Pain Relief Pharmacy

Surgery

Surgery is reserved for people with severe osteoarthritis who do not get pain relief from medicine, home treatment, or other treatments and who have significant loss of cartilage.

Surgery relieves severe, disabling pain and may restore joint function and mobility. Some surgical procedures, such as osteotomy or arthroscopy, may postpone total joint replacement.

Surgery Choices

Surgeries to treat osteoarthritis may include:

• Arthroscopy, which can provide temporary (and sometimes long-term) relief of symptoms of osteoarthritis. Arthroscopy also can fix a joint if it becomes “locked” or stuck due to loose cartilage or bone fragments.
• Osteotomy of the knee or hip, used in cases of hip deformity and abnormality of the legs in active people younger than 60 with mild osteoarthritis.
• Joint replacement surgery, considered when pain and disability have not been controlled by conservative treatment such as exercise and medicine, and joint damage is visible on X-rays.¹⁶
  • Shoulder replacement surgery
  • Hip replacement surgery
  • Knee replacement surgery
• Hip resurfacing surgery, which doctors use primarily for younger, more active people with pain and disability due to hip deterioration. No long-term results are available yet, but short-term results are positive up to about 8 years after surgery.
• Arthrodesis, surgery that joins (fuses) two bones in a diseased joint so that the joint can no longer move. Doctors may use it for the spine, ankles, hands, and feet, but rarely for the knees and hips.
• Small joint surgery, used if the joints of the hands or feet are so disabled that function is impossible. Severe finger deformity is more commonly seen in rheumatoid arthritis than in osteoarthritis. Doctors replace toe joints occasionally, in cases of severe pain and disability, but rarely in younger or more active people.

What To Think About

Surgery for osteoarthritis is considered a choice (elective surgery). Surgery may not be appropriate for some people who are in poor health or who have other diseases that would make surgery less successful.

You will need several months of rehabilitation following surgery.

An artificial joint may only last for 10 to 20 years. You may need repeat surgery if an implanted joint wears out. Shoulder replacement for osteoarthritis is less common, and generally less successful, than hip or knee replacement.

Many people with arthritis have symptoms and degeneration in the inner knee. A new procedure inserts a small C-shaped cup called a UniSpacer in the joint space of the inner knee. The intent is to cushion the joint to delay the need for a knee replacement. Studies on the UniSpacer continue.

If you decide to have surgery: Before you go to the hospital, it’s a good idea to make sure your home is ready for your return. Be sure you have someone to help you for a few days after you come home, and put a telephone and important phone numbers near where you will be spending time. If your surgery will be on your leg or foot, you may need to avoid stairs for a while. Be sure there’s a bed for you to sleep in without having to go up or down stairs. If your bed is low, consider raising it with extensions under the legs or even an extra mattress on top. Finally, clear away any extra furniture and clutter, small rugs, or cords on the floor. You need a safe walking surface with plenty of space to move around safely.

Medicine can often help you to relieve the symptoms of osteoarthritis and allow you to continue daily activities. But pain relief medicine does not cure arthritis or decrease the rate of cartilage breakdown and should be used along with home treatment and other treatments, as recommended by your health professional.

• You can often manage mild to moderate arthritis pain with nonprescription pain relievers, such as acetaminophen or nonsteroidal anti-inflammatory drugs (NSAIDs).
• Moderate to severe pain may require stronger pain relievers, such as opioids. Your doctor may also prescribe opioids if you cannot tolerate NSAIDs.

Medication Choices

Medicines doctors use to treat osteoarthritis include:

• Acetaminophen, which may help relieve pain.
• Nonsteroidal anti-inflammatory drugs (NSAIDs), which reduce inflammation and relieve fever.
• Corticosteroid injections in the joint (intra-articular), which reduce inflammation.
• Hyaluronan injections, which may relieve pain.
• Opioids, which may relieve moderate to severe pain.

Some studies have shown that acetaminophen and nonsteroidal anti-inflammatory drugs are equally effective for mild to moderate joint pain. Other studies suggest that NSAIDs are more effective than acetaminophen and that side effects are similar.

Topical (applied to the skin) agents may provide short-term pain relief. These include topical NSAIDs, capsaicin, and pain-relieving creams.

What To Think About

Pain relief is important, not just for quality of life and for your mood, but for maintenance of joint function and rehabilitation. If you limit or decrease the movement of your joints because of pain, you will develop tightening, shortening, and weakness of the ligaments, tendons, and muscles that move the joint. This leads to less mobility and function.

When using pain medicine, your goal is to find relief without side effects. Acetaminophen has the fewest side effects of any pain medicine for osteoarthritis. In some studies it is as effective as nonsteroidal anti-inflammatory drugs (NSAIDs) and in some studies it is not. But because it has the fewest side effects, it is the medicine to try first for pain relief.

If you have no history of gastrointestinal bleeding (such as stomach ulcers), kidney insufficiency, or heart failure and if you are not taking blood thinners, you can try nonprescription NSAIDs, including ibuprofen (such as Motrin or Advil) or naproxen (Aleve). Take the lowest possible dose that controls your pain. It may take a couple of weeks before NSAIDs can relieve your pain well.

In addition to relieving pain, NSAIDS also reduce inflammation. But inflammation does not commonly occur with osteoarthritis, so most cases of osteoarthritis do not require an anti-inflammatory drug (NSAID). Even so, many people with osteoarthritis say that NSAIDs work well for them. Just remember that NSAIDS do not stop joint tissue from breaking down as osteoarthritis progresses.

If you are taking NSAIDs every day, especially for longer than 1 month, your doctor may want to check a blood count or a blood test for kidney function. He or she may also suggest that you take omeprazole to protect you from stomach ulcers. If NSAIDs are not effective, contact your doctor, who may prescribe a higher dose, a different NSAID, or an opioid.

Doctors may prescribe opioid pain relievers (such as codeine or hydrocodone) for people who cannot take NSAIDs or whose pain is unrelieved by other therapies. Used correctly, opioids can be a safe and effective means of pain control. Studies show that you can discontinue opioids without withdrawal difficulties if the opioid is tapered off.

Talk to your health professional about what medicines may be best for you. The effectiveness of medicines and the risk of side effects are different for different people. You can try different medicines until your symptoms are controlled.

Medicines that are being studied for osteoarthritis include diacerein and doxycycline. Diacerein helps reduce inflammation. Doxycycline is an antibiotic but it may help keep the joint space from getting smaller in osteoarthritis. These medicines are not available yet for use with osteoarthritis.