Pain, pain go away
MANILA, Philippines - The 1930s’ American humorist Will Rogers describes the sensation so well. He said, “Pain is such an uncomfortable feeling that even a tiny amount of it is enough to ruin every enjoyment.” Now, imagine having to live with a constant awareness of aches and pains. Unless one is a masochist, pain will always be unpleasant, whether it is dull, throbbing and nagging; or severe, piercing and thoroughly excruciating. Not surprisingly, most people will remember to take their medications when their ailments involve pain.
The problem with painkillers, however, is that they may come with some unpleasant side effects. More recently, a class of drugs called coxibs or COX-2 inhibitors, which were meant to relieve the pain and inflammation caused by osteoarthritis and rheumatoid arthritis, have been implicated in cardiovascular diseases including heart attacks.
Even over-the-counter painkillers can be dangerous when overused or abused. These can likewise cause a host of unpleasant side effects such as upset stomach or stomach pain, indigestion, constipation, diarrhea, dizziness, drowsiness, headache, swelling, and vomiting. It can happen that because of numerous adverse effects, the patient’s initial complaint of pain will be compounded by tiredness, weakness, nausea, nervousness, sleeplessness, and anxiety.
In the treatment of chronic pain from arthritis, the drugs that are most commonly used for symptomatic relief are called NSAIDS or non-steroidal inflammatory drugs. Because these can also cause adverse reactions such as ulcers and gastrointestinal (GI) bleeding, physicians usually recommend that pain-relieving NSAIDs be taken with drugs called proton pump inhibitors (PPI.) The main action of the complementary drug is to inhibit the stomach acids that can cause damage to the GI tract.
At a recent round-table discussion with health writers on the topic of osteoarthritis, Dr. Leo Daniel Caro, orthopedic surgeon and clinical associate professor, UP-PGH, said, “Patients are always looking for a way to deal with pain every day.”
He explains that osteoarthritis is a degenerative joint disease caused by the breakdown and eventual loss of cartilage in one or more joints. But “because of the belief that the pain is all part of the aging process, many patients are unaware that they can be helped.”
Dr .Caro continues, “Apart from aging, a combination of factors can contribute to osteoarthritis. These include being overweight, joint injury or stress, heredity, and muscle weakness. Osteoarthritis commonly affects the hands, spine or large weight-bearing joints, such as the hips and knees.”
Estimates indicate that 151 million individuals are affected by the disease worldwide, and over three million suffer from chronic arthritis in the Philippines. Of course, the local figure may be under-reported since there are those who do not seek medical advice or care or what the doctors call “tip of the iceberg statistics.”
“Apart from pain, deformity is a concern,” adds Dr. Caro. “Deformity can make tasks of simple living difficult.” He explains that aside from the common phenomenon of misshapen hands and fingers, fusing of the spine results in the loss of normal curvature. The physical manifestation of this is what is called “chin-to-chest deformity” and “bamboo spine.” And undoubtedly, arthritis has a considerable impact on quality of life.
“As doctors, our goals go beyond controlling pain and providing symptom relief,” says Dr. Caro. “We should be able to improve our patients’ quality of life, improve their functioning and productivity, and minimize disability and side effects.”
He adds.” It is a good idea to embark on a multidisciplinary approach to the management of chronic arthritis.” Apart from its physical effects, the disease has repercussions on the psychological, social, and economic well-being of patients. Recognizing that poor patient compliance may be a result of the high cost of medication, Dr. Caro believes, “we should be able to reduce the cost of effective treatments.”
And thus, the recently launched combination pill for arthritis by innovation-driven pharmaceutical company AstraZeneca is good news. “A single pill combining a proven pain reliever and a highly effective drug against NSAID-associated stomach ulcers is certainly welcome news to the millions of arthritis patients worldwide,” says Dr.Yvonne Sherrer, medical director and director of clinical research at the Center for Rheumatology, Immunology, and Arthritis in Florida at the same forum. The Naproxen/ Esomeprazole combination pill is markedly cheaper, compared to when the two components are taken separately. However, it is also only available with a doctor’s prescription.
“Not all pains are osteoarthritis,” concludes Dr. Scherrer. ”But if pain is chronic and persistent, then you probably need expert evaluation.”
But the point of all this is that one should never self-medicate. Apart from visiting the doctor only when you experience pain, it is always a good idea to visit the health experts more regularly.
