Drug Therapy for Orthopaedic Conditions

About drug therapy

A number of prescription and over-the-counter drugs help relieve the pain, swelling and other symptoms that come with fractured bones, injured ligaments, disease, aging and degeneration of joints and bones.

Managing pain is important for your recovery. Severe pain or pain that doesn't go away can lead to depression, difficulty sleeping, limitations on your ability to move around and changes to your daily activities. All of these can slow down your healing and prolong a painful bone condition.

You should always consult with your doctor about how best to deal with your pain. Be careful about taking drugs you haven't had before. Be sure to tell your doctor about all drugs that you are taking, including over-the-counter medicines. Also, be sure to take any drugs your doctor prescribes the way that he or she tells you and for as long as you are asked to take them.

Avoid using alcohol to relax or relieve pain. While it may relax muscles, it is not a pain reliever. Many doctors believe alcohol may cause more problems than it solves. Alcohol is a major depressant and can be habit-forming. In addition, it can have serious side effects with pain-relieving drugs. Alcohol is also fattening and tends to slow your recovery.

The information provided here about each category of drugs is general in nature. It does not cover all the possible drugs that could be given for orthopedic conditions, nor does it describe all the possible uses, side effects, interactions with other drugs or vitamins and herbal supplements. Please talk to your doctor or pharmacist for full information about the drugs that are prescribed. This information should not be used as medical advice for individual health problems.

If your doctor thinks that a drug therapy program can benefit you, he or she will develop a program that is specific to your condition, age, general health and other drugs you may be taking. Drugs should be taken as prescribed. Tell your doctor all drugs and supplements are taking and any side effects you may have.

Below is an overview of the main categories of drugs that may be recommended for orthopaedic conditions:

Antidepressants

Chronic pain can be depressing. Nearly one out of every five people who has chronic pain also has depression. The pain may prevent you from going to physical therapy sessions. This, in turn, can set off a vicious cycle of a slower recovery, more depression, less mobility, more pain, more depression and so on.

Antidepressants may benefit a person who has an orthopaedic condition by providing:

  • Better sleep
  • Pain relief
  • Depression relief

Common antidepressants used to treat arthritis and orthopaedic conditions include selective serotonin reuptake inhibitors such as Prozac®, Paxil®, Zoloft® and Zyban®. This is a class of antidepressants that works by increasing the amount of serotonin, a neurotransmitter, in the gaps between nerves.

These drugs have relatively few side effects. They do, however, interact in a life-threatening way with another type of drug, monoamine oxidase inhibitors. Brand name examples include Nardil®, Parnate® and Marplan®.

Teenagers who are prescribed antidepressants should be monitored closely. Antidepressants can sometimes increase teenagers' depression and thoughts about harming themselves.

Anti-Seizure Drugs

Neuroleptic drugs are often prescribed to relieve the stabbing or shooting pain that sometimes accompanies nerve injury, damage or degeneration. Examples include:

  • Gabapentin (Neurontin®)
  • Topiramate (Topamax®)
  • Carbamazepine (Carbatrol®, Tegretol®)

Although it's not clear how these drugs work to relieve pain, they often provide relief when nothing else does. Because these drugs work in different ways, a combination of several may be prescribed at the same time.

These drugs are not addictive. They can cause a variety of side effects, so it is important to discuss their effects carefully with your doctor. Side effects are slight and may include fatigue, dizziness and nausea.

Corticosteroids

Corticosteroids can be given by injection or taken by mouth. Steroids effectively reduce swelling. Drugs in this category include prednisone and methylprednisolone

A shot of corticosteroids in a joint can relieve some pain for four to six months. Knee joints may be treated with hylan G-F20 (Synvisc®), but treatment requires three to five weekly injections. Relief from pain with these drugs may be slower to take effect but lasts longer than corticosteroids.

Oral steroids are usually taken only for one to two weeks. Serious side effects can occur if these types of drugs are for a long time. The side effects can include weight gain, stomach ulcers and corticosteroid-induced osteoporosis. If you're at risk for developing osteoporosis, your bone density should be measured before and during treatment.

Steroids can make infections get worse and raise the level of sugar in the blood, so avoid them if you have an infection or diabetes.

Muscle relaxants

Muscle relaxants include a variety of drugs that have an overall sedative effect on the body. They are typically prescribed early in treatment and are usually taken on a short-term basis.

Common muscle relaxants include:

  • Carisoprodol (Soma®)
  • Cyclobenzaprine (Flexeril®)
  • Diazepam (Valium®)

Some muscle relaxants may be habit-forming, and many have major side effects. It is important for your doctor to monitor you while you take these drugs. Be sure to report any unusual symptoms to your doctor right away.

Narcotic Pain Relievers

These are strong and potentially addictive drugs. They should be given only by a doctor in cases of severe pain.

Commonly prescribed narcotic pain medications include:

  • Codeine (Tylenol #3®)
  • Propoxyphene (Darvocet®)
  • Hydrocodone (Vicodin®)
  • Oxycodone (Percocet®, OxyContin®)

Narcotics are effective in treating pain for up to two weeks. After that, the body quickly builds up a natural tolerance to the drug, which then becomes less effective.

Narcotics have several major side effects and risks, including:

  • Addiction
  • Drug interaction with acetaminophen
  • Impairment of mental function and drowsiness
  • Significant constipation

It is important for your doctor to monitor you while taking these drugs. Be sure to report any unusual symptoms to your doctor right away.

Nonsteroidal anti-inflammatory drugs

Nonsteroidal anti-inflammatory drugs include aspirin, ibuprofen (Advil®), Nuprin® and Motrin®. All are available without a doctor's prescription. These drugs are usually the first used for relieving pain, swelling, redness and stiffness that affects joints or bones. For mild to moderate pain, these may be all that is needed. They can have side effects including:

  • Bleeding in the stomach or intestines; if you have had stomach ulcers, talk to your doctor before taking NSAIDs)
  • Changes in the ability to think, reason and be oriented
  • Fluid retention
  • Heart failure
  • Kidney damage
  • Ringing in the ears
  • Ulcers

A class of NSAIDs, COX-2 inhibitors, has been found to potentially increase users' risks of heart attacks and strokes. These pain-relieving drugs had been widely prescribed because they were not likely to produce stomach ulcers and had fewer complications than other types of NSAIDs. COX-2 inhibitors included:

  • Rofecoxib (Vioxx®) and valdecoxib (Bextra®), which have been taken off the market
  • Celecoxib (Celebrex®), which has new package information to alert users to the potential for increased risk of heart attack and stroke, by order of the Food and Drug Administration

If you are taking or have taken these drugs, talk to your doctor about their potential impact on your health.

Osteoporosis Drugs

Thinning bones and the natural aging process can lead to painful bone fractures. Several drugs have been approved to treat osteoporosis and may reduce the risk of fractures. These work by reducing the loss of bone and increasing the amount of calcium that is deposited in the bones. They include alendronate (Fosamax®) and calcitonin (Miacalcin®), which is a hormone that enhances bone-forming cells and inhibits the bone-destroying cells.

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