Sunday, April 7, 2019

Taking Over the Counter Pain Relievers for Arthritis

Osteoarthritis is the most common cause of joint pain in the US, affecting over 30 Million adults. The first line of medication treatment recommended by physicians for osteoarthritis is either acetaminophen (Tylenol) or a Non-Steroidal Anti-Inflammatory (NSAID).  70% of people 65 and older take Over-the-Counter (OTC) pain relievers at least once a week.  Studies show that after 2 weeks of regular use, they effectively reduce pain by 50% and increase mobility by 60%.  They are inexpensive, relatively safe, and widely available. 


You can purchase 3 types of NSAIDS at the drug store:  ibuprofen (Motrin), naproxen (Aleve)  and aspirin (Bayer/Bufferin).   They are very effective to reduce pain, inflammation, and even fever.  They do not cause the side effects of prescription pain relievers such as addiction, dizziness, sleepiness, or constipation.  Because the over the counter doses are lower than prescription, they have less risk of stomach bleeds or cardiovascular events such as heart attacks or strokes.  Tylenol is another product sold for pain relief at the drug store, but it is not an NSAID and while it reduces pain and fever, it does not reduce inflammation.  All the medications work within 30-60 minutes. 

These medications are recommended for short term (10 days to 2 weeks) use.  They have been researched to provide their strongest pain relief in the first 2 weeks of regular use, becoming less effective after 20 weeks.  For some, Advil is more effective than Aleve and vice versa.  The only way to know what will work best for you is to try, so buy the smallest amount possible to start.  Generic is fine as long as the product is made in the US. 

Always start with the lowest dose, as you can add a second pill within an hour if no effect.  Make sure you follow the dosage recommendations.  Aspirin and Tylenol have the maximum dose listed in directions on the bottle;  ibuprofen and naproxen labels recommend over-the-counter doses that are half of the prescription version of these drugs.  It is never a bad idea to take the medications with food or milk; an empty stomach can get irritated as NSAIDS reduce the protective lining.  Taking the medication with an OTC acid reducer like Zantac, Pepcid or Prilosec will reduce the irritation to the stomach. If your symptoms persist, speak with your doctor who will likely prescribe another type of pain reliever. 
 
If you also are suffering from headaches, cold or flu symptoms, read the labels of combination products as they often contain pain relievers.  Most contain acetaminophen (Tylenol) which can be taken with NSAIDS.  Your daily acetaminophen dose should not exceed  2000 miligrams. Taking aspirin or salicylate products with ibuprofen or naproxen is not advised. 

Finally, if you are having trouble swallowing pills, you can try children’s liquid doses or a topical product such as aspercreme which has a form of aspirin in it.  There are NSAID containing prescription gels and patches which provide the least overall side effect risks.  If you notice leg are swelling, headaches, stop the NSAID, check your blood pressure if you can, and call your doctor. Some people develop life threatening allergic reactions to NSAIDS, so look out for swelling of the mouth or face, itching, rashes, or trouble breathing in which case you must call ambulance immediately and ask if anyone around you has an Epipen for immediate use. 

For most, OTC NSAIDS are wonderful, allowing the maintenance of an active fitness life which prevents other health problems such as heart disease or diabetes.  Taking 1 OTC dose once a day on active days is common and acceptable.  Just make sure you let your doctor know about these and any OTC products you are taking.