Osteoarthritis: Easing Joint Pain

Pharmacy Times, August 2014 Pain Awareness, Volume 80, Issue 8

Left untreated, joint pain can significantly interfere with an individual's level of activity and daily routine.

Left untreated, joint pain can significantly interfere with an individual’s level of activity and daily routine.

A host of nonprescription products on the market help provide symptomatic relief of the common medical ailment arthralgia, which is frequently referred to as joint pain. Several supplements formulated to promote joint health are also on the market.

Left untreated, joint pain can significantly interfere with an individual’s level of activity and daily routine. Arthralgia can manifest as a result of injuries or various medical conditions. Patients presenting with joint pain may report symptoms of pain (especially after activity), stiffness, swelling, limitation of movement, weakness, and fatigue.1 The Arthritis Foundation estimates that 27 million individuals in the United States have some degree of osteoarthritis (OA)—a common cause of joint pain.2,3

This article focuses on the nonprescription products available for self-treatment and management of joint pain associated with OA.

According to the Centers for Disease Control and Prevention (CDC), 30% of US adults are estimated to have experienced some degree of joint pain during the preceding 30 days.4 In addition, 18% of respondents reported knee pain, 9% reported shoulder pain, 7% reported joint pain in fingers, and 7% reported hip pain.4 While OA and rheumatoid arthritis are among the most prevalent causes of joint pain, other medical conditions and factors can cause or exacerbate joint pain (Table 14-6). According to the Handbook of Nonprescription Drugs, joint pain associated with OA is approved for self-treatment only after a medical diagnosis has been established and self-treatment has been deemed appropriate.7 While OA can develop in any joint, it most often affects the weight-bearing joints of the hips, knees, and lower back; OA can also affect the neck, small finger joints, the base of the thumb, and the big toe.5,7,8

Managing and Treating Joint Pain

Typically, the goal of treating OA is to improve an individual’s quality of life by providing pain relief and enhancing joint mobility. Therapy is typically individualized, and it depends on factors including the severity of OA, as well as the patient’s symptoms, medical history, medication profile, and allergy history.7

Therapy may involve a single therapy or combination of therapy, which may include the use of a systemic and/or topical medication (Online Table 2), physical therapy, rest, heat and cold therapy, weight loss, and the use of devices to reduce the strain on joints (eg, canes, splints), and surgery, when warranted.7,9 For the treatment of OA, nonsteroidal anti-inflammatory drugs (NSAIDs) and acetaminophen are commonly used when no contraindications or drug interactions exist.7,9 Because of its reduced adverse

effect profile, acetaminophen is considered the drug of choice for treating OA when inflammation is not a chief concern; however, NSAIDs are preferred when inflammation is also present and there are no contraindications or drug interactions.7

Table 2: Examples of Nonprescription Products for Managing Joint Pain

Category/Class

Brand Name/Manufacturer

Oral analgesics

Capsicum, capsicum oleoresin, capsaicin

· Aleve

· Advil

· Motrin

· Tylenol Arthritis

· Capzasin Gel

· Capzasin P Creme

· Capzasin HP Crème

· Salonpas-Hot Capsicum Patch

· WellPatch

· Zostrix Hot and Cold Therapy System for Joint and Muscle Pain

· Zostrix HP Arthritis Pain Relief Cream

Counterirritants (contain camphor, menthol, or methyl salicylate

· Bengay Ultra Strength Pain Relieving Cream

· Bengay Zero Degrees

· Bengay Vanishing Scent Gel

· Bengay Ultra Strength Pain Reliving Patch

· Bengay Pain Relief and Massage Gel

· Bengay Cold Therapy

· Bengay Maximum Strength Spray

· Blue-Emu Ice Spray

· Eucalyptamint Maximum

· Flexall Maximum Strength

· Icy Hot Medicated Patch

· Icy Hot Knee and Ankle Sleeve

· Icy Hot Naturals

· JointFlex Pain Relieving Cream

· Joint-Ritis Maximum Strength Arthritis Pain Reliever Roll-On

· Therapeutic Mineral Ice

Salicylates (contains trolamine salicylate 10%)

· Aspercreme Analgesic Cream

· Aspercreme Medicated Back and Body Patch

· Mobisyl Maximum Strength Arthritis Pain Reliever Cream

· Myoflex Crème

· Sportscreme

Combination Products

· ActivOn Topical Analgesic Arthritis

· ActivOn Joint and Muscle

· Arth-Rx Topical Analgesic Arthritis Pain Relief

· Pain Relieving Cream

· Flexall Plus

· Icy Hot Advanced Relief Cream

· Icy Hot No Mess Liquid

· Icy Hot Chill Stick Extra Strength Pain Relieving Crème

· JointFlex Roll On

· Mentholatum Deep Heating Rub

· Sloan’s Liniment

· Stopain Extra Strength Pain relief Spray with Glucosamine & MSM

· Thera-Gesic Maximum Strength Pain Relief Cream

· Tiger Balm Arthritis Rub

·

Supplements

· Boiron Arnicare Arthritis

· Cosamin DS Exclusive Formula Joint Health Supplement

· Cosamin ASU Joint Health Supplement

· Osteo Bi-Flex Double Strength Glucosamine / Chondroitin ComplexCaplets

· Osteo Bi-Flex Advanced Glucosamine Chondroitin with Joint Shield

· Flex-A-Min Maximum Strength Glucosamine + Chondroitin + MSM

· Nature’s Bounty Maximum Strength Glucosamine 1700

· Nature Made Glucosamine Tablets

· Schiff Move Free Advanced Glucosamine Chondroitin, Coated Tablets

· Schiff Move Free Advanced Glucosamine Chrondroitin Plus MSM Coated Tablets

· TripleFlex Tablets

Topical Therapies

Various topical analgesics are available for treating joint pain, and can be used alone or in conjunction with oral analgesics. Topical analgesics typically contain 1 or more of the following ingredients: methyl salicylate, camphor, menthol, methyl nicotinate, capsaicin, and trolamine salicylate. Topical analgesics are available as gels, sprays, ointments, creams, lotions, and patches.

During counseling, patients should be advised (1) to only apply topical products to skin that is intact and (2) not to cover areas treated with counterirritants with tight bandages or occlusive dressing.7 Patients should be advised not to use heating devices when using topical counterirritants.7

Topical heat therapy patches in various sizes are available for treating joint pain, providing 8 to 12 hours of continual heat therapy. In addition, the manufacturer of Icy Hot (Chattem Inc) has announced the availability of a new portable device called Icy Hot Smart Relief, which employs a drug-free wireless system to block pain signals at the nerve to relieve muscle and joint pain.

Dietary Supplements

Dietary supplements, such as glucosamine, chondroitin sulfate, methyl-sulfonyl-methane (MSM) and S-adenosyl-L-methionine (SAM-e), are marketed for the treatment of joint pain and joint health. These supplements are available as single-entity or combination products. Results from some studies have shown that glucosamine sulfate not only reduces pain associated with OA but may also slow progression of the disease.10-12 Glucosamine is classified as an endogenous mucopolysaccharide that is used in the synthesis of cartilage.10-12 The most common adverse effects of glucosamine include mild gastrointestinal (GI) upset, nausea, heartburn, and diarrhea, all of which can be avoided by taking glucosamine in divided doses with meals.10-12

Patients should be advised that glucosamine should not be used if an individual is allergic to shellfish.10-12 Patients with diabetes should be made aware of the possibility of hyperglycemia when using glucosamine, so they should be advised to routinely monitor their blood glucose levels if they elect to use this product and to talk with their primary health care provider if they have any concerns.10-12

Chondroitin sulfate is classified as a glycosaminoglycan made from glucuronic acid and galactosamine present in animal cartilage and helps cartilage retain water.10,13,14 As a dietary supplement, it is usually found in combination with other dietary supplements for joint health.10,13,14 Common adverse effects include mild GI upset and nausea.10

MSM is often found in glucosamine/chondroitin supplement products. MSM is a sulfur source that is released on breakdown by intestinal bacteria.10 While the exact mechanism of action of MSM in regard to OA is unknown, studies suggest that MSM has an essential role in maintaining the elasticity and flexibility of the connective tissues that make up joints.10 Patients should be advised that these dietary supplements will not relieve pain as quickly as NSAIDs or acetaminophen and that the therapeutic effects of these supplements may not be evident for several weeks or months.10 Patients should be advised to adhere to the manufacturer’s recommended dosing guidelines. More information on these supplements can be found at the National Institutes of Health National Center for Complementary and Alternative Medicine website, http://nccam.nih.gov.

The Pharmacist’s Role

Before recommending any of these products, it is important to assess the appropriateness of self-treatment by evaluating the patient’s symptoms, medical and allergy histories, and drug profile and by screening for drug—drug interactions and contraindications associated with using these products. Patients who have preexisting medical conditions, who are taking prescription medications, or who are pregnant or lactating should be reminded to consult their primary health care provider before using any medication.

During counseling, patients should be advised on the proper use of the selected product, including the dosage, duration of use, and potential adverse effects. Pharmacists can make recommendations about various nonpharmacologic measures that may alleviate joint pain. Patients with severe and continual joint pain should be encouraged to seek further care from their primary health care provider, when warranted, especially if they see no signs of improvement or if pain worsens. Patients should be encouraged to use the various patient education resources on joint pain (Table 3).

Ms. Terrie is a clinical pharmacy writer based in Haymarket, Virginia.

References

1. Baer A. The approach to the painful joint. Emedicine website. www.emedicine.com/med/topic3762.htm. Accessed July 30, 2014.

2. Common arthritis topics. Arthritis Foundation website. www.arthritis.org/disease-center.php?disease_id=32. Accessed July 30, 2014.

3. Arthritis-related statistics. Centers for Disease Control and Prevention website. www.cdc.gov/arthritis/data_statistics/arthritis_related_statistics.htm. Accessed July 30, 2014.

4. Adults reporting joint pain or stiffness in the past 30 days, 2006. Centers for Disease Control and Prevention website. www.cdc.gov/features/dsjointpain/index.html. Accessed July 30, 2014.

5. What is osteoarthritis? National Institute of Arthritis and Musculoskeletal and Skin Diseases website. www.niams.nih.gov/Health_Info/Osteoarthritis/osteoarthritis_ff.asp. Accessed July 30, 2014.

6. Joint pain. National Institutes of Health MedlinePlus website. www.nlm.nih.gov/medlineplus/ency/article/003261.htm. Accessed July 30, 2014.

7. Olenak J. Musculoskeletal injuries and disorders. In: Krinsky D, Berardi R, Ferreri S, et al, eds. Handbook of Nonprescription Drugs. 17th ed. Washington, DC: American Pharmacists Association; 2012.

8. Treatment options. Arthritis Foundation website. www.arthritistoday.org/arthritis-treatment/?utm_source=AF&utm_medium=leftrail&utm_campaign=treatment&_ga=1.104681858.367668056.1397495076. Accessed July 30, 2014.

9. Osteoarthritis. Arthritis Foundation website. www.arthritis.org/conditions-treatments/disease-center/osteoarthritis. Accessed July 30, 2014.

10. What are glucosamine and chondroitin sulfate? National Center for Complementary and Alternative Medicine website. http://nccam.nih.gov/research/results/gait/qa.htm#b2. Accessed July 30, 2014.

11. McQueen C. Natural products. In: Krinsky D, Berardi R, Ferreri S, et al, eds. Handbook of Nonprescription Drugs. 17th ed. Washington, DC: American Pharmacists Association; 2012.

12. Glucosamine sulfate. Medline Plus website. www.nlm.nih.gov/medlineplus/druginfo/natural/807.html. Accessed July 30, 2014.

13. Chondroitin sulfate. Medline Plus website. www.nlm.nih.gov/medlineplus/druginfo/natural/744.html. Accessed July 30, 2014.

14. Osteoarthritis and complementary health approaches. National Center for Complementary and Alternative Medicine website. http://nccam.nih.gov/health/arthritis/osteoarthritis. Accessed July 30, 2014.