Osteoarthritis of the knee: Choosing the right pain medicine

hey sorry I'm a bit late today

oh no problem I only just got here

anyway I noticed maybe your Annie's

giving you trouble good and how hey you

see me doctor yet yeah actually the

reason why I'm late I saw this morning

so what'd she say oh she said this osteo

arthritis osteoarthritis would that the

same thing is just plain arthritis well

I'm really not sure


osteoarthritis is a condition that

affects a person's joints often the

knees there are several types of

arthritis and they have different causes

and treatments osteoarthritis is one

time it's the most common type of

arthritis and it's mostly caused by wear

and tear on a joint so it's more common

as we age and more likely to affect

joints we've overused or injured in the

past osteoarthritis can affect any joint

hips shoulders wrists and even the

joints in the hands and fingers but in

this program we're going to talk about

osteoarthritis of the knee the inside of

a healthy knee looks like this it's

padded with cartilage which is a rubbery

tissue that provides a cushioning effect

and it also contains a small amount of

fluid when the cartilage wears away the

bones are rubbing together without that

cushion and can cause the joint to

become inflamed which results in pain

and stiffness

a person who has osteoarthritis of the

knee finds it harder to move because of

the pain the knee may even be swollen

and tender to the touch some patients

say their pain and stiffness are more

noticeable after exercise or movement

sometimes a knee can also hurt and feel

a little stiff in the morning getting

better when you start moving around

these symptoms or what you experience

tend to get worse over time

at first it might go away when you rest

as time goes on it might still be there

even at rest or it may even wake you up

at night

your doctor can tell if you have

osteoarthritis by discussing your

symptoms with you examining your joints

and looking at an x-ray of your knee

osteoarthritis tends to run in families

other people at risk for getting

osteoarthritis are those who have old

knee injuries or who have done sports or

work that overuse their knees and people

who are overweight carrying around extra

pounds causes greater wear and tear

which damages the joints particularly

the knees your risk of developing

osteoarthritis increases as you age

osteoarthritis doesn't usually get

better on its own no treatment can cure

osteoarthritis but the recommendations

and drugs we'll talk about in this

program can relieve or reduce the pain

and help you move around better

so what else did the doc say man what

kind of treatment to that well she's

going to talk me through all that when I

go in to see her on Friday I wonder if

maybe that surgery they do would help

you know the one that you threw that

little scope I don't know

and there's this other thing I heard

about where they give you injections in

your knees you know maybe that would

help I'll ask about this oh I don't know

might be worth asking and what my mom

has some kind of arthritis she takes

different pills for hers and she uses

creams I'm not sure what all she uses it

I know she uses something she gets from

a health food store I'm not sure how

much good it does her yes a lot of

questions so I guess you have to you

know read up talk to the doc maybe make

a list


if you were diagnosed with

osteoarthritis your doctor will discuss

three major areas of treatment with you

they are activity and exercise weight

control and pain relief let's look

closer at each one starting with your

activity your doctor will want you to

get regular exercise especially doing

things that strengthen the muscles that

support your knee swimming water

aerobics or gentle exercise and warm

water are particularly good for

osteoarthritis as they don't put undue

stress on joints walking is also

excellent exercise for this if you feel

that pain keeps you from being able to

exercise your doctor may recommend

physical therapy physical therapists can

teach you exercises that aren't painful

but will help with strength and

flexibility so you can move more

comfortably if you don't have access or

can't afford a physical therapist you

can ask your doctor to teach you some

exercises for your knees it's important

that you do them daily and you have to

remember that it may take a few weeks

before you see improvement in your knees

a second thing your doctor will discuss

is whether you're overweight the extra

weight we carry puts a great deal of

stress on our knees every pound you lose

can result in thousands of pounds of

less stress on your knees over time so

if you're carrying extra weight your

doctor will recommend ways for you to

lose some of it and finally your doctor

will discuss pain relief with you

whether you need medication and what

kind is best for you in the next segment

of the program we'll be looking at

different options you might consider

over-the-counter pills and creams and

prescription drugs as you'll see for

each of them there are benefits but also

risks to consider but before we continue

let's talk about treatments you may have

heard about that your doctor probably

won't recommend for your hostile

arthritis you may have heard of

arthroscopic surgery where the surgeon

operates on your knee joint through a

small opening in the skin although there

are many knee conditions that are helped

by this kind of surgery osteoarthritis

is not one of them another treatment you

might have heard of

is one where these injections or shots

are filled with joint lubricant a

gel-like substance injected right into

the knee these shots aren't the same as

cortisone shots that are sometimes used

when your joints get swollen the

lubricant treatments are usually given

over several weeks however this

treatment has not been found to be

effective for osteoarthritis of the knee

studies found that people receiving

these shots didn't get much pain relief

or improvement in movement and the shots

do have the risk of complications such

as infection swelling and pain so your

doctor is not likely to suggest joint

lubricant injections these lubricant

shots are different from the cortisone

shots that are directly applied to the

joint many people do feel an improvement

after a cortisone shot another treatment

that you may hear your doctor talk about

is glucosamine and chondroitin these are

two substances that are sometimes sold

as nutritional supplements instead of as

drugs or medications because they are

not sold as drugs they might not be

checked for their quality so the dose

and quality is different between each

brand and sometimes bottles of the same

brand are different there have been some

studies looking at whether glucosamine

and chondroitin are beneficial for hasti

or arthritis of the knee in general most

studies have shown that they were not

very helpful keep in mind also that even

though they are not labeled or

classified as drugs they can still have

side effects or cause problems taking

them to review the main treatment

approaches for osteoarthritis will be

exercised with possible physical therapy

weight loss if it's needed and pain

relievers next we're going to look at

the kinds of pain relievers you and your

doctor will consider

my knee pain from that osteoarthritis

got so bad it was interfering with my

whole life I was feeling down and

isolated from my friends and family

because I couldn't take part in too many

activities we used to do together I knew

I needed to do something about it and

make a decision as soon as possible but

I just wasn't sure which treatment was

best for me I could barely get out of

bed in the mornings I would have to lie

in bed for a while Wayne until my joint

stiffness was bearable enough to be able

to get up and start my day my knee also

heard as I tried to walk it was caused

me to be late for work and I don't think

my boss was too happy about that

that osteoarthritis was taken over my

life now I knew I didn't want to get the

surgery on my knee I think they call it

arthroscopic surgery because first of

all I couldn't take time off from work

and also because I couldn't afford it

but the real reason is because I've

actually frightened the idea of surgery

even though the surgery is supposed to

be done through just a small cut my

friend said that I should use

glucosamine and chondroitin because they

said it helped them reduce their pain

well it really didn't work for me

another friend of mine said that I

should try joint lubricant shots these

are shots given to the knee with a gel

like material I was given a few shots

over a few weeks I felt a little better

but not that much though my doctor said

the treatments work differently for

every person and that these shots may

help some people but many others don't

feel any improvement I think that when

people use one type of treatment and it

doesn't work they should talk to their

doctor about moving on to another

hey happy Monday

yeah not so much I just got that manual

with the new rules and regs yeah me too

there's a couple in there I want to ask

you about but first fill me in on the

knee I take it surgery and knee

injections aren't the ticket nope

nothing what's wrong with this me kind

of lose a few pounds get some exercise

she wants me to get some physical

therapy hmm

so what'd you say about the pain well

that's gonna be the biggest question

what kind of medicine I can take for it

I don't they just tell you which one is


huh turns out they're quite a few things

that can go into the decision for any

one person different side effects for

one oh yeah yeah I guess you have to

decide what you're willing to put up

with yeah I guess

then that's whether you just use an

over-the-counter one or need a


I guess that affects the cost - so you

gave me a bunch of stuff to read and she

gave me one to start off with just to

see how it's working so I'll go back in

two weeks with another list of questions

probably yeah that's how you get it

right yeah so what you think is going to

happen in Don's apartment not at the



we've seen that exercise possibly with

physical therapy and weight control are

two very important components of

treating osteoarthritis of the knee but

most patients will also need some kind

of medicine for pain relief as well

either on a regular basis or just

occasionally there are several kinds of

medicines that may be recommended by

your doctor for pain relief and there

are differences between them you'll want

to know about they differ in the kinds

of benefits they offer the side effects

they have and some may pose more risks

for some people than others they also

differ in how much they cost you can

find information about individual drugs

and their costs in this booklet now

let's look at each of the categories of

pain relievers and a little more depth

we'll start with the simplest and safest

many people get pain relief from

capsaicin skin cream like za streaks or

Thera gram with few or no side effects

or risks

capsaicin creams don't reduce

inflammation or swelling but can give

some pain relief

if you need more relief than what a skin

cream provides one of the most commonly

recommended medicines that you can buy

over-the-counter and take it orally or

by mouth is acetaminophen which you may

know by its brand name tylenol the

benefits of tylenol are that it provides

most people with pain relief and most

people can take tylenol without problems

or side effects

however tylenol may not be enough for

some patients and they may need to try

other treatments one of the best

alternatives is to use non-steroidal

anti-inflammatory drugs or NSAIDs these

are drugs that as the name indicates are

not steroids but do act to reduce

inflammation you may be familiar with

insides like ibuprofen which you might

know by brand names like Advil or motrin

or naproxen which you might know by its

brand name believed aspirin is also an

NSAID NSAIDs are effective at relieving

pain and they also reduce inflammation

and swelling

however these medications have more

risks than tylenol one of the most

serious is that they can be hard on the

stomach and can cause stomach bleeding

in some people the people at most risk

for stomach bleeding are those who take

high doses of these pills or use them

for a long time people who have had

stomach bleeds before people who are

older especially those over age 75 and

people who are taking blood thinner

drugs like coumadin or aspirin to

prevent blood clots stomach bleeds can

be very serious and even

life-threatening so people in these risk

groups should be very careful about

taking NSAIDs and only do so under a

doctor's supervision if you have ever

had an ulcer in your stomach and

especially if you have had bleeding from

it you should not take NSAIDs including


be sure your doctor knows if you have

had stomach bleeding all of the drugs

we've mentioned so far can be bought

over the counter without a doctor's


many of these medicines ibuprofen or

naproxen for example can also be

prescribed in higher doses by your

doctor another prescription and said is

called a cox-2 inhibitor it's brand name

is celebrex prescription NSAIDs celebrex

and prescription-strength ibuprofen are

very effective at relieving pain and

swelling they may also have the same

risk of stomach irritation as other


and in addition they appear to slightly

increase the risk of heart attacks so

they may not be suitable for you if you

have other heart risk factors such as

smoking or high cholesterol or high

blood pressure if you want to lower

these risks it's best to use naproxen or

a leaf or Tylenol take low doses less

often and supplement with other pain

relief like the skin creams that go over

your joints one of the most powerful

treatments for inflammation is steroids

like cortisone but their effect is only


and it is dangerous to use steroids too

often especially if they are taken by

mouth because of this cortisone pills

are usually not recommended for

osteoarthritis because these medicines

have the potential for side effects and

some potentially serious risks you

should be sure to ask your doctor about

any drug you take so you can be aware of

any unwanted reactions and report them

to your doctor don't forget that weight

control and exercise or physical therapy

can reduce the amount of pain medication

you might need doctor I have some

questions about my medication good good

let's talk about it well I probably is

but first I wanted to ask you none of

the medicines we've discussed gets rid

of osteoarthritis but many have been

shown to help with pain and inflammation

and allow people to resume their

activities we've seen that there are a

number of things to consider when

choosing a pain relief treatment for

osteoarthritis with your doctor you and

your doctor need to choose more

carefully if you're on certain

medications like blood thinners if

you've ever had stomach bleeding if you

have ever had a heart attack or are at

risk for one if you smoke are overweight

have high blood pressure risks of heart

attack are also higher as we age you

also have to be careful if you have

kidney problems because NSAIDs can make

them worse the goal is to choose a pain


helps you feel better and be more active

without having too many problems some

pain relievers work right away and

others have to be taken regularly to see

any therapeutic effect your doctor needs

to see you regularly in order to monitor

how you are doing and to make sure your

medications are not causing any harm to

you so it's important to keep up with

all of your clinic and doctors

appointments a few weeks ago I was at

the gym with my workout buddy

Mike who also has osteoarthritis in his

knee and he just wasn't working out as

hard as he used to I asked him if you've

gotten enough sleep the night before he

told me that he's been feeling pretty

tired and weak lately I asked him if he

had gotten the flu or something and he

told me he didn't know why he had no

energy I told him that he should

probably see his doctor because it just

didn't seem normal to me it turns out

that might want to see one of those

stomach doctors I think they're called

gastroenterologist and the doc told him

that he had an ulcer in his stomach it

was probably caused by him taking those

non-steroidal anti-inflammatory drugs

also known as incense for his knee pain

the doc told him that he was losing

blood through the ulcer and that was why

he was feeling so weak he asked him to

stop taking the NSAIDs immediately the

doctor said that some people on top of

feeling weak see blood in their stools

they might even notice of black and

sticky tall like substance the doc told

Mike that when people see this in their

stools they need to call their doctors

right away because it can be an

emergency he also said that if you're

taking these anti-inflammatory medicines

and you start having heartburn or

stomachache you should let your doctor

know before more serious problems happen

so catch the game on Saturday how's that

my kids little league game I got the

good parts on the radio though you mean

the bad parts oh yeah we got stomped Rob

it's more like it yeah definitely

you know I saw that last play on TV

later yeah bad call worst so looks like

you're getting around bet at Eve days

treatment working pretty much I guys see

my back mole off in two just to make

sure yeah that's a good idea

I told my mom some of what you told me I

think she needs to see her doc you know

she takes a lot of medicine for hers and

she's getting older so my sister made an

appointment for we're gonna go with or

talk to the doc see if we can't sort out

something better at least make sure

she's doing okay that's the right thing

to do yeah

exercise works best for me I thought

that exercise would be bad for my needs

since the cartilage is worn away I was

completely wrong staying active helps to

decrease the pain and gives you more

energy throughout your day every morning

I wake up and take my dog for a walk

around my neighborhood on Tuesday and

Thursday evenings I go to water aerobics

class at the Community Recreation Area

there is no way that I can run would

jump around but I love the water aerobic

exercises because it doesn't hurt my

knees and it makes my legs feel stronger

it is actually quite relaxing and suits

my arthritis pain since I started

exercising I also started to eat

healthier I have lost a few pounds by

changing my diet and by starting my new

exercise plan I can really see that just

by losing a few pounds I have a lot less

pain a friend told me that when you walk

the force on your knees is two to five

times the total weight of your body so

losing only a little weight will take a

lot of pressure off the knee joint and

it may even slow the progression of