Is There a Safe Treatment for Gout Pain?

Gout is an extremely painful condition in which uric acid builds up in the blood stream to the point that it precipitates out in the form of small sharp crystals. When these lodge in the joints, the result is excruciating pain. The joints may also become red and swollen. Unlike arthritis pain, gout pain may go away after a few days or weeks. But a person who has had gout pain is quite susceptible to a another flare-up. What can be done?

Pros and Cons of Naproxen for Gout Pain:

Q. I used to take naproxen for gout pain during a flare-up, but now I hear it can cause a problem with my Coumadin. Is there any safe anti-inflammatory medication that can be taken with Coumadin to help with the intense pain caused by gout flare-ups? Are there any natural anti-inflammatory supplements or foods that might help?

A. Warfarin (Coumadin) is an anticoagulant medicine that reduces the risk for blood clots. Drugs like naproxen or other NSAID pain relievers (celecoxib, diclofenac, ibuprofen, meloxicam, etc.) can add to the anti-clotting effect and increase the risk of bleeding. Adding to the danger of this combination, NSAIDs often damage the lining of the digestive tract. Even a tiny ulcer could bleed dangerously when warfarin is being taken.

Tart Cherries for Gout Pain:

Many people report that tart cherries or cherry juice (Montmorency) can be helpful to ease gout pain (BMC Complementary and Alternative Medicine, March 1, 2016).  We could find no research on interactions between cherries and warfarin. If you decide to try cherries, make sure you have your blood tested on a regular basis to make sure it is not altering your INR (International Normalized Ratio, a measurement of how well the warfarin is working).

What Else Can Be Done?

Presumably your doctor did not prescribe the most common gout treatment, allopurinol, because it might interact with warfarin and raise the INR. Another gout drug, colchicine, may also interact badly with warfarin (Canadian Pharmacists Journal/Revue des Pharmaciens, Jan/Feb, 2011). Nonetheless, there are other steps you might take to decrease your risk of another flare-up with its attendant gout pain.

Research on mice demonstrated that an old medication, olsalazine (Dipentum), can bring uric acid down effectively (Niu et al, Journal of Pharmacological Sciences, Nov. 2017). Your doctor might be willing to prescribe it.

Lifestyle Approaches to Control Gout:

Because the kidneys are responsible for flushing out uric acid, drink plenty of fluid-but not alcoholic beverages such as beer, which could make the problem worse. Hydration is crucial.

Foods to Avoid:

There is a long list of foods to avoid, including anything with high fructose corn syrup or sugar. Weight loss is beneficial, and avoiding excess carbohydrates to lose weight also appears helpful for those who are suffering painful joints (Kolasinski, Current Rheumatology Reports, April 2014). People with gout are also advised to avoid foods rich in purines: liver, kidney, mackerel, herring, sardines or anchovies; and even vegetables like asparagus, cauliflower, beans, peas and lentils, mushrooms and spinach. We found a recommendation for a low-purine diet from the University of Pittsburgh that might help you avoid additional gout pain.

Revised 6/14/18