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Medications for Spinal Osteoarthritis

Pain Medications

Analgesics

Painkillers such as Tylenol, which relieve pain, but do not reduce inflammation. Tylenol (acetaminophen) is usually well tolerated.

Because Tylenol does not erode the stomach lining as NSAIDs can with long-term use, it is commonly prescribed for the pain of osteoarthritis and other chronic conditions.

It is usually safe to take Tylenol with most prescription medications but taking Tylenol with alcohol can cause liver damage. Exceeding the recommended daily limit also can damage your liver.

Codeine Preparations

When Tylenol is not enough, more potent medications such as Tylenol with Codeine may be prescribed. Codeine is a narcotic that helps reduce pain. It is rarely addictive when used for pain relief. However, when codeine is used regularly for a long time, you develop a tolerance to it - you need larger amounts of the medication to relieve the pain. Since osteoarthritis is a chronic condition, save codeine preparations for your really bad days.

Tylenol 1 contains a low dose of codeine - 8 mg. Tylenol 2 contains 15 mg of codeine & Tylenol 3 contains 30 mg of codeine.
Acetylsalicylic acid (Aspirin), and Ibuprofen with codeine are also available

Side effects of codeine are constipation, which can be counteracted with fiber, stool softeners, prune juice, lots of fluids

NSAIDs

(Non-steroidal anti-inflammatory drugs) are medications used to treat pain and inflammation.

Non-prescription NSAIDs:
- Acetylsalicylic acid (ASA), Brand names: Aspirin, Anacin
- Ibuprofen, Brand names: Advil, Motrin, Nuprin
- Naproxen, Brand names: Aleve

Prescription NSAIDs:
Diclofenac (Voltaren, Arthrotec), Celebrex

Side effects of NSAIDs:
Side effects are dose related:
Short-term use may cause upset stomach, nausea, and heartburn.
Long-term use can cause erosion of the stomach lining and potentially life-threatening bleeding ulcers in some people. Medications to reduce the risk of ulceration can be prescribed. NSAIDs should be taken with a meal to reduce the risk of stomach upset.

Slow release NSAIDs dissolve mostly in the small intestine, past the stomach, decreasing the chance of stomach upset - however, the gastrointestinal effects of these medications are not eliminated. NSAIDs decrease inflammation by decreasing prostaglandins (natural substances involved in inflammation) and certain prostaglandins are required to protect the stomach lining from stomach acid. Some NSAIDs have less severe gastrointestinal side effects than others because they have less effect on the stomach prostaglandins (e.g. Cox-II Selective Inhibitors)

Celebrex (celecoxib): is a COX-2 inhibitor (COX-2 Selective NSAID) - a subset of NSAIDs that are less likely to cause stomach ulcers with long-term use than the other NSAIDs. Celebrex is commonly prescribed for osteoarthritis.

Celebrex was linked to increased risk of heart attacks and strokes in large clinical trial in December 17 2004 but is still on the market. The FDA concluded "The benefits of Celebrex outweigh the potential risks in properly selected and informed patients." Two other COX-2 inhibitors, Vioxx and Bextra, were taken off the market in 2004 and 2005 as the risks appeared to outweigh the benefits.

Based on the currently available data the FDA has concluded that the potential for increased risk of serious cardiovascular adverse events may be a class effect of NSAIDs - excluding aspirin. Non-prescription NSAIDs (including of ibuprofen and naproxen) are of a lower dose and when taken short-term do not appear to significantly increase the risk of serious cardiovascular events.

THE FDA requires boxed warnings of potential cardiovascular risk for all prescription COX-2 pain relievers and non-selective NSAIDs, including older non-specific drugs such as ibuprofen and naproxen. Some drugs are available in both prescription and non-prescription form. The FDA also requires manufacturers of non-prescription NSAIDs to include specific information about potential cardiovascular and gastrointestinal risks and a warning about potential skin reactions in their labeling. See NSAID drug list.



Topical Medications

Some prescription topical creams contain an NSAID that is absorbed through your skin directly to the area where it is needed. The amount of drug absorbed by the bloodstream is minimal, eliminating or significantly reducing the side effects associated with oral NSAIDs. Because some medication still gets into the bloodstream, if you are taking oral NSAIDs for spinal osteoarthritis you may have to reduce the dosage of your medication.

 

Corticosteroids

In severe cases of spinal osteoarthritis, where mobility is severely restricted, corticosteroids (steroids) can be injected into the facet joints (spinal joints) for quick relief that can last from weeks to months to years. Steroid medications have powerful anti-inflammatory properties but also can have serious side effects. Used too frequently, they can actually lead to more cartilage degradation. In osteoarthritis, corticosteroids are not given orally because the side effects outweigh the benefits.