Dear Dr. Roach: My husband suffers from systemic pain, sometimes it is worse than others. He has osteoarthritis in his lower back. He has been resistant to taking over-the-counter pain medication because he thinks it upsets his intestinal tract. He has been taking two glucosamine tablets each morning for quite a while, but doesn't think it is effective. After reading your advice to take ibuprofen for its anti-inflammatory effect, I persuaded him to take one Advil a day. He has been doing this for a week and feels less pain. Is it safe to take one Advil indefinitely? Should he switch between Advil, Aleve, etc.? Would it be safe to take two Advil to see if it relieves pain better?
K.S.
Ibuprofen (Advil and many others) and naproxen (Aleve and others) are over-the-counter nonsteroidal anti-inflammatory drugs, or NSAIDs. They are the most commonly used medication treatment for mild or moderate pain from osteoarthritis. They are reasonably effective, though some people will respond better than others.
The low dose your husband is taking makes the likelihood of side-effects very small, and it can be taken safely by most people. Among the possible side-effects of ibuprofen are stomach upset, stomach ulcers, diarrhea and kidney damage, but again, those risks are very low when staying below the recommended dose. People who have a history of stomach problems or are over 60, and those taking other medications that can cause bleeding issues 鈥� such as aspirin or clopidogrel (Plavix) 鈥� are at a higher risk.
The manufacturer states that adults can take up to 3,200 mg a day (that鈥檚 16 tablets of the 200 mg OTC strength), but I recommend keeping at or below 2,400 mg daily if possible, especially for people with one or more risk factors. In your husband鈥檚 case, two or three tablets a day is likely to have a greater benefit than just one tablet while still bringing only a low risk of side-effects.
It is not recommended to switch among different NSAID drugs, as that increases toxicity without increasing effectiveness. He should pick the one that works best for him and stick with it. One advantage to naproxen (Aleve) is that its effects may last longer. I don鈥檛 recommend more than one or two of the 220 mg OTC tablets once or twice daily.
Dear Dr. Roach: How often is it safe to have cortisone injected into an arthritic knee? For me, these injections are effective for three to four months. I would like to delay knee replacement for as long as possible. I am a healthy, very active 80-year-old male who takes no medications.
W.F.
Although doctors have injected joints with steroids (such as cortisone) for decades, recent evidence has shown that they can damage the cartilage over time and aren鈥檛 much more effective than a placebo injection. Also, people who get steroid injections and then get a knee replacement might be at increased risk for infection in the new joint.
This is frustrating to many patients and doctors, because we had believed the injections helped. However, the study was pretty compelling, and I no longer routinely administer steroid injections every three months. I do, however, still have some patients who appear to get benefit that lasts much longer, and feel comfortable doing an injection on, say, at most a yearly basis.
Dr. Roach regrets that he is unable to answer individual letters, but will incorporate them in the column whenever possible. Readers may email questions to [email protected].
