Pain relief osteoarthritis

As a prostaglandin synthetase inhibitor, diflunisal exhibits analgesic, fever-reducing, and anti-inflammatory action. It is used for long- and short-lasting symptomatic relief of low to moderate pain in osteoarthritis and rheumatoid arthritis.Synonyms for this drug are dolobid, adomal, noladol, and others. 

Pavelka K, Peliskova Z, Stehlikova H, Ratcliffe S, Repas C. Intraindividual differences in pain relief and functional improvement in osteoarthritis with diclofenac or tramadol. Clin Drug Invest 1998 16 421-9. 

In early 2009, a phase II clinical trial sponsored by a company aptly named CherryPharm was launched to determine the effects of drinking cherry juice on pain perception in subjects with severe knee osteoarthritis. This human research was based on laboratory studies charting inflammation-induced pain behavior in rats. Results showed that tart cherry extracts reduce inflammation-induced pain and edema similarly to a dose of the pain-relief drug indomethacin. Although these studies indicate that tart cherry anthocyanins may have a beneficial role in the treatment of inflammatory pain, most of this research is based on test-tube or rat studies, meaning that progress remains within the lower half of the research pyramid. 

According to a 2002 survey conducted by the National Institutes of Health, more than 8.2 million Americans have used acupuncture for the prevention of pain or other health problems.7 It is effective at treating numerous ailments, from back pain and menstrual cramps to headaches and fibromyalgia. A study funded by the National Center for Complementary and Alternative Medicine demonstrated that acupuncture provides pain relief and improves function for people with osteoarthritis of the knee.8 There are hundreds of scientific studies like this one outlining the incredible effectiveness of acupuncture. 

Diclofenac decreases inflammation, pain, and fever, probably through inhibition of cyclooxygenase activity and prostaglandin synthesis. It is indicated in the treatment of rheumatoid arthritis, ankylosing spondylitis, and osteoarthritis. Potassium salt is approved for management of mild to moderate pain and primary dysmenorrhea when prompt pain relief is needed. Ophthalmic used for treatment of postoperative inflammation after cataract removal temporary relief of pain and photophobia following corneal refractive surgery. Topical used for treatment of actinic keratosis. 

Acetaminophen (paracetamol JV-acetyl-p-aminophenoF, TYLENOL, others) is an effective alternative to aspirin as an analgesic-antipyretic agent however, its anti-inflammatory effects are much weaker. While it is indicated for pain relief in patients with noninflammatory osteoarthritis, it is not a suitable substitute for aspirin or other NSAIDs in chronic inflammatory conditions such as rheumatoid arthritis. Acetaminophen is well tolerated and has a low incidence of GI side effects. It is available without a prescription. Acute overdosage can cause severe hepatic damage, and the number of accidental or deliberate poisonings with acetaminophen continues to grow. Chronic use of less than 2 g/day is not typically associated with hepatic dysfunction. 

Diclofenac gel is indicated for the relief of the pain of osteoarthritis of the joints amenable to topical treatments such as the knees and those of the hands. Diclofenac patch is indicated for the topical treatment of acute pain due to minor strains, sprains and contusions [2,3]. In controlled trials during the premarketing development approximately 600 patients with minor sprains, strains, and contusions were treated safely with diclofenac patch for up to 2 weeks [4j. A randomized, double-blind, placebo-controlled, trial evaluated the efficacy and tolerability of diclofenac patch, self-administered every 12 h to injury site, in 384 patients aged 18-65 years with minor soft tissue injury and moderate to severe pain intensity >5 (0-10 scale). The most common injuries were contusion (42.6%), strain (31.1%), and sprain (24.4%) most common sites were ankle, shoulder, knee, and foot (67.3%). Patients treated with diclofenac patch experienced improved mean pain scores (40.4% of baseline score) vs. patients using placebo (47.4%, P < 0.05) with an overall pain reduction of 14.8% (Figure 52.3). Patients treated with the patch reached pain resolution 3 days sooner than those in the placebo group (median 10.0 vs. 13.5 days, P = 0.01). Patient response to treatment was rated good to excellent 57.8% for the diclofenac patch vs. 48.4% placebo (P < 0.01). 

COX-2 Inhibitor Celecoxib (Celebrex, Pfizer) inhibits the enzyme COX-2, which is involved in pain and inflammation, but it has no effect on the COX-1 enzyme, which helps to maintain stomach lining. It is prescribed for the relief of pain and symptoms of osteoarthritis and rheumatoid arthritis. Previously, nonsteroidal anti-inflammatory drugs (NSAIDs) were used. NSAIDs inhibit both COX-1 and COX-2 enzymes and cause stomach bleeding (see Case Study 2). 

Temporary relief of pain from rheumatoid arthritis, osteoarthritis, and relief of neuralgias such as the pain following shingles (herpes zoster) or painful diabetic neuropathy. 

Tolmetin (Tolectin) is indicated for the relief of osteoarthritis, rheumatoid arthritis, ankylosing spondylitis, and moderate pain. It is ineffective in gouty arthritis for unknown reasons. Tolmetin can inhibit both COX-1 and COX-2 but has a moderate selectivity for COX-1. The most frequently reported side effects are GI disturbance and CNS reactions (e.g., headache, asthenia, and dizziness). These effects are less frequently observed than after aspirin or indomethacin use. Blood pressure elevation, edema, and weight gain or loss have been associated with tolmetin administration. Tolmetin metabolites in urine have been found to produce pseudoproteinuria in some laboratory tests. 

It is indicated for the relief of pain and inflammation in osteoarthritis, rheumatoid arthritis, ankylosing spondylitis and musculo-skeletal trauma. 

Paracetamol is used for the rapid relief of fever, pains and aches such as headache, earache, toothache, fibrositis, myalgia, neuralgia, arthralgia, osteoarthritis and postoperative pain. 

Finally, local anesthetics can be administered via a transdermal patch.1 In particular, transdermal patches containing 5% lidocaine have been used to treat localized pain in musculoskeletal conditions (osteoarthritis, low back pain, myofascial pain)22,25,26 and various types of neuropathic pain (postherpetic neuralgia, diabetic neuropathy).2,24,58 As indicated in Chapter 2, transdermal patches provide a convenient and predictable method for administering drugs to a given anatomical site, and lidocaine patches are now being used to provide symptomatic relief in many conditions involving fairly localized pain. 

When used to treat osteoarthritis, viscosupplementation typically consists of 2 to 10 weekly injections of hyaluronan Hyalgan, Synvisc, others. Patients often experience a decrease in pain within days after injection, and pain continues to diminish within the first weeks after treatment. Duration of relief is variable, but most patients who respond to viscosupplementation experience beneficial effects for 6 months to 1 year after a series of injections.74... 

This pungent product is responsible for the intense irritant effects of topical Capsicum preparations. Repeated application of capsaicin can deplete and prevent reaccumulation of substance P, an endogenous mediator of pain impulses from the periphery to the CNS. Since the early 1990s, capsaicin cream has been available in the U.S. as an approved drug for relief of postherpetic neuralgia and pain due to diabetic neuropathy and osteoarthritis. 

Oral ibuprofen is often prescribed in lower doses (< 2400 mg/d), at which it has analgesic but not anti-inflammatory efficacy. It is available over the counter in low-dose forms under several trade names. A topical cream preparation appears to be absorbed into fascia and muscle an (S)( ) formulation has been tested. Ibuprofen cream was more effective than placebo cream for the treatment of primary knee osteoarthritis. A liquid gel preparation of ibuprofen 400 mg provided faster relief and superior overall efficacy in postsurgical dental pain. In comparison with indomethacin, ibuprofen decreases urine output less and also causes less fluid retention than indomethacin. Ibuprofen has been shown to be effective in closing patent ductus arteriosus in preterm infants, with much the same efficacy and safety as indomethacin. Oral ibuprofen is as effective as intravenous administration in this condition. 

NSAIDs are groups of unrelated organic acids such as mefenamic acid, which have analgesic, antiinflammatory, and antipyretic activities. NSAIDs are used to relieve mild to moderate pain, raised temperature, and acute and chronic inflammatory disorders such as osteoarthritis, rheumatoid arthritis, juvenile chronic arthritis, and ankylosing spondylitis. NSAIDs are applied locally for the relief of muscular pain and are useful in ophthalmic preparations for inflammatory eye disorders.1-4 NSAIDs have been used to relieve pain, particularly in cancer patients, forming a cornerstone in pain management. NSAIDs also are used... 

HA is the basis of the lubricant and "shock absorber" properties of synovial fluid. Osteoarthritis is the most common disease of joints, and correlates with a deterioration of synovial HA. Intra-articular administration of HA is a widely used therapy for OA, providing relief of pain, and other symptoms. The first arthroscopic viscosurgical application of HA was in 1989 [150]. There are several preparations of partially cross-linked HA that are now used in this context. However, only one preparation will be discussed here. Synvisc , also known as hylan G-F 20, is a viscoelastic fluid containing modified HA produced from rooster combs. Hylans are cross-linked derivatives of HA. Synvisc contains hylan A (average molecular size 6x10 Da) and hylan B, a hydrated gel in a buffered salt solution. 

Capsaicin is a counterirritant that depletes and prevents reaccumulation of substance P, principal transmitter of pain impulses, from periphery to the CNS. Capsaicin is indicated in temporary relief of pain from rheumatoid arthritis and osteoarthritis relief of neuralgias (e.g., pain after shingles, diabetic neuropathy). Capsaicin is a naturally occurring substance derived from hot chili peppers of the genus Capsicum. 

Celecoxib is a selective COX-2 inhibitor/GI agent that reduces inflammation (e.g., pain, redness, swelling, heat), fever, and pain by inhibiting chemicals in the body that cause inflammation, fever, and pain. This is probably caused by the inhibition of prostaglandin synthesis, primarily via inhibition of cyclooxygenase-2 (COX-2) isoenzyme. Celecoxib is indicated in relief of symptoms of osteoarthritis relief of symptoms of rheumatoid arthritis in adults management of acute pain in adults treatment of primary dysmenorrhea and reduction of the number of adenomatous colorectal polyps in familial adenomatous polyposis (FAP), as an adjunct to usual care (e.g., endoscopic surveillance, surgery). 

Fenoprofen is a NSAID agent, which decreases inflammation, pain, and fever, probably through inhibition of cyclooxygenase activity and prostaglandin synthesis. It is indicated in the symptomatic relief for rheumatoid arthritis, osteoarthritis, and mild to moderate pain. 

Meclofenamate is indicated in the relief of mild to moderate pain (50 mg/6 hours) in the treatment of primary dysmenorrhea (100 mg t.i.d.) and in acnte and chronic rhenmatoid arthritis and osteoarthritis (200 to 400 mg/day in 3 to 4 equal doses). Meclofenamate is a nonsteroidal antiinflammatory agent that has analgesic and antipyretic properties. The menstrual cycle is associated with two potentially incapacitating events dysmenorrhea and the premenstrnal syndrome. Substantial evidence indicates that the excessive production of prostaglandin 2 is the major sonrce of painful menstruation. The nonsteroidal antiinflammatory drngs such as aspirin, ibuprofen, meclofenamate, mefenamic acid, and naproxen are used to treat dysmenorrhea. 

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