Arthritis Pain Relief Update (cont.)
Do you think, given the possible cardiac side effects of Cox-2 drugs, that other medications should be tried first?
We believe one of the opportunities this debate creates is to encourage people to really look at all options for the treatment of their arthritis, that pain medications really only represent one approach to arthritis treatment. In particular, for people with osteoarthritis, which is
the most common arthritis in the world, we believe not enough attention is paid
to diet. The impact that being overweight has on this disease is a risk factor
and is also a factor for the progression of the disease. We also believe not
enough attention is paid to exercise and fitness.
Now, as for medications -- the recommendations of the American College of Rheumatology suggest for most people that they begin with a pure pain reliever, like acetaminophen or Tylenol, to see what effect that has on the control of pain before they actually try an NSAID.
Do you think patients dismiss acetaminophen and other over-the-counter medications because they are available over the counter?
For many people there is a mystique about a prescription drug being more effective than an over-the-counter drug. It's important to recognize that many over-the-counter drugs were at one point prescription medications. So there are three aspects here. One, they are generally more affordable than prescription drugs; second, there's a long history of use of these medications. That means by the time they become over-the-counter drugs they are known to be effective and known to be safe Third, there is little question that over-the-counter drugs as well as prescription drugs play an important role particularly in pain management of arthritis.
But at the same time, some people over use over-the-counter drugs and don't follow the directions because they discount their effectiveness.
This in fact relates to the question about the effective dose and side effects and certainly the very same principle applies to over-the-counter medications. When used in higher dosages, there is a greater potential for side effects, so it becomes very important that people follow the directions carefully.
There's actually a second caution with regards to acetaminophen or Tylenol, in that acetaminophen is often used in other over-the-counter preparations. For example, it's a common ingredient in medications for headaches and colds. People need to be very careful to check all their over-the-counter medications to make sure they're not taking more than their recommended dose that's being used for their arthritis. In other words, the problem here is they may be taking acetaminophen for their arthritis but, unknowingly, they are taking acetaminophen for their headaches and cramps. That can lead to overmedication of acetaminophen. There has to be a particular caution about this particular drug.
You can always ask your pharmacist about your over-the-counter medications as well as your prescription medications.
|"One needs to be particularly cautious about combining NSAIDs, including aspirin, and remind people to make sure their doctors are aware of all medications, including over-the-counter meds that are being taken."|
Do NSAIDs lose their effectiveness over long-term use to control pain?
That's an excellent question. Studies that have traditionally been done with NSAIDs actually ask the question how well they control pain over a short interval, typically between seven and 30 days. There have been very few, if any, studies that have actually asked the question how effective are they when used chronically, and we would certainly encourage studies to address that question. People with arthritis use these drugs for months or years, and we do not have good information from studies that address if they continue to have an important effect on pain, and is that lost over time.
I have heard that taking Tylenol over a long period of time for pain relief can cause problems with your liver and kidneys. I have been taking Tylenol 3 for five years. Is there any truth to this concern and are their any alternatives that will not place my health at risk?
There are two considerations with Tylenol. One is the use of Tylenol in excess dosage, and the second is that alcohol use, particularly overuse, can also lead to side effects from Tylenol. However, people who use the standard recommended dose of this drug and who use social or conservative amounts of alcohol can be assured this is a safe medication with minimal risks of side effects.
I really feel that Celebrex greatly helps the quality of my life. However, I also take a low-dose aspirin regimen. I have been experiencing excessive bleeding when I had a minor cut or oral surgery. I take the aspirin regimen to inhibit the possibility of cardiac problems. Do you have any suggestions to resolve the bleeding problems? And does the aspirin regimen really help prevent cardiac problems with Cox-2 inhibitors?