painkillers for osteoarthritis
October 31, 2011 | 15,00 EUR | answered by Dr. med. Ralf Berg
Due to ankylosing spondylitis, I have developed hip osteoarthritis. After being medicated with Indomethacin and Ibuprofen (I also did not tolerate Cox-2 inhibitors at the time), diclofenac preparations worked best for me. (I usually manage with 50-100 mg daily). However, following several recent publications that mention an increased risk of heart attack with diclofenac intake, I am now unsure. I would like to switch to a different pain medication and know if there is a true alternative to nonsteroidal anti-inflammatory drugs that can be recommended (preferably over-the-counter).
Hello, dear inquirer
There is actually no real medication alternative to the NRSA. The COX 2 inhibitors would be an option, but unfortunately you are one of the people who cannot tolerate them.
Of course, the steroidal pain medications like cortisone are a real alternative, but due to the side effects of long-term use, they are not recommended for osteoarthritis as a long-term therapy, except in cases of acute exacerbation. Also, these are not available over the counter.
However, the cardiac side effects should not be overestimated. It is not clear if they affect all individuals or only those with pre-existing heart conditions. Additionally, there is no conclusive model that could explain these side effects. It has only been observed that long-term use may come with an increased risk.
If you have good liver values, do not consume much alcohol, you could try using paracetamol. As far as we know, this does not have the same side effects and is also available over the counter. However, in the case of arthritic pain, you would need to take a high dose to experience relief (2-3 grams per day, equivalent to 4-6 tablets of 500 mg).
(Be sure to monitor your liver values!)
Due to its good tolerability, this may be worth a try for you.
But as you described, despite all the side effects, diclofenac = Voltaren remains the most effective medication for osteoarthritis. If paracetamol is not sufficient for your pain, and you do not have heart disease, choosing diclofenac is probably the best option.
Best regards, Dr. R. Berg
