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Getting to Know the Pain Medications for Arthritis - Steroids, Narcotics, DMARDs and Biologics

What do steroids, narcotics, DMARDs and biologics all have in common? They are all medications prescribed to those who suffer from the pain of arthritis. All of these medications carry with them benefits and risks that patients and their doctors should discuss before a pain management plan is put into action.

Steroids:

Steroids are strong anti-inflammatory medications whose purpose is to reduce swelling, inflammation and the associated pain. Those who suffer from both osteoarthritis and rheumatoid arthritis may be given steroid injections directly into the painful joint to relieve pain in that joint. There are also steroid pills that can temporarily relieve flare-ups of rheumatoid arthritis. There are also low-dose pills that can be taken over a longer term to help maintain the occurrence of inflammation and pain. The use of steroids can make a big difference in the quality of life especially for those suffering from rheumatoid arthritis.

The long-term use of steroids can increase the risk for infections; increase blood sugar levels and can also lead to a person's bones becoming thin. Usually doctors will prescribe the use of steroid pills for short-term use to avoid these side effects. Steroid injections carry a lower risk for side efforts experienced outside of the joint area and can be used for longer time periods.

Narcotics:

Doctors may prescribe prescription narcotic pain relievers such as codeine, fentanyl, morphine or oxycodone for the relief of severe arthritis pain. Narcotics work because they control pain by disabling the nerve cell pain receptors. Narcotics are rarely prescribed for pain relief for arthritis suffers but in cases where the patient is so debilitated by pain that they are unable to move; narcotics may be the answer to get them mobile again. Mobility is very important to the management of pain for arthritis sufferers. The reason narcotics are not used more often is that there are a lot of side effects when using them. Narcotics tend to cloud the thinking processes of people who take them. Constipation is another common side effect to narcotic usage.

DMARDs:

DMARDs (Disease Modifying Anti-Rheumatic Drugs) are used to prevent the joint damage that inflammation causes in rheumatory patients. One commonly prescribed DMARD is methotrexate. These medications usually can take weeks before they will take noticeable effect on the patient so often times other pain relievers like steroids will be prescribed until the DMARDs take effect.

The use of DMARDs can drastically improve the lifestyle of patients with rheumatoid arthritis.

Like most medications there is a risk with using DMARDs. The way they work is by suppressing the immune system, so as a result patients on DMARDs are more susceptible to infections while they are on this particular medication therapy. They are also at increased risk for liver issues, low blood count occurrences and a slightly increased risk of certain cancers.

As in any course of medication therapy the patient and doctor must weight the benefits against the risks. If the disease is progressive and creates a current or future risk of disability without the treatment than that is a major consideration. Quality of life is important and the decision to proceed with DMARDs medication therapy must be weighted seriously against other pain management alternatives.

Biologics:

Biologics (Biological Response Modifiers) are a more aggressive medication therapy that is used to slow down the progression of rheumatoid arthritis. Biologics are used when DMARDs therapy is no longer helpful.

The biologics that have been approved for arthritis pain relief are: Enbrel, Humira, Kineret, Orencia, Remicade and Rituxan.

These medications are designed to inhibit or to supplement different components of our immune systems. Unlike DMARDs they do not effect the entire immune system, only a part of it.

Biologic medications can only be given by either injection or by intravenous infusion (IV). If given by IV, it can take up to 2 hours to receive the entire dosage.

Studies have only been available for approximately ten years so long-term effects are not known at this time. It is known that biologics can carry a increased risk for certain cancers, can cause diseases that have been in remission to flare-up again like tuberculosis and other chronic diseases. Biologics are discouraged from being prescribed for patients younger than 50.