Difficult trade-offs have plagued arthritis patients for long enough.
For years, some patients were torn between debilitating inflammation or treatment with potentially addictive opioids. Now, with opioid prescribing on the decline, patients and physicians rely more than ever on NSAIDs – non-steroidal anti-inflammatory drugs like ibuprofen – to treat painful osteoarthritis or rheumatoid arthritis. Unlike opioids, the drugs don’t expose patients to addiction risk. NSAIDs also target the inflammation fueling patients’ pain, while opioids do not.
But here patients face another catch-22. Taken in high doses, NSAIDs can cause gastrointestinal problems. Complications can come on quickly, with some patients experiencing GI issues as few as 6.5 days after starting high-dose NSAID treatment. People with osteoarthritis and rheumatoid arthritis who take NSAIDs are 2.5-5.5 times more likely to be hospitalized with GI issues. And as many as one in four regular NSAID users can develop a GI ulcer.
“Systemic NSAIDs carry a risk,” explained Meredith Konya, MD, of the Cleveland Clinic’s department of orthopaedic surgery, adding that, “The risk increases with the duration of treatment.”
Choosing between agonizing joint pain and potential opioid addiction was a lose-lose proposition for people with osteoarthritis and rheumatoid arthritis. Choosing between painful inflammation and stomach ulcers is hardly an improvement.
What works better? Pain management that takes a balanced, personalized approach rather than presenting patients with either-or scenarios.
A balanced approach might entail combination therapies. For instance, newer forms of prescription NSAIDs couple inflammation-reducing medication with a GI protectant in a single tablet. The medicines offer higher doses than what’s available over the counter, increasing the benefit to patients. And treatment as a single tablet increases the likelihood that patients take their medicine as prescribed.
In other cases, patients may benefit from topical NSAIDs. Osteoarthritis knee pain, for example, can be treated with an NSAID cream that reduces inflammation with fewer of the GI complications presented by oral medication.
But while the public recognizes the risks of treating pain with opioids, they are less likely to understand how NSAIDs can damage their GI tract. Patients need more information – about the likelihood of GI complications, the dangers of even asymptomatic GI ulcers and the value of treatments that don’t address one health problem by creating another.
They also need insurance policies that facilitate balanced, personalized treatment. After all, health plans that favored inexpensive opioids helped fuel the nation’s opioid abuse epidemic. As the nation shifts its attitude toward pain management, policymakers must recognize: Trading one generic, one-size-fits-all approach for another isn’t a solution.
For people with osteoarthritis and rheumatoid arthritis in particular, balanced pain management offers a better way – an individualized, integrative approach that puts patients’ needs, patients’ health and patients’ safety first.
