WHY PARACETAMOL WON’T HELP . . . AND THE TREATMENTS THAT WILL
OSTEOARTHRITIS patients all have one thing in common: pain.
Controlling that pain is vital — not only to make life bearable, but also to help you stay fit and strong.
For many, paracetamol is the first line of defence. Unfortunately, ‘paracetamol has very little effect on osteoarthritis pain’, says Professor Philip Conaghan, a consultant rheumatologist.
A 2016 study of 74 trials published in the Lancet found that paracetamol had only a 0 to 4 per cent chance of improving osteoarthritis pain.
The next option is a non-steroidal anti-inflammatory drug (NSAID), such as ibuprofen or diclofenac.
NSAIDs are highly effective at relieving arthritis pain, the same 2016 study concluded. However, the pills aren’t for everyone. They can have side-effects, including stomach problems. They may also interfere with other medicines, including those for high blood pressure.
But these problems can be avoided with NSAIDs in cream or gel form that are rubbed on the skin. Doctors can prescribe these. Weaker formulations can be got over the counter.
Capsaicin cream, also prescribed, can be offered if topical NSAIDs aren’t helping. Derived from chilli peppers, it blocks the nerves that carry pain messages to the brain.
Opioid painkillers, such as codeine, may be a last resort but these are not very effective for osteoarthritis. A 2014 review by the authoritative Cochrane Collaboration found that for osteoarthritis pain opioids were
little opioids If used better can for become addictive than placebos. any length of time, many, ‘the major issues are things such as constipation and drowsiness’ says Professor Conaghan. too much opinion ‘With a bit can be a cause in your system they
Some patients may be offered injections of steroids into their knee. This may buy them up to six weeks' pain relief, he explains.
‘We use them as “circuit-breakers”, to give a patient a good window of
opportunity to really work on building up their muscles.’
Many people, however, are discovering that the key to relief from the pain of osteoarthritis is not drugs, but exercise.
In England an exercise rehabilitation programme for people with chronic knee and hip joint pain is being rolled out to help people combat their issues.
The initiative is called ESCAPE-pain is a six-week rehabilitation programme of two hour-long classes a week. It’s now running in more than 200 community settings, including leisure centres and church halls.
Each class involves 40 minutes of exercises tailored to each patient’s ability, from stretches to riding stationary bikes. It’s suitable for anyone over 45 with knee or hip osteoarthritis and it is hoped other countries will follow suit.
Research showed the long-term benefits are comparable to those of outpatient physiotherapy for chronic knee pain.