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Arthritis Pain Patch
In the drive to bring relief to osteoarthritis sufferers, doctors are finding some success with a low-dose painkilling patch
Working in a charity shop heaving bags of second-hand clothes across the floor eventually took its toll on Jan Slaney's back. On some days she couldn't even walk the 100 yards home because of the pain.
"It was unbearable, like a crushing weight pushing me into the ground," says Jan, 59, who was diagnosed with osteoarthritis in her spine 12 years ago. Paracetamol eased the pain at first, but when the condition appeared in her right hip a few years later she turned to stronger prescription painkillers. "My daughter Hannah, 29, couldn't understand how bad the pain was until one day I couldn't walk to work. It became so severe I couldn't drive or do gardening, let alone house chores," says Jan, from Yate, near Bristol, who was forced to leave her job in 2000.
The following year she had a successful hip replacement but her back pain steadily worsened. She tried acupuncture, physiotherapy, glucosamine supplements and even "exercise on prescription" in the form of subsidised sessions at her local gym. "None of them made a big difference and now I can only see my condition worsening," says Jan.
However, a new painkilling patch may offer some hope to Jan and thousands like her. BuTrans contains an opioid drug which she has tried before in tablet form but had to give up because it made her very sleepy. Other side effects include nausea, vomiting, sedation, constipation and dry mouth. But because the patch contains a low-dose strong opioid, side effects are reduced.
Dr John Dickinson, a rheumatology specialist who treats 3,000 patients a year in North Yorkshire, says: "Many side effects diminish within weeks or may not even occur. Also, addiction, dependence and tolerance to the drug rarely appear in patients being treated for pain and its safety record is
good."
The launch of the new patches comes at a time when sufferers are anxious because of fears of heart problems linked to some painkillers, and many patients have been advised by their GPs to switch to other medicines. Concern surrounds painkillers called coxibs (or COX-2 inhibitors). One coxib, Vioxx, was withdrawn last year because of a small increased risk of heart attack and stroke.
Then Bextra, another drug in the same class, was suspended in April 2005 because of safety concerns over skin reactions.
Around 8.5 million people in the UK have osteoarthritis, yet research from Arthritis Care reveals that fewer than four in 10 are happy with their medication. As a result the charity is urging GPs to review patients' drug treatments within the next six months. "I worry patients are suffering because risks linked to some painkillers have been over-emphasised.
Choosing the right treatment means balancing benefits and risks which vary between individuals," says Dr Dickinson.
Treatment toolbox
Those that work:
- Paracetamol is recommended as the first-line treatment by the British Society for Rheumatology. The maximum safe dose is eight 500mg tablets over 24 hours.
- Ibuprofen and other non-steroidal anti-inflammatory drugs (NSAIDs) and coxibs help beat pain and reduce inflammation but can't cure osteoarthritis. Safety concerns exist at high doses, so use at the lowest possible dose for the shortest time necessary to control symptoms.
- Opioids also offer quality of life. BuTrans gives 24-hour relief for seven days and has fewer side effects than tablets.
- Pain-relief creams contain anti-inflammatory drugs but are effective only for the first two weeks; however most flare-ups of joint problems don't last longer than that.
- Artificial joints can successfully replace damaged knees and hips.
- Exercise (physiotherapy and walking) for at least three months helps to build muscle - the body's natural shock-absorbers, which protect joints. See the home exercise plan at www.move.uk.net.
- Physical aids include shoe wedges, joint braces and splints.
- Using a walking stick in the opposite hand to the affected joint takes a quarter of the weight off that joint.
- Shock-absorbing insoles made from sorbothane are sold in sports shops for about £20.
- Osteotomy, surgical removal of some knee bone, realigns the joint and relieves pressure but is only suitable for about 5% of patients.
- Cod liver oil helps the body produce its own anti-inflammatory substances. Users are more likely to delay onset of symptoms and less likely to need joint replacements.
- Acupuncture relieves pain in a third of patients.
- A technique called TENS (Transcutaneous electrical nerve stimulation) treats pain by passing small electric currents into nerves through the skin via small pads.
- Another, chondroitin, attracts fluid that lubricates joints. Seven Seas JointCare Projoint formula (30 capsules, £14.99) contains both these plus cod liver oil.
- Pomegranate extract slows cartilage deterioration and has anti-inflammatory properties. Studies are needed to see whether it promotes cartilage repair.
- Finally, research shows positive thinking to be as effective as a shot of morphine.
This article first appeared in Saga Magazine.
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Information on this site is for interest only and is not a substitute for professional medical advice. You should consult your own doctor about any specific health concerns.
