Joint pain, also referred to as arthralgia, can be caused by various types of injuries or conditions. Joint pain often involves various degrees of inflammation of the synovial membrane and cartilage loss.1 Individuals affected by joint pain may experience localized swelling and tenderness. One in 3 individuals suffers with some degree of joint pain, and in many cases it affects an individual's quality of life and ability to engage in daily routine activities. Some possible causes of joint pain include osteoarthritis, rheumatoid arthritis, bursitis, gout, tendinitis, injuries?including fractures?and some autoimmune disorders, such as influenza, hepatitis, and Epstein-Barr syndrome.
Because of the recent recall of Vioxx, many consumers are seeking alternatives for treating joint pain. Management of mild-to-moderate joint pain can be achieved through the use of oral nonprescription medications?such as acetaminophen and various nonsteroidal anti-inflammatory drugs
(NSAIDs; Table 1)?and a multitude of topical analgesics. Nonprescription analgesics are considered to be generally safe and effective when taken appropriately for mild-to-moderate joint pain. Acetaminophen is considered to be highly effective in treating pain. Acetaminophen works by inhibiting the synthesis of prostaglandins in the central nervous system, and it peripherally blocks pain impulse generation.2 NSAIDs are the most frequently used agents among consumers to treat both pain and inflammation. The mechanism of action for NSAIDs is the inhibition of prostaglandin synthesis by decreasing the activity of the enzyme cyclooxygenase, which in turn results in a reduction in the formation of prostaglandin precursors.2 According to a recent survey, 69% of individuals take more than the recommended dosage, 63% take the next dose sooner than directed, and 44% take more than the recommended number of doses per day.3 The FDA recently launched a campaign to alert and advise consumers on the safe utilization of OTC products.
Pharmacists can play an integral role in educating their patients on the safe use of nonprescription agents. Selection of these agents should be made after a careful assessment of the patient's medical condition and medication profile to prevent the potential for drug-drug interactions (adverse effects related to preexisting medical conditions or hypersensitivity to active ingredients).
When the use of OTC oral analgesics is not an option for treating joint pain, a host of topical or external analgesics are available for mild-to-moderate joint pain (Table 2). Tight occlusive bandages should not be applied after using topical analgesics in order to prevent tissue damage. Topical analgesics can be divided into 3 main classes: capsaicin, counterirritants, and salicylates.
Capsaicin is the active ingredient found in red chili peppers. It is thought to reduce substance P, a chemical found in the body that contributes to the inflammatory response. Common adverse effects include stinging, burning, irritation, or erythema. Capsaicin should not be applied to irritated skin areas. It usually is applied 3 to 4 times daily.
Counterirritants include such agents as methyl salicylate, camphor, and menthol. When applied to the skin, they provide a cooling sensation followed by a warming sensation to provide the patient with relief.
Salicylates inhibit pain and inflammation. These agents should be used with caution in individuals who are allergic to aspirin and in those with asthma. Some of these agents contain trolamine salicylate.
Other common topical analgesics may contain eucalyptus oil, witch hazel, emu oil, glucosamine, and chondroitin. Topical analgesics may contain a combination of some of the ingredients listed above.
Supplements and Alternative Therapies
One popular supplement is glucosamine, which is found naturally in the body and which is believed to form and repair the body's cartilage. Glucosamine should be used with caution in individuals who are allergic to seafood, however. It is often combined with chondroitin, which cushions cartilage tissue to help relieve joint stress.
Methylsulfonylmethane (MSM) is believed to maintain the elasticity and flexibility of the connective tissue that makes up the joints. S-adenosyl-Lmethionine (SAM-e) also is a popular agent used for the treatment of joint pain. It is believed to promote joint repair and emotional well-being. The FDA does not regulate these agents.
Patient Counseling Tips
Nonprescription pain medications can be both beneficial and effective in treating mild-to-moderate pain if patients have a thorough understanding of how to take them. It is important for pharmacists to remind patients to discuss the use of all medications? including nonprescription medications? with their physicians. Patients also should notify their health care providers if nonprescription analgesics do not provide adequate pain relief. In addition, patients should attempt to employ nonpharmacologic approaches to treating joint pain, such as bed rest, physical therapy, changes in levels of activity, and weight loss, whenever possible, to prevent further damage.
Ms. Terrie is a clinical pharmacy writer based in Slidell, La.
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