| Topical Painkillers Only Offer Temporary
Arthritis Relief
By Ed Edelson
HealthDay Reporter
FRIDAY, July 30 (HealthDayNews) -- Topical painkillers used to treat
osteoarthritis offer only passing relief, a new study finds.
In formal medical language, non-steroidal anti-inflammatory creams (NSAIDs)
give only temporary help for the pain of the joint condition, said the
report in the July 31 issue of the British Medical Journal.
Doctors often prescribe topical NSAIDs to avoid the intestinal bleeding
that can occur when the drugs are taken orally, said Weiya Zhang, a senior
lecturer in epidemiology at the University of Nottingham, and lead author
of the report.
But there was very little research on the longer-term pain relief provided
by the topical NSAIDs, Zhang said. So he and his colleagues examined the
medical literature and gathered information from 13 studies that looked
at the efficacy of treatment with topical versions of NSAIDs. The drugs
ranged from over-the-counter medications such as aspirin and ibuprofen,
to prescription drugs such a diclofenac (Cataflam, Voltaren) and piroxicam
(Feldene, Nu-Pirox). The trials included nearly 2,000 patients and lasted
up to four weeks.
"After two weeks, there was no evidence of efficacy," Zhang
said. "We really need some sort of long-term treatment for this disease."
Osteoarthritis generally occurs later in life, as the cartilage that
cushions joints is degraded over the years. It's the most common form
of arthritis and a major cause of disability in older people. The damaged
joints generally are in the fingers, knees, hips and spine, and the pain
can be intense.
A newer class of drugs, Cox-2 inhibitors, can be an alternative to NSAIDs,
Zhang said. But these drugs, the first of which were Celebrex and Vioxx,
are expensive and can cause intestinal problems, he said.
The new study results "coincide with the experience of those who
use topical NSAIDs," said Dr. Frank B. Kelly, a member the American
Academy of Orthopaedic Surgeons' board of directors, who is in private
practice in Macon, Ga. Those drugs are more effective for soft-tissue
problems such as tendonitis, he said.
Kelly said his treatment regimen for the pain of osteoarthritis starts
with lifestyle changes. "About 90 percent of what we do is nonsurgical,"
he said.
Weight loss can help someone who is obese, as can an exercise program
aimed at strengthening muscles, Kelly said. If drug treatment is needed,
he generally starts with an oral anti-inflammatory medication such as
buffered aspirin or ibuprofen. Cox-2 inhibitors can be used if those drugs
fail to give relief. If all else fails, injections of a steroid such as
cortisone might be tried, he said.
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