The People's Perspective on Medicine

Opioids for Osteoarthritis Seem Scary! How About Topical NSAIDS Instead?

People with osteoarthritis are stuck. Opioids are heavy guns and can be addicting. Oral NSAIDs can cause ulcers or heart attacks. What about topical NSAIDs?

When you are in pain it is hard to function. People who have osteoarthritis of the spine, hips or knees have difficulty getting around, let alone exercising. There are no perfect drug solutions for treating this kind of inflammation. We were surprised to learn that some doctors are still prescribing opioid pain relievers for osteoarthritis. That might have been common a decade ago, but these days it seems inappropriate. What else can people do when they are in chronic pain? Why aren’t more doctors prescribing topical NSAIDs?

Opioids for Osteoarthritis?

Q. I have osteoarthritis of the knees and back. Some days I can barely get out of bed. My primary care doctor advised me to take hydrocodone every eight hours as needed.

Taking opioids regularly worries me, so I haven’t taken this medicine recently. What else can I do to deal with the pain and stiffness?

Alternatives to Opioids?

A. You and millions of other arthritis sufferers are caught between the proverbial rock and a hard place. Oral medicines like opioids or NSAIDs (celecoxib, diclofenac, ibuprofen, naproxen, etc) have potentially serious side effects. You can read more about oral NSAIDs at this link.

Opioids Were No Better Than…

In a study published in JAMA (March 6, 2018), opioids proved no better for osteoarthritis than medications like acetaminophen, oral NSAIDs, antidepressants (amitriptyline, etc) or liniments containing capsaicin or lidocaine.

What About Topical NSAIDS?

Topical NSAIDs such as diclofenac gel or patch (Flector patch, Voltaren Gel, etc) may have fewer systemic side effects than oral medicines (British Journal of Sports Medicine, May, 2018). Some people get substantial benefit from topical NSAIDs while others are super sensitive to side effects.

Readers Share their Stories with Topical NSAIDS:

William in California got relief from the Flector Patch:

“I went off Celebrex after many years and switched to Pfizer’s “Flector Patch,” which gave me twice the pain relief of Celebrex.”

Chas in New Jersey reports:

“I have been using Diclophenac gel (previously Voltaren Gel) for years for my arthritis pain, ever since the price of Flector patches went through the roof. I have never had any adverse effects with either version of diclophenac gel, abdominal or otherwise, except occasional skin irritation.”

Harriet in Connecticut loves her “magic patches”

“I’ve been using Voltaren Gel and Flector patches( I have called them “magic patches” for years. Oral NSAIDS cause me major stomach pains. I use the gel for knees, feet, and hip arthritis pain and it works well enough so I can continue on my demanding exercise schedule.

“These meds are not going through your liver, kidneys and other sensitive internal organs at the same rate as oral meds. So far, and this is 3 years and counting, I’m not having any reaction issues. I get these meds at my local Connecticut pharmacy. They do require a prescription from my doctor.”

Tom in Spokane, Washington developed a skin sensitivity to topical NSAIDs like Voltaren Gel:

“About 15 years ago I was prescribed Voltaren Gel (VG) for chronic pain on the top of my foot. I used it with moderate to great success for about two years. At that point I developed a severe rash. I had developed an allergy to this topical medicine. When I stoped using VG the rash stopped. This past January I developed medial tendonitis in my right elbow. I attempted to use VG and once again got a severe rash within about 3 days.”

Jesse in Texas could not tolerate topical NSAIDs:

“I used Pennsaid gel and within weeks developed painful stomach problems diagnosed as gastritis by upper GI scope. The doctor said it was caused by Pennsaid. I was told never to take an NSAID again. That is unfortunate because it was the only thing that gave any pain relief for my knees. I had with a torn meniscus. The burning GI pain kept me awake at night until it healed.

“The Pennsaid gel had a warning that it can cause heart damage, ulcers and death. So now, despite having CRPS (Complex Regional Pain Syndrome) I am going to have knee surgery. It may not be helpful at all and could make me worse.”

Learn More About Alternatives for Arthritis!

You can learn more about the pros and cons of topical NSAIDs as well as nondrug approaches to easing joint pain in our book, The Graedons’ Guide to Alternatives for Arthritis. It is $12.95 plus $4 shipping and handling from:

Graedon Enterprises, Inc., AFA

PO Box 52027

Durham, NC 27717-2027

You can also order it from online book store at www.PeoplesPharmacy.com.

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About the Author
Joe Graedon is a pharmacologist who has dedicated his career to making drug information understandable to consumers. His best-selling book, The People’s Pharmacy, was published in 1976 and led to a syndicated newspaper column, syndicated public radio show and web site. In 2006, Long Island University awarded him an honorary doctorate as “one of the country's leading drug experts for the consumer.” .
Graedons’ Guide to Alternatives for Arthritis (book)
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This 100+ page book provides information on a variety of herbal and home remedy-base treatment options for Arthritis. Are there safer options than NSAIDs?

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I’ve had great success with knee pain by having hyaluronic acid injections. Having one a week for 5 weeks would give me about 4 years worth of relief. I also took two capsules of hyaluronic acid daily. The Dr. used Supartz brand. The last time I thought I needed it, I took Instaflex (OTC) capsules instead, and it has really helped and I have not had the injections! DMSO cream is also very helpful for the occasional ache or pain. That may have to be ordered as it is not available in all states. I order through Vitacost as it is less expensive.

Google, Rex Newnham and arthritis. Spend a couple of dollars on a box of Twenty Mule Team Borax. Its enough to last you a life time. You can get info on Earth Clinic.com on how to use it. Do your research and get it right. Some people see good effects in a few days. I have used it for a couple years and it works.

It is really sad that doctors don’t look at food before suggesting drugs. I spent two years seeing doctors, having tests, getting PT, etc., but only got worse hip, knee, shoulder, elbow and back pain. One day I read an offhand remark about gluten causing inflammation. I researched it, and the very next day went gluten free. Within two weeks, I was free from pain and could move again. That was 10 years ago, and I am still gluten free, and still can move without pain. I don’t have celiac, just osteoarthritis, which is kept at bay. I do not eat any dairy, red meat, poultry. My diet is rich in vegetables legumes and non-glutinous grains.

In 2008 at the age of 70, I had serious pain in my right hip. While I waited to schedule a hip replacement I was prescribed celebrex for the pain: As the result of the celebrex I developed A-Fib. Also, I suffered kidney pain and infection as a side effect of the celebrex.

The opioids actually work for pain, and in retrospect I should have taken opioids. Once in a great while I have neuropathy pain in my feet. The only thing that cuts the pain is opioids, nothing else. Now doctors are paranoid about prescribing opioids; however, they are very effective in pain management, and the tragedy is that the opioid paranoia and hysteria is responsible for many people suffering from pain with no relief in sight.

I was prescribed voltaren for knee and back pain some years ago. The stuff was magic but at $50 per tube I only used it when I absolutely needed it. On a trip to Canada I discovered it was available over the counter for $17 a tube. I buy a couple of tubes every trip.

Using the OTC patches help with back pain. It takes the edge off the pain.

NSAIDS are a no-go for many people with osteoarthritis. Blood thinners and aspirin, which many people have to take, cannot be combined with NSAIDS. There are also a lot of other medicines that have an intereaction with NSAIDS. My doctor gave me codeine but, for obvious reasons, I don’t really want to use it. However, I have found acupuncture pretty effective for any kind of pain.

My Mom was prescribed an NSAID gel, and it was over $200 for a tube this past summer. Insurance would not cover it (Medicare), and she could not afford the cost. Her insurance did cover the oral form, so her doctor went ahead and prescribed that for her. It does not make sense to me that insurance will cover the form that will most likely cause problems that might cost the insurance company more money in the long run. Maybe the drug company will not compromise on price with insurance companies?? Anybody have an explanation?

Thank you so much for adding the Newsletter Reading List back to the bottom of each newsletter subject. It is so helpful to have a link to each subject without returning to the email each time!
I have requested its return several times and have noticed it is available this week. Please continue to provide this helpful link!

Oral NSAIDs — I think I tried them all over the years. They wrecked my stomach, and so I’m reluctant to touch even topical NSAIDs with a ten-foot plastic fishing rod. Opioids are a definite no-no for everyday life: reserved for post-surgery if unavoidable.

I also have Type 1 diabetes, for which a low-carb diet helps me use less insulin and control my blood sugar, so no raisins soaked in anything, either. 😸

I get by with some topical freezing spray, a cane, and sometimes a little CBD oil, but that’s the extent of it. (Long hikes in the woods are a thing of the past.)

If some of our friends, using the word very loosely, in Big Pharma finally develop something that’s both effective and safe for osteoarthritis, I do hope they’ll give me a call. I am not holding my breath.

I have been taking NSAIDS for many years and now on Naproxin 500mg. twice daily. I was recently told that this is damaging my kidneys and liver but, if I do not take it., I have pain all over
and I don’t know what to do. I always take it with food and have not been seeing any side effects from taking this medication.

Without Glucosamine&Chondroitin and copious 95% Curcumin I would be pretty much housebound. With them I get a twinge in a thumb now and then or a knee will be uncomfortable for a couple of hours. And they don’t come with the warnings Naproxen has or the untoward effects of too much Ibuprofen.

My father had osteoarthritis in his knees and oral medications were really causing severe stomach problems and bleeding. Someone told him about topical ibuprofen but he could not obtain it in the US. Through contacts he was able to get some from Europe. I t provided relief

Giving up sugar and grains got rid of all my arthritis pain, along with many other benefits.

Unfortunately (I don’t eat grains or sugar anyway) that doesn’t work for me.

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