Yvette C. Terrie, BSPharm, RPh
Ms. Terrie is a clinical pharmacy writer based in Haymarket, Virginia.
Arthralgia, commonly referred to as
joint pain, can be the result of both
injuries and various medical conditions
and is commonly characterized by
symptoms of stiffness, swelling, limitation
of motion, weakness, and fatigue.
1
According to statistics from the Centers
for Disease Control and Prevention
(CDC), in 2006, an estimated 30% of
adult individuals reported experiencing
some type of joint pain during the
preceding 30 days. In addition, 18% of
respondents reported knee pain, 9%
reported shoulder pain, 7% reported
joint pain in fingers, and 7% reported
hip pain.
2 Joint pain can be caused by
osteoarthritis (OA), various types of
injuries, prolonged abnormal posture,
or repetitive motion.
2
OA and rheumatoid arthritis are 2 of
the most prevalent causes of joint pain.
Other medical conditions that can cause
joint pain include gouty arthritis, lupus,
bursitis, tendonitis, and osteomyelitis.3,4
In addition, examples of other possible
contributors to joint pain include excess
weight, increasing age, genetic defects
in joint cartilage, sedentary lifestyle, and
stress on the joint from certain sports
activities or occupations.3,4 Only the pain
associated with OA is approved for self-treatment
after an initial medical diagnosis
has been established.5 Statistics
from the Arthritis Foundation report
that an estimated 27 million individuals
in the United States have some degree
of OA.6,7 Whereas OA can occur in any
joint, the condition most often affects
the weight-bearing joints of the hips,
knees, and lower back. It also can affect
the neck, small finger joints, the base of
the thumb, and the big toe.3,6
In general, the goals for treating OA
include improving an individual's quality
of life by providing pain relief and
enhancing joint mobility. Selection of
treatment is dependent upon various
factors, including severity of the OA,
the patient's medical history, current
medication profile, and allergy history.
After these factors are evaluated for
potential contraindications, the elected
therapy may include one or more of the
following: systemic and topical pharmacologic
agents, physical therapy, rest,
heat and cold therapy, weight loss, the
use of devices to take strain off of joints,
such as canes and splints, and surgery,
when warranted. OTC analgesics such
as nonsteroidal anti-inflammatory drugs
(NSAIDs) and acetaminophen are commonly
used in the treatment of OA.
Acetaminophen, when compared with
NSAIDs, is considered to be the drug
of choice for the treatment of OA when
inflammation is not a chief concern
because of its reduced adverse effect
profile.5 NSAIDs are the preferred drugs
of choice, however, when inflammation
also is present and no potential
contraindications or drug interactions
are present.5
Topical Therapies
Topical products used for treating joint
pain can be used in conjunction with
systemic agents or as the sole therapy of
choice. They may contain one or more
of the following ingredients: methyl
salicylate, camphor, menthol, methyl
nicotinate, capsaicin, or trolamine salicylate,
and are available as gels, ointments,
creams, lotions, and patches.
Patients should be advised to apply topical
products only to skin that is intact
and should not cover areas treated with
counterirritants with tight bandages or
occlusive dressing.5 Patients also should
be advised not to use heating devices
with topical counterirritants.5 Topical
patches for treating joint pain are available
in various sizes that provide 8 to 12
hours of continual heat therapy.
Dietary Supplements
Also available for the treatment of joint
pain are various dietary supplements,
such as glucosamine, chondroitin sulfate,
methylsulfonylmethane (MSM),
and S-adenosyl-L-methionine (SAMe).
These supplements are available
as either single-entity or combination
products. Studies have shown that glucosamine
sulfate not only reduces the
pain associated with OA but may also
slow down the progression of the disease.8
Glucosamine is an endogenous mucopolysaccharide
used in the synthesis of
cartilage.9,10 The most common adverse
effects of glucosamine include mild gastrointestinal
upset, nausea, heartburn,
and diarrhea, which can be alleviated if
it is taken in divided doses with meals.10
Glucosamine should not be used if an
individual is allergic to shellfish. Patients
with diabetes should be aware of the possibility of hyperglycemia
when using glucosamine and should be advised to
discuss the use of this product with their physician prior to
use.10 Chondroitin sulfate is a glycosaminoglycan made from
glucuronic acid and galactosamine present in animal cartilage
and helps cartilage retain water.10,11
MSM also has been added to many of the glucosamine/
chondroitin supplement products. MSM is a sulfur source that
is released on breakdown by intestinal bacteria.10 Although
its exact mechanism of action with regard to OA is unclear,
MSM has an essential role in maintaining the elasticity and
flexibility of the connective tissue that makes up joints.11,12
Patients should be advised that these supplements will not
provide pain relief as quickly as NSAIDs or acetaminophen,
and their therapeutic effects may not be evident for several
weeks or months.10
SAM-e is produced primarily in the liver.10 It is best known
and marketed as a mood stabilizer. Both liver disease and low
levels of vitamin B12 and folate may reduce SAM-e levels.10
SAM-e should not be used in conjunction with antidepressants
and 5-HT1 agonists because of an increased risk of serotonin
syndrome.10
More information on these supplements can be found
at the National Institutes of Health's National Center for
Complementary and Alternative Medicine Web site at nccam.nih.gov.
The Role of the Pharmacist
Prior to recommending any of these OTC products, pharmacists
should always assess the appropriateness of selftreatment
by evaluating the patient's symptoms, review the
patient's medical history, drug profile, and allergy history, and
screen for drug?drug interactions and possible contraindications
associated with the use of these products. Furthermore,
pharmacists should remind patients currently taking any
other medications, those with preexisting conditions, and
women who are pregnant or lactating to always consult a
physician before using any of these products. Key points to
address during counseling include the proper use (dosage
and administration guidelines) of these products, as well as
potential adverse effects. Pharmacists also can make recommendations
about nonpharmacologic measures that patients
may incorporate into their treatment regimen to help alleviate
joint pain. Patients with severe and continual (or worsening)
joint pain should be encouraged to seek further evaluation and
treatment from their primary health care provider, when warranted.5 For more information regarding OA and its treatment
and management, please visit the following Web sites:
Table |
Examples of OTC Products for Joint Pain |
Systemic Analgesic Products |
? Arthriten Maximum Strength Coated Tablets
? Advil Tablets/Caplets
? Bayer Extra Strength Back & Body Pain
? BC Arthritis Strength Pain Reliever/Fever Reducer, Powders
? Ecotrin Arthritis Relief Maximum Strength
? Motrin
? Tylenol Arthritis Pain Extended Release Pain Reliever Caplets |
Topical Products For Joint Pain |
? ActivOn Topical Analgesic, Ultra Strength Joint & Muscle
? Arthritis Hot Deep Penetrating Pain Relief Cream
? Aspercreme Nighttime Arthritis Pain Relieving Lotion
? Bengay Arthritis Formula Pain Relieving Cream
? Blu Stop Pain Relieving Gel
? Capzasin Arthritis Pain Relief
? Castiva Arthritis Pain Relief Lotion
? Cura-Heat Penetrating Pain Relief, Arthritis
? IcyHot PM Medicated Lotion
? Mobisyl Maximum Strength Arthritis Pain Relieving Creme with Aloe Vera
? MyoRx Arthritis and Muscle Pain with Omega Oils Cream
? Natrol MSM with Glucosamine Topical Creme
? ThermaCare Arthritis HeatWraps
? Tiger Balm Arthritis Rub
? Ultra Blue Topical Analgesic Gel Pain Reliever with MSM and Emu Oil
? WellPatch Arthritis Relief
? Zostrix Triple Strength Formula Arthritis Pain Relief Topical Analgesic Cream |
Dietary Supplements |
? Cosamin DS Joint Health Supplement
? Cosamin MSM
? Flex-A-Min Glucosamine Chondroitin MSM, Triple Strength
? Inholtra Premium Lubri-Joint Gel Caps
? Nature Made Glucosamine Tablets
? Nature Made Triple Flex Bone & Joint Caplets
? Nature's Way Glucosamine Sulfate MSM Tablets
? Osteo Bi-Flex Double and Triple Strength Glucosamine Chondroitin with MSM and Joint Shield Coated Caplets
? RenewIn Joint Care Tablets
? Schiff Move Free Advanced Triple Strength
? Schiff Move Free Advanced Triple Strength Plus MSM and Vitamin D
? Schiff Move Free Advanced plus MSM |
Homeopathic Products |
? Hyland's Arthritic Pain Formula Natural Relief Tablets
? Boiron Arthritis Pain Relief Tablets
? NatraBio Arnica Relief Tablets |
|
References
- Baer A, Patel V, McCormack R. The approach to the painful joint. Emedicine Web site. www.emedicine.com/med/topic3562.htm. Accessed December 11, 2008.
- QuickStats: percentage of adults reporting joint pain or stiffness—national health interview survey, United States, 2006. MMWR Morb Mortal Wkly Rep. Centers for Disease Control and Prevention Web site. www.cdc.gov/mmwr/preview/mmwrhtml/mm5717a9.htm. Accessed December 11, 2008.
- Arthritis. National Institute of Arthritis and Musculoskeletal and Skin Diseases (NIAMS) Web site. www.niams.nih.gov/Health_Info/Osteoarthritis/osteoarthritis_ff.asp. Accessed December 11, 2008.
- Joint Pain. National Institutes of Health's Medlineplus Web site. www.nlm.nih.gov/medlineplus/ency/article/003261.htm. Accessed December 11, 2008.
- Wright E. Musculoskeletal Injuries and Disorders. In: Berardi RR, Kroon LA, McDermott JH, et al, eds. Handbook of Nonprescription Drugs. 15th ed. Washington, DC: American Pharmacists Association; 2006:111-129.
- Osteoarthritis. Arthritis Foundation Web site. www.arthritis.org/disease-center.php?disease_id=32. Accessed December 11, 2008.
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