Do NSAIDS Provide Long-Term Pain Relief for Arthritis?

While millions of Americans suffer from degenerative joint disease, osteoarthritis, or simply ‘arthritis’ as most people refer to it, there’s still a limited number of treatment options available.  In fact, none of the available treatment options offer adequate results in terms of long-term pain management.  For those suffering from arthritis, this is a difficult reality.

In consultation with your treatment provider, you can discuss various options including acetaminophen (typically taken at maximum allowable doses around-the-clock of Tylenol Arthritis), NSAIDS or non-steroidal anti-inflammatory medications such as ibuprofen, topical NSAIDS (such as Voltaren Emulgel), COX-2 inhibitors (celecoxib or Celebrex is currently the only one available after others including valdecoxib (Bextra) and rofecoxib (Vioxx) were withdrawn from the market due to serious adverse cardiovascular events.

In some cases, patients are forced to take low dose narcotic pain relievers though this option is controversial.  Other options include intraarticular hyaluronic acid or corticosteroids.  Injections of either are usually only options in those that have osteoarthritis is one or a few affected joints.  Typically, injections in the knee joints are most common.

Do Topical NSAIDs Work?

Topical NSAIDs are believed to have a lower risk of systemic side effects that are typically seen with oral NSAID use.  Common preparations include Voltaren Emulgel.

In one filtered resource at the Alberta College of Family Physician website (source link [pdf warning]), they concluded that topical NSAIDS are equivalent to oral NSAIDs for treating musculoskeletal pain while having side effects similar to placebo.

However, in contrast to these conclusions, researchers from Yale University School of Medicine conducted their own systematic review of the literature with the following conclusions (Makris U et al, 2010):

“Although topical NSAID are safer than oral NSAID (fewer severe gastrointestinal AE), a substantial proportion of older adults report systemic AE with topical agents. The withdrawal rate due to AE with topical agents is comparable to that of oral NSAID. Given the safety profile and withdrawal rates described in this study, further data are needed to determine the incremental benefits of topical NSAID compared to other treatment modalities in older adults with OA.”

In terms of this apparent discrepancy, it’s important to note that the Yale researchers were specifically looking at adverse effects topical NSAID use in those with osteoarthritis in a patient population over 60 years of age.

In contrast, the ACFP tools for practice recommendations primarily relied on a Cochrane review which had a broader age criteria (over 16 vs. over 60) and simply required that participants were treated for at least six days (vs. >2 weeks).

Do non-steroidal anti-inflammatory type drugs (NSAIDS) provide long-term pain relief for those who have osteoarthritis?

For the millions of Americans who suffer from joint pain or arthritis, this is a particularly important question–especially given the potential side-effects associated with NSAIDS (risk of gastrointestinal complications such as ulcers).

From a recent study published in the European Pain Journal:

In this study which included over 14,000 patients, they concluded that NSAIDS or non-steroidal anti-inflammatory drugs offer limited pain relief in comparison to a placebo after the first month of treatment. This suggests that long-term pain management in patients with osteoarthritis of their knee will be difficult to manage with NSAIDS alone.

“Clinical effects from pharmacological interventions in OAK are small and limited to the first 2-3 weeks after start of treatment. The pain-relieving effects over placebo in OAK are smaller than the patient-reported thresholds for relevant improvement.”(Bjordal JM, et. 2007)

Bottom line: The results of this meta-analysis suggest that NSAIDS are not effective for long-term pain relief for osteoarthritis of the knee.  For more information about Natural Remedies for Arthritis, follow the link.  

References:

  1. Bjordal JM, Klovning A, Ljunggren AE, Slørdal L. Short-term efficacy of pharmacotherapeutic interventions in osteoarthritic knee pain: A meta-analysis of randomised placebo-controlled trials. Eur J Pain. 2007 Feb;11(2):125-38. Epub 2006 May 8.
  2. Makris UE, Kohler MJ, Fraenkel L. Adverse effects of topical nonsteroidal antiinflammatory drugs in older adults with osteoarthritis: a systematic
    literature review. J Rheumatol. 2010 Jun;37(6):1236-43. Epub 2010 Apr 1. Review. PubMed PMID: 20360183; PubMed Central PMCID: PMC2880214.

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