Options for Pain Besides Anti Inflammatory medications
Topics discussed:Anti inflammatory medications, side effects, why you should minimize.
Other options.Supplement options.Regenerative medicine options.Disease modifying medication options.
Hello, this is Siddharth Tambar from Chicago Arthritis and Regenerative Medicine. Welcome to our weekly educational meeting that is live, it’s August 17th, 2020, welcome everyone. On this broadcast I tried to go over either questions that I’ve gotten from patients in the last week or that my own team has, from either their own sort of questions or things that they’re hearing from patients and sometimes also just frequently asked questions that I get about musculoskeletal health and wellness and so today what I’d like to talk about is anti-inflammatory medications, nonsteroidal anti-inflammatory medication why you want to avoid them other options and I think smart ways about how we can tell if someone’s improving sometimes by how they’re using less anti-inflammatory medications.
So anti-inflammatory medications have been around since roughly the 1960s the more commonly used one since then and they have gone from being prescription based medications to essentially over-the-counter medications and they can include things as routine as Ibuprofen Advil, Aleve to things that are more prescribed like celebrex, diclofenac and even other prior meds that have been taken off the market, including things like Vioxx and they’re used so routinely by people for aches and pains that there’s a relative normalization that people have when it comes to using these medications and because of that, they feel like it’s downright low risk or no risk and the problem is that that is not correct, just because it’s sold over-the-counter, just because it’s utilized super frequently does not mean that it’s actually low risk or no risk and so there are a number of potential side effects that you should be aware of and that includes things such as stomach ulcers, kidney damage, liver damage and even increasing the rates of heart disease. So these are medications that have potential issues in the past when there really weren’t other good treatment options, frankly for various inflammatory arthritis conditions, nonsteroidal anti-inflammatory medications were considered revolutionary. That was however, I mean, 40 to 50 years ago if not longer than that and so in this day and age, when we have a lot of other treatment options, we should be utilizing, maximizing those options in order to really do better because the potential side effects when you sort of weigh risks, benefits and then consider other options you need to realize that these kinds of medications, while they may provide pain relief, they don’t really fix what your underlying problem is and the problem with that is you may be getting some degree of pain relief, but not only are you not correcting longterm issue, but you’re actually increasing the risk of longterm issues as well so considering all that you need to have other options.
The other thing is that the way that I look at it for my patients who are telling me that they’re stuck taking nonsteroidal anti-inflammatory medications long term is that whatever the condition is that we’re treating is obviously not being adequately controlled or treated and it’s a signal to me that we need to be doing more than just having you take that kind of pain medication that kind of anti-inflammatory medication and it’s a signal to me that I need to be digging deeper, looking further into what the problem is in order to make sure that you are being adequately treated.
So what are other potential options? Anytime you have a musculoskeletal issue, arthritis, tendonitis, back pain injuries that’s causing pain, functional limitations, you know, reduction in your normal activities or exercise, you absolutely should be considering physical therapy and some over-the-counter supplements. So physical therapy is that’s a no brainer, quite frankly, if you have an injury or if you have a abnormal motor pattern, exercise pattern, movement pattern, physical therapy is very helpful to help correct that, improve that and optimize that so 100% you should definitely be doing that.
The kind of over-the-ounter supplements that I recommend and, you know, I hear a lot of things that patients are taking, a lot of them without really very good evidence of whether they work or not, but a lot of them do seem to provide patients pain relief, the three big ones that I generally recommend however, which do have decent evidence of efficacy in arthritis and tendonitis patients would include glucosamine, curcumin as well as omega-3. So glucosamine which has been around for many years has decent evidence that it can help with wear and tear arthritis, wear and tear arthritis is in particular for knees, there’s evidence that glucosamine can help in 50% of people that take it. Number two, omega-3, omega-3 is a anti-inflammatory that you can get from fish oil, flaxseed oil those are the two big sources and there’s decent evidence that it can help with pain and even functional limitations in inflammatory arthritis conditions such as Rheumatoid arthritis. So I think it’s a good low risk anti-inflammatory medication and lastly is curcumin, which you get in turmeric, turmeric’s been around for, I mean, centuries, if not thousands of years utilize medicinally for all that time as well. There’s actually been some evidence that curcumin can actually provide similar degree of pain relief as anti-inflammatory medications for wear and tear arthritis. So again, a great low risk option that I think can provide pain relief and certainly preferable over anti-inflammatory medications may not be as strong, but it’s low risk, gives benefit and is definitely preferable on a longterm basis glucosamine, omega-3 and curcumin.
So those really conservative options, physical therapy, exercises, altering some of your activities, over-the-counter supplements is not enough then if you’re still kind of hooked onto anti- inflammatory medications, then I would recommend escalating to the next level of treatment and what that treatment is depends on what is really the cause of your problem. The issue with anti-inflammatory meds is that they don’t treat the cause of your problems if you have, let’s say a wear and tear arthritis or tendonitis issue, then the next step would be an injection option, again, I don’t recommend steroid injections cause it’s not the right longterm option, but rather a regenerative medicine treatment options such as platelet-rich plasma, bone marrow aspirate stem cells is really the next appropriate treatment option to consider treating your arthritis, tendinitis and pain. Number one, it will actually do a better job in terms of longer term management or for that isse compared to anti-inflammatory med. Number two, it’ll actually be safer for the joint, the tendon, the ligament, it’ll strengthen those tissues as well, which is another reason why it helps with pain relief and functional improvement also.
On the other end, if your issue is more of an inflammatory arthritis conditions, such as Rheumatoid arthritis, Psoriatic arthritis or Ankylosing spondylitis, I would strongly recommend if you have significant active inflammation throughout your body, to then utilize a medication such as, a disease modifying treatment, a biologic treatment that will actually treat the condition at its source and what’s really causing the inflammation and problem rather than just taking more and more anti-inflammatory meds. Now, there are some people where medication may be an issue because they have other medical problems and number one, understand that your physician should be nuanced enough to be able to choose a treatment that’s going to be low risk in your case. In some settings, if someone cannot tolerate those kinds of medications, rather than being stuck on those kinds of anti-inflammatory meds, like Ibuprofen, Advil, Meloxicam, you can then consider some of the regenerative medicine treatment options that have more of an anti-inflammatory angle to them and so in all cases, these are the options that you should be considering for chronic musculoskeletal pain rather than chronic anti-inflammatory medications and really the reason is because you should always be thinking longterm, longterm in terms of benefit and longterm in terms of potential risks and when you weigh all those together, you realize that chronic, Ibuprofen, Advil, Diclofenac anti-inflammatory meds is not right way to go.
Another interesting thing is that for patients who are on those kinds of medications long term, anytime we’re trying to figure out how well is somebody doing from treatment for their musculoskeletal condition. You’re always looking for objective evidence, whether that’s objective evidence that inflammation is down in a joint or a patient telling you, hey, my pain level is down or hey, my functional improvement is better or my range of motion is better I’m able to do activity X, which I was not able to do six months ago those are somewhat objective options. Things like pain scores can be subjective of course, but there are definitely disease activity scores and ways to get more objective measurements from that. But another, I think interesting objective way is, has a person reduced their pain medication? Have they reduced their ingestion of anti-inflammatory medications? That’s another, I think clever and nuanced way to tell if someone is actually improving, because the goal is to get you off those kinds of medications.
So anti-inflammatory medications, not the way you want to go longterm for treating arthritis, tendinitis, injuries and back pain definitely plenty of other better options. If you’re stuck on those kinds of meds, make sure you’re maximizing things like over-the-counter supplements and physical therapy. If that’s not enough then make sure you’ve looked into regenerative medicine treatment options or medications for inflammatory arthritis conditions and lastly, if you’re not getting that kind of opinion, make sure you find a trusted physician who will keep you on track to make sure you’re being optimized in terms of your musculoskeletal health. Thank you for your time until we reconnect and again, I do a live session Mondays and Wednesdays until the next time have a good day and live well, bye bye.
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About this video
In this video Siddharth Tambar MD from Chicago Arthritis and Regenerative Medicine discusses Options for Pain Besides Anti Inflammatory medications.