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Several types of medication are used for knee and hip problems, some to control pain and inflammation and others to interfere with various disease processes.

Acetaminophen. For pain relief, acetaminophen (Tylenol, other brands) is generally the first choice because it is effective and easy on the stomach. Do not exceed the recommended dosage of acetaminophen, however, because it can damage the liver, especially in heavy drinkers who may already have some liver damage.

NSAIDs. Nonsteroidal anti-inflammatory drugs such as aspirin, ibuprofen (Advil, Motrin), naproxen (Aleve, Anaprox), and several others may be more effective than acetaminophen, particularly during sudden flare-ups of pain, because they are superior at reducing inflammation. There are also a number of prescription NSAIDs such as nabumetone (Relafen) and oxaprozin (Daypro). Stay within recommended dosages. Regular use of NSAIDs can produce gastrointestinal bleeding and ulcers, often without warning. Combining acetaminophen with a smaller amount of an NSAID may provide equivalent pain relief with a reduction in side effects. Ask your doctor about this. Also inquire about possible risks and benefits of taking a proton-pump inhibitor such as esomeprazole (Nexium) or lansoprazole (Prevacid) to reduce the risk of gastric bleeding and ulcers.

COX-2 inhibitor. Celecoxib (Celebrex) is in a class of prescription NSAIDs known as COX-2 inhibitors, which relieve pain with less stomach irritation than traditional NSAIDs. Concerns about cardiovascular side effects mean it should be used only in cases in which a patient does not have heart disease, has tried other pain relievers without success, and is not taking blood thinners (anticoagulants such as warfarin).

Opioids. Opioid medications such as codeine and oxycodone, which have morphine-like properties, are another large class of pain-relieving drugs. Opioids work by interacting with the receptors on brain and spinal cord nerves for endogenous opioids, which are the body's natural painkilling substances. For orthopedic problems such as knee and hip conditions, opioids may be prescribed judiciously, often for only brief periods just before and after surgery. They may also be prescribed for patients with severe pain who are not helped by, or are unable to tolerate, NSAIDs. While opioids effectively mask pain, they do not reduce inflammation and usually should not be prescribed for arthritis. Care must be taken to avoid building up a tolerance to them, which develops after just two weeks. Side effects such as dizziness can make it difficult for people to participate in physical therapy while taking these medications. Opioids can be habit-forming, too, creating physical and mental dependence, which can be a serious problem when the drugs are prescribed to treat arthritis pain. Abuse of these painkillers, which slow breathing, is responsible for an accidental death every 19 minutes, according to the Centers for Disease Control and Prevention.

Corticosteroids. Corticosteroids, such as prednisone, reduce the body's ability to generate an inflammatory reaction. They relieve pain by reducing inflammation. Corticosteroids are credited with treating and causing knee and hip problems. When first introduced in the 1950s, corticosteroids were regarded as miracle drugs because of the dramatic effect on patients with active rheumatoid arthritis. Many were able to literally throw down their crutches. But within a few years, the devastating effects of long-term use of oral corticosteroids became apparent: bone weakening, compression fractures of the back, diabetes, increased susceptibility to infections, cataracts, hypertension, and other health problems. Most side effects occur when these drugs are taken orally, but repeated corticosteroid injections into a joint can thin cartilage and weaken ligaments. In the short term, though, corticosteroids sometimes provide quick and dramatic relief.

Last Annual Review Date: 2012-09-01 Copyright: Copyright Harvard Health Publications

Reference: Arthritis section on Better Medicine

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