NEWS - Pain in a Post-Vioxx World: Weighing Risks, Benefits, Unknowns

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Pain in a Post-Vioxx World: Weighling Risks, Benefits, Unknowns

Tuesday, November 23, 2004; Page HE04

Patients with osteoarthritis who took the pain medication Vioxx have

several options to discuss with their doctors.

PREVENTION AND MANAGEMENT

Exercise and weight control. Patients may not like it, and some

doctors fail to emphasize it, but exercise and weight control can

reduce, defer and in some cases even eliminate the need for other

arthritis treatments. Exercise reduces joint pain and stiffness, builds

muscle around joints and increases flexibility and endurance. The

Arthritis Foundation (800-283-7800) has a brochure and other information

on exercising with arthritis at www.arthritis.org.

PRESCRIPTION AND OVER-THE-COUNTER DRUGS

Which drugs a doctor recommends depends on the patient's risk profile.

The following is adapted from University of Michigan Medical School

professor A. Mark Fendrick's recent article in the Journal of Managed

Care; some comes from interviews with other doctors.

No cardiovascular risk, possible gastrointestinal side effects.

Doctors may recommend the COX-2 drugs Celebrex or Bextra. Other

clinicians are waiting for the February Food and Drug Administration

meeting on the safety of these drugs and may recommend a traditional

NSAID (either prescription or over-the-counter versions such as Advil

and Aleve), along with a proton pump inhibitor medication like Prilosec

to help control gastrointestinal side effects. Non-NSAID drugs such as

acetaminophen (including Tylenol and a combination drug called Ultracet)

may be considered. Those with sulfa drug allergies can't take Celebrex

or Bextra.

Elevated cardiovascular risk, possible gastrointestinal side effects.

Doctors may recommend a traditional NSAID, likely combined with a

medication to protect the stomach.

Other drugs with low gastrointestinal side effect risks such as

acetaminophen may also be considered. Doctors recommend taking the

lowest dose of acetaminophen effective at controlling pain; patients and

doctors should monitor side effects. High doses of acetaminophen can

cause liver damage.

Patients taking low-dose aspirin to prevent or treat a heart condition

have additional considerations. Taking aspirin and a COX-2 would cause

patients to lose the protective benefit the pain drug offers the

gastrointestinal tract. Those on aspirin therapy should be cautious

about ibuprofen because the combination may block the protection aspirin

offers for the heart; naproxen (Aleve) may be a better option.

No cardiovascular risk, no or low gastrointestinal side effect risk.

Doctors may recommend traditional NSAIDs, or Celebrex or Bextra.

Elevated cardiovascular risk, no or low gastrointestinal side effects

risk.

Doctors may recommend a traditional NSAID, and a low-dose daily aspirin

regimen to prevent or treat heart conditions. If gastrointestinal risk

warrants protection, a drug like Prilosec may be added. Other choices

include acetaminophen.

DIETARY SUPPLEMENTS

Research shows that glucosamine and chondroitin sulfate -- both sold

as dietary supplements, often in combination -- may offer some benefit

for osteoarthritis.

" Both are natural components of cartilage, " said Joan M. Bathon, a

professor of medicine and the director of the s Hopkins Arthritis

Center. The thinking is that taking them may help repair cartilage that

has begun to wear away. She added that the science is not solid but

suggests they may relieve pain from osteoarthritis as well as NSAIDs and

COX-2 inhibitors.

There is no clear indication that either slows disease progress, though

glucosamine may offer some benefit, Bathon said. Results of more

definitive studies are expected over the next few years.

TEMPORARY RELIEF

Topical creams are sold over-the-counter and by prescription. Examples

include corticosteroids, Bengay and capsaicin, which may provide

temporary pain relief.

Heat and ice applied to the sore area may also relieve pain

temporarily.

ACUTE, OCCASIONAL PAIN

Corticosteroid shots " can be helpful in decreasing inflammation,

irritation in the joint, particularly if there is extra fluid in the

joint, " said Borenstein, a rheumatologist at Arthritis and

Rheumatism Associates of land and the District. Relief can last for

several months.

Complications include infection, and repeated injections can boost

cataract and bone-weakening risks. In rare cases, skin whitens and thins

at the injection site.

Hyaluronic acid, given weekly in a three- or five-shot series, helps

some patients. The effect lasts several months.

http://www.washingtonpost.com/wp-dyn/articles/A5455-2004Nov22.html

I'll tell you where to go!

Mayo Clinic in Rochester

http://www.mayoclinic.org/rochester

s Hopkins Medicine

http://www.hopkinsmedicine.org