(4) Charlotte Cunningham-Rundles, M.D., Ph.D., “Dietary
Antigens and Immunologic Disease in Humans,” Rheum
Dis Clin North Amer 17(2) (1991):287-307.
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