When Are Pain Medications Appropriate for Arthritis Patients?

Analgesics are an option for controlling arthritis pain

Some arthritis patients try to do without pain medications (analgesics) because they fear becoming addicted. Are these patients doing more harm than good by avoiding pain medications? When is it appropriate for pain medications to be prescribed as part of the treatment plan for arthritis patients? Are pain medications appropriate as a long-term treatment or maintenance treatment, or should they only be used short-term?

Chinese man taking medication
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Pain Is Often Poorly Managed

Most patients with rheumatic conditions experience pain or discomfort as a part of their condition. Recognition of patients’ pain is an important aspect of patient care but, despite the fact that chronic pain adversely affects the quality of life of patients, it is often poorly managed.

Measures to Control Pain

Non-pharmacologic Measures

Non-pharmacologic measures to control pain include practitioner-administered treatments such as:

  • meditation and relaxation
  • hypnosis
  • massage
  • acupuncture
  • exercise

Pharmacologic Measures

Pharmacologic treatments include:

  • Topical preparations
  • Herbal remedies
  • Dietary supplements
  • Antidepressants
  • Muscle relaxants
  • Anticonvulsants
  • NSAIDs (nonsteroidal anti-inflammatory drugs)
  • Acetaminophen (Tylenol)
  • Opioids

Opioids

Due to their effectiveness, the use of opioids is a common therapy to treat musculoskeletal pain. Their long-term use to treat musculoskeletal pain doubled from 1999 to 2016. They can be quite useful to help control the pain of periodic flares. Some patients will find that they can be taken during the day and not cause drowsiness, while others will need to limit their use to evenings. Opioid therapy for long-term non-cancer musculoskeletal pain remains controversial due to insufficient evidence for effectiveness and concern over adverse effects, overdose, and misuse.

Despite their benefits, there is a potential downside to the use of opioids. However, studies have not sufficiently assessed the risks of long-term use of opioids in patients with chronic musculoskeletal conditions. 

There has been a tendency to use stronger opioids such as hydrocodone (e.g., Norco) and morphine (MS Contin, Avinza), although tramadol (Ultram) is a weak synthetic opioid that has gained widespread use.

Side Effects

In addition, like many medications, side effects exist in addition to drowsiness and include nausea, constipation, and cognitive impairment. Many may cause withdrawal symptoms such as dizziness, anxiety, as well as other physical symptoms if stopped suddenly.

Dr. Scott Zashin says: “In general, I recommend most patients try to first control their chronic pain with non-pharmacologic therapies or pharmacologic therapies without addictive properties.”

Scott J. Zashin, MD, is a clinical assistant professor at the University of Texas Southwestern Medical School, Division of Rheumatology, in Dallas. Dr. Zashin also is an attending physician at Presbyterian Hospitals of Dallas and Plano. He is a fellow of the American College of Physicians and the American College of Rheumatology and a member of the American Medical Association. Dr. Zashin is the author ofArthritis Without Pain - The Miracle of Anti-TNF Blockers and co-author of “Natural Arthritis Treatment.”

3 Sources
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  1. Stokes A, Berry KM, Hempstead K, Lundberg DJ, Neogi T. Trends in prescription analgesic use among adults with musculoskeletal conditions in the United States, 1999-2016. JAMA Netw Open. 2019;2(12):e1917228. doi:10.1001/jamanetworkopen.2019.17228

  2. Nadeau SE, Wu JK, Lawhern RA. Opioids and chronic pain: An analytic review of the clinical evidenceFront Pain Res (Lausanne). 2021;2:721357. doi:10.3389/fpain.2021.721357

  3. Welsch P, Petzke F, Klose P, Häuser W. Opioids for chronic osteoarthritis pain: an updated systematic review and meta‐analysis of efficacy, tolerability and safety in randomized placebo‐controlled studies of at least 4 weeks double‐blind duration. Eur J Pain. 2020;24(4):685-703. doi:10.1002/ejp.1522

By Scott Zashin, MD
Scott J. Zashin, MD, is board-certified in internal medicine and rheumatology. He was a volunteer clinical professor of internal medicine at the University of Texas Southwestern Medical School Dallas.