Many treatment options exist for joint pain. The options include non-prescription medication, prescription medication, activity modification, and surgery.

Non-Prescription Arthritis Medication

Acetaminophen

You or your loved one’s healthcare professional may suggest over the counter medications such as acetaminophen for mild to moderate joint pain.

Analgesics help relieve arthritis pain. They have no effect on inflammation. For chronic arthritis pain, the American College of Rheumatology recommends acetaminophen, the active ingredient in Tylenol®, as the first-line drug for arthritis. When arthritis pain is not accompanied by much inflammation, as is often the case with osteoarthritis, analgesics like Tylenol are a good choice because they carry fewer risks of side effects such as stomach problems. Tylenol is also less likely than many other arthritis remedies to cause drug interactions with other medicines you are taking.

Often analgesics are used in addition to other classes of arthritis medicines when additional pain relief is needed. Acetaminophen often is the active ingredient in products labeled "aspirin-free pain reliever." Over-the-counter analgesics also may contain ingredients, such as caffeine to speed pain relief, or antihistamines to promote sleep. It is important to be aware of these additional ingredients when choosing a pain reliever.

NSAIDs (Non-steroidal anti-inflammatory drugs)

• Aspirin
• Ibuprofen (the medicine in Advil® and Motrin®).
• Naproxen sodium (the medicine in Aleve®).
• Ketoprofen (the medicine in Orudis KT® and Actron®).

Your doctor may recommend a non-steroidal anti-inflammatory medication for the relief of your arthritis-related pain. NSAID pain relievers work by reducing some of your body's protective functions, including protecting the lining of the stomach. By interfering with these protective functions, NSAID pain relievers can sometimes cause stomach irritation.

NSAIDs can also inhibit blood from clotting, so if you are taking a blood thinner such as warfarin for heart or circulatory problems, consult your doctor about which non-prescription pain reliever is right for you.

For people with mild to moderate arthritis, nonprescription medicines that are available over the counter are often the first line of defense. Tylenol and NSAIDs attack arthritis in very different ways. While these drugs have the potential to provide some relief for arthritis, each has side effects. Talk with your physician about which one is right for you.

For more information about over-the-counter medications for arthritis pain visit www.allaboutarthritis.com.

Topical Analgesics

Topical analgesics are ointments and creams that are rubbed directly on the painful area. Because they work only on the areas of the body where they are applied, they minimize the risk of side effects associated with pills, although you can burn or irritate your skin if you do not adhere to the label instructions or if you have sensitive skin. Common topical analgesics available over the counter include ones made from capsaicin, (an ingredient found in cayenne peppers). Others are made from menthol, oil of wintergreen, camphor, eucalyptus oil and turpentine oil, which stimulate or irritate the nerve endings, distracting the brain's attention from the arthritis pain.

For more information about non-surgical treatment options for your arthritis pain visit: www.allaboutarthritis.com.

Prescriptions for Arthritis

Prescription NSAIDs (nonsteroidal anti-inflammatory drugs) can play an important role in the management of arthritis. Doctors may prescribe NSAIDs for patients who have both arthritis pain and inflammation. (For patients who have arthritis pain but not inflammation, doctors may prescribe other drugs, such as analgesics). NSAIDs are used to treat arthritis symptoms; they do not change the underlying condition of the disease.

Physicians can choose from more than a dozen prescription NSAID formulas based on a patient's needs. They are powerful drugs and can cause potential side effects. The most common side effects are nausea, headache, upset stomach, skin rash, and liver and kidney problems.

In some cases, prescription NSAIDs are stronger doses of drugs available over-the-counter. Other prescription NSAIDs have no over-the-counter version.

How Prescription NSAIDs Work

NSAIDs work by blocking chemical reactions in the body that contribute to pain and inflammation. But NSAIDs, in the process of blocking the inflammatory processes, also block beneficial chemical functions that protect the stomach lining and help to maintain kidney function. Thus, NSAIDs can lead to upset stomach, bleeding and peptic ulcers. Traditional prescription NSAIDs, generic and brand-name, include:

• diclofenac (the medicine in Voltaren®, Cataflam®).
• diflunisal (the medicine in Dolobid®).
• etodolac (the medicine in Lodine®).
• (the medicine in Ansaid®).
• ibuprofen (the medicine in Rufen®).
• indomethacin (the medicine in Indocin®).
• ketoprofen (the medicine in Orudis®).
• ketorolac (the medicine in Toradol®).
• meclofenamate (the medicine in Meclomen®).
• nabumetone (the medicine in Relafen®).
• naproxen (the medicine in Naprosyn® and Anaprox®).
• oxaprozin (the medicine in Daypro®).
• piroxicam (the medicine in Feldene®).
• salsalate (the medicine in Salflex® and Disalcid®).
• sulindac (the medicine in Clinoril®).
• tolmetin (the medicine in Tolectin®).

The goal is to provide the optimum relief at the lowest possible dosage and manage possible side effects. Unfortunately, some people have bad reactions to NSAIDs, as noted: stomach ulcers, internal bleeding, and other potentially serious reactions.

Who Can Take NSAIDs

Only your doctor can determine the right medication for you. Many patients may not be candidates for NSAIDs. If you are allergic to aspirin or any type of NSAID, you may not be a candidate. Also, if you have heart problems, kidney problems, high blood pressure, or are pregnant you may also not be able to take NSAIDs.

What Are the Possible Side Effects

Again, the possible side effects of NSAIDs can include constipation or diarrhea, dizziness, drowsiness, gas or heartburn, headache, nausea, vomiting, and insomnia. More serious side effects that you should report immediately to your doctor may include dark yellow or brown urine, decrease in the amount of urine passed, difficulty breathing, fast heartbeat, ringing in the ears, skin rash, and redness, blistering, peeling or itching, swelling of eyelids, throat, lips or feet, unusual bleeding or bruising, and yellowing of eyes or skin.

Joint Injection

Your doctor may suggest injections to help alleviate the symptoms of your advancing arthritis. Learn more about injections.

Physical Therapy

Physical therapy has proven beneficial in reducing the symptoms of advanced arthritis and in increasing the sufferer's mobility. Physical therapy usually includes an exercise program, which studies show can improve aerobic capacity and alleviate depression and anxiety among arthritis sufferers. Exercise activities may include range of motion, strengthening and endurance exercises.

Specialized Braces

Specialized Braces may be helpful in some cases of arthritis. The braces are designed to create a force which transfers load from an area of the joint where the cartilage is most worn to an area where there is still some cartilage remaining.

Weight Reduction

Obesity does aggravate the symptoms of arthritis. Your physician may recommend weight loss as a way to relieve some of the stress on your joints and reduce pain and inflammation.

Additionally, some arthritis sufferers seek alternative treatments, including everything from herbal supplements to copper bracelets, mineral springs, magnets, large doses of vitamins and even snake venom. Before taking any medication or alternative treatment, consult your primary care physician.

Surgery

If and when you can no longer manage the pain or deal with the loss of mobility caused by your severe arthritis through non-surgical treatments, surgery may offer some relief. Your physician or surgeon can discuss with you in-depth your surgical options. Below we've listed the most common surgical interventions recommended to arthritis sufferers.

Total Joint Replacement

People with advanced symptoms of arthritis that cannot be managed with medications or physical therapy are often candidates for total joint replacement surgery. With total joint replacement, the old, worn out surface of the joint is surgically removed and a new synthetic surface is put in place.

Arthroscopy

When osteoarthritis occurs, small pieces of cartilage tend to wear away from the joint surface and float around inside the joint. This debris is thought to cause inflammation and pain. In certain cases of arthritis, your doctor may suggest arthroscopy to try to remove some of the debris and provide temporary pain relief. Arthroscopy is a minimally-invasive surgical procedure in which degenerated and worn cartilage is trimmed and smoothed, reducing the source of inflammation.

Cartilage Transplant

It is now possible to transplant cartilage from one location to another. Healthy cartilage from an area of the joint that does not bear weight can be transplanted to another area where weight-bearing cartilage has been damaged. Unfortunately, in most cases of advanced arthritis, the degeneration and wear of cartilage involves the majority of the joint surface, and cartilage transplant is not always a viable treatment option.

Fascial Reconstruction

Before artificial joints, surgeons tried many things to keep the worn-out bone surfaces of arthritic joints from rubbing against each other. Surgeons found that fascia - the connective tissue that makes up the covering of muscles - could be placed between the rubbing bone surfaces to create a tough connection of scar tissue that cushioned the ends of the bones. This approach is still used in some cases.

Fusion

Before the advent of artificial implants, fusion was much more common than today. In fusion, the joint is removed and the bone ends are allowed to grow together, or fuse, into one bone. Patients who undergo fusion regain strength in the fused joint, but they lose mobility - the joint doesn't move. Fusion is an option for patients with compromised immune systems or other systemic diseases that would significantly impact the potential success of joint replacement.

Osteotomy

Osteotomy is an operation that cuts the bone, either above or below the joint, and re-aligns the joint to a better position. An osteotomy is often used for younger people where the limb is clearly not straight and the cartilage wear is confined to one part of the joint. Unfortunately, the success of this operation decreases as the degree of arthritis increases.

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