Osteoarthritis: Pain Management Beyond Steroids and Topicals

Osteoarthritis

Hello Dr.
Li: My mother is 48 years old and frequently experiences joint pain in her legs.
She has been diagnosed with osteoarthritis, and the doctor prescribed pain relievers for her.
However, she believes that pain relievers are equivalent to steroids, so she has not taken them and instead has been using topical analgesics and anti-inflammatory patches.
Recently, the news reported that long-term use of non-steroidal anti-inflammatory drugs (NSAIDs) in topical formulations can lead to side effects such as gastrointestinal bleeding and renal impairment.
I understand that arthritis cannot be cured, only managed, and I have informed my mother about the news, but she is not receptive.
I would like to ask Dr.
Li: 1.
Are all pain relievers steroids? 2.
If she does not want to rely on topical patches, are there other methods besides heat therapy? Thank you for your response.

Younger Daughter in Distress, 20~29 year old female. Ask Date: 2004/10/08

Dr. Li Wenlin reply Orthopedics

Hello, in response to your question...
The treatment for degenerative arthritis includes the following options:
1.
Pain relief and anti-inflammatory medications: Modern medications have made significant advancements.
Orthopedic doctors prescribe non-steroidal anti-inflammatory drugs (NSAIDs) rather than steroids.
There are also newer COX-2 inhibitors that are less likely to cause gastrointestinal bleeding.
Indeed, long-term use of pain medications can lead to side effects such as gastrointestinal bleeding and renal impairment, but if a patient is experiencing severe pain due to arthritis, using these medications under a physician's supervision can help mitigate these side effects.
Additionally, topical treatments such as patches, ointments, sprays, and steam can also deliver NSAIDs through the skin, providing similar effects, albeit with different dosages and routes of administration.
2.
Rehabilitation therapy: Rehabilitation is also a form of treatment, including therapies such as heat application, cold therapy, infrared therapy, shortwave therapy, and ultrasound therapy, which can alleviate joint pain.
3.
Oral glucosamine or local hyaluronic acid injections: Many people utilize these two methods.
Glucosamine is classified as a dietary supplement in some countries and as a medication in others.
Its exact pharmacological action is not well-defined, but it has shown good clinical results.
Local hyaluronic acid injections directly deliver lubricating fluid and precursors for cartilage into the knee joint.
Both methods do not carry the side effects associated with pain medications, but there are regulations under health insurance that must be followed to receive coverage.
4.
Surgery: Current orthopedic techniques are continually improving.
Minor surgeries such as arthroscopy, partial knee replacement, or minimally invasive total knee replacement can more thoroughly address knee pain issues.
I recommend that you take your mother to a nearby orthopedic specialist for evaluation.
Based on her condition (considering appearance, standing X-rays, and clinical presentation), the most appropriate recommendations can be made.
Wishing you and your mother good health,
Li Wenlin

Reply Date: 2004/10/08

More Info

Osteoarthritis (OA) is a degenerative joint disease characterized by the breakdown of cartilage, leading to pain, stiffness, and reduced mobility. It is a common condition, especially among older adults, and can significantly impact daily life. Your mother's situation, where she is experiencing frequent joint pain and is hesitant to take prescribed medications, is not uncommon. Let's address your questions and provide some insights into pain management strategies beyond steroids and topical treatments.

1. Are all pain medications steroids?
No, not all pain medications are steroids. Pain relief can be achieved through various classes of medications. Nonsteroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen and naproxen, are commonly used to manage pain and inflammation associated with osteoarthritis. These medications work by inhibiting enzymes involved in the inflammatory process. While steroids (like prednisone) are also anti-inflammatory, they are typically reserved for more severe cases due to potential side effects with long-term use. It's important to clarify to your mother that there are many options available that do not involve steroids.

2. What are alternative methods to manage pain besides topical treatments and heat?
There are several effective strategies for managing osteoarthritis pain that do not rely solely on topical treatments or heat. Here are some options:
- Physical Therapy: Engaging in a structured physical therapy program can help strengthen the muscles around the joints, improve flexibility, and reduce pain. A physical therapist can tailor exercises to your mother's specific needs and limitations.

- Exercise: Regular low-impact exercises, such as swimming, walking, or cycling, can help maintain joint function and reduce stiffness. Exercise releases endorphins, which are natural pain relievers.

- Weight Management: If your mother is overweight, losing weight can significantly reduce the stress on weight-bearing joints, such as the knees and hips, alleviating pain and improving mobility.

- Dietary Changes: Some studies suggest that certain diets, such as those rich in omega-3 fatty acids (found in fish) and antioxidants (found in fruits and vegetables), may help reduce inflammation. Supplements like glucosamine and chondroitin are also popular, although their effectiveness can vary.

- Acupuncture: This traditional Chinese medicine technique involves inserting thin needles into specific points on the body. Some studies have shown that acupuncture can help relieve osteoarthritis pain.

- Mind-Body Techniques: Practices such as yoga, tai chi, and meditation can help manage pain by promoting relaxation and reducing stress, which can exacerbate pain perception.

- Assistive Devices: Using canes, braces, or shoe inserts can help alleviate pressure on affected joints and improve mobility.

- Injections: In cases where pain is severe and other treatments are ineffective, corticosteroid injections or hyaluronic acid injections may be considered. These can provide temporary relief but should be used judiciously.

3. Education and Communication: It's crucial to have open discussions with your mother about her treatment options. Providing her with information about the risks and benefits of different pain management strategies can help her make informed decisions. Encourage her to consult with her healthcare provider about her concerns regarding medications and explore alternatives together.

4. Regular Follow-ups: Encourage your mother to maintain regular follow-ups with her healthcare provider to monitor her condition and adjust her treatment plan as needed. This can help ensure that her pain is managed effectively and that she receives appropriate care.

In conclusion, while osteoarthritis cannot be cured, there are numerous strategies available to manage pain and improve quality of life. It's essential to approach pain management holistically, considering both medical and non-medical interventions. By exploring various options and maintaining open communication with healthcare providers, your mother can find a pain management plan that works best for her.

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