Posts Tagged ‘Nonsteroidal Anti Inflammatory Drugs’

Common Medications for Dental Pain (Part 1)


The pathophysiology of dental pain is a complex central and peripheral nervous system process, and the use of combination analgesics that act at multiple pain sites can improve dental pain relief. In general, for the treatment of mild to moderate dental pain, the most appropriate options are:

• Acetaminophen (Tylenol), 650mg every 4-6 hour as needed for dental pain; • Non-steroidal anti-inflammatory drugs, or NSAIDs (Advil, Motrin, Aleve), 400mg every 4-6 hours as needed for dental pain; and • COX-2-selective inhibitors, celecoxib (Celebrex) and rofecoxib (Vioxx), 25-50mg per day as needed for dental pain.

Acetaminophen: Acetic acid and p-aminophenol, or APAP—commonly known as acetaminophen—is classified as a nonnarcotic pain reliever. Dentists generally use it for mild to moderate dental pain. It acts as both anti-pain and anti-fever. It has rapid painkiller action. Acetaminophen, unlike nonsteroidal anti-inflammatory drugs, or NSAIDs, has little anti-inflammatory action. It generally is safe for acute dental pain. At very high single doses it causes liver damages.

Acetaminophen’s dose of 500-650 milligrams is good dental pain-reliever. However, such relief is brief, peaking one hour after administration. Significantly more dental pain relief can be provided by acetaminophen’s dose of 1,000 mg. At this dosage, the maximal efficacy of acetaminophen is achieved and last up to four hours after administration. There is no more oral pain relief in dose higher than 1000 mg. Because of this “ceiling-dose” effect, acetaminophen is good shot-term reliever for mild dental pain.

NSAIDs: NSAIDs have been the traditional treatment for moderate dental pain and inflammation. NSAIDs such as ibuprofen, ketorolac, flurbiprofen, ketoprofen, diclofenac, aspirin and aspirin derivatives diminish local dental pain. Long-term use of NSAIDs, however, can gastrointestinal distress, bleeding, kidney damages, and cardiovascular problems. Also, NSAIDs have been shown to interact with several high blood pressure drugs, which may compromise blood pressure control. The most common short-term side effects of NSAID usage are upset stomach, diarrhea and abdominal pain.

NSAIDs generally require a higher dose to achieve maximum anti-inflammatory and anti-pain effect. Dosage of 800 mg three times per day may be needed for dental pain. The FDA-recommended daily dose is 2,400 mg. Studies has indicated that no more dental pain reliever is achieved with higher-than-the-recommended dosage. Comparing to acetaminophen, NSAID’s are better pain killer, but they act slower and last about the same time (about 4 hours).

COX-2 NSAIDs: COX-2 NSAIDs were developed to limit NSAID’s adverse effects. The two COX-2-selective inhibitors, celecoxib (Celebrex) and rofecoxib (Vioxx) are characterized by the following:

• less risk of GI ulceration than nonselective NSAIDs; • similar types of other GI side effects, such as abdominal pain, dyspepsia, diarrhea and nausea; • lack of effect on platelet function, unlike nonselective NSAIDs; • renal toxicity similar to that of other NSAIDS; • generally long duration of action, with once-daily administration for rofecoxib and once- or twice-daily administration for celecoxib.

However, while COX-2 therapy may reduce the risk of GI ulcerations, recent evidence indicates that COX-2 therapy may not reduce the risk of cardiovascular complications (heart attacks). This is the reason why Vioxx is currently taken off the US market.



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Arthritis Remedy


Arthritis is often referred to as a chronic disease. This means that it can affect the person afflicted with arthritis over a long period of time, perhaps for the rest of a person’s life. It cannot be cured, but it can be treated through a variety of products, both prescription and over-the-counter, as well as natural and medical-related methods. Learning how to manage your pain over the long term is an important factor in controlling the disease and maintaining a good quality of life. This is a brief overview of some of the methods and products that arthritis sufferers can use to alleviate many of the symptoms associated with arthritis, especially joint pain.

Detailed information on joints and joint pain products:

Over-The-Counter Products

Acetaminophen

People afflicted with osteoarthritis often times have very little inflammation. As such, pain relievers such as acetaminophen, the most well know of which is Tylenol, may be effective. Acetaminophen is a pain reliever but does not reduce swelling. Acetaminophen does not cause stomach irritation and is less likely than nonsteroidal anti-inflammatory drugs (NSAIDs), described later, to cause long-term side effects. Research has shown that acetaminophen relieves pain as effectively as NSAIDs for many patients with osteoarthritis. People with liver disease, people who drink alcohol heavily, and those taking blood- thinning medicines or NSAIDs should use acetaminophen with caution.

Ibuprofen

On the other hand, people afflicted with rheumatoid arthritis generally have pain caused by inflammation and often benefit from aspirin or other nonsteroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen (Motrin or Advil). Ibuprofen combines anti-inflammatory with pain relief, but does typically cause some stomach discomfort if not taken with food and have been linked to ulcers with long-term use.

Glucosamine and Chondroitin

Glucosamine and Chondroitin are components of natural joint cartilage. Studies indicate that glucosamine and chondroitin can help alleviate joint pain related to osteoarthritis and improves general joint function including greater joint flexibility. It appears that together they help offset joint space narrowing, the loss of cartilage within the joint, seen with osteoarthritis by stimulating production of new cartilage. Both glucosamine and chondroitin are synthesized by the body and are naturally found in cartilage. Researchers theorize that glucosamine assists in the creation of new cartilage, while chondroitin slows cartilage destruction. Some studies indicate that glucosamine may help as much as nonsteroidal anti-inflammatory drugs (NSAIDs) such as aspirin, ibuprofen, naproxen, and tolmetin in relieving symptoms of osteoarthritis, particularly in the knee, with fewer side effects.

Prescription Products

Prescription Nonsteroidal Anti-Inflammatory Drugs (NSAIDs)

This class of drugs includes aspirin and ibuprofen that are used to reduce pain and inflammation, as noted above, and may be used for both short-term and long-term relief in people with osteoarthritis and, more commonly, rheumatoid arthritis. NSAIDs also include Vioxx (rofecoxib), Celebrex (celecoxib), and Bextra (valdecoxib), all of which are classified as COX-2 inhibitors. COX-2 inhibitors work by blocking an enzyme known to cause an inflammatory response. COX-2 inhibitors had been approved for short-term use in the treatment of pain, and for longer-term use to treat the signs and symptoms of osteoarthritis and rheumatoid arthritis.

Biological Response Modifiers

These drugs include Enbrel and Remicade and are used for the treatment of rheumatoid arthritis through reducing the inflammation in the joints. It is theorized that they block the reaction of a substance called tumor necrosis factor, an immune system protein involved in immune system response.

Disease-Modifying Antirheumatic Drugs (DMARDs)

These drugs include Arava, methotrexate, hydroxychloroquine, penicillamine, and gold injections. Typically, these are drugs used to treat people with rheumatoid arthritis who have not responded to NSAIDs or are no longer taking NSAIDs because of the FDA recall of Vioxx, Celebrex, and Bextra (COX-2 inhibitors). It is theorized that these drugs influence and correct abnormalities of the immune system responsible for a disease like rheumatoid arthritis and other rheumatic diseases. Due to the likelihood of adverse side effects, treatment with these medications requires careful monitoring by the physician.

Corticosteroids

Corticosteroids can be taken by mouth or given by injection directly into the affected joint. Prednisone is the corticosteroid most often given by mouth to reduce the inflammation of rheumatoid arthritis. In both rheumatoid arthritis and osteoarthritis, the doctor also may inject a corticosteroid into the affected joint to stop pain. These hormones are very effective in treating arthritis but cause many side effects, including damage to the cartilage. In fact, frequent injections may cause damage to the cartilage, and as such, they should only be done once or twice a year.Hyaluronic Acid Products

These drugs include Hyalgan and Synvisc. It is theorized that these drugs mimic a naturally occurring body substance that lubricates the knee joint and permits flexible joint movement without pain.

Natural Methods

Heat and Cold

Since heat and/or cold is not recommended to alleviate symptoms associated with all types of arthritis, the decision whether to use it or not should be discussed with your doctor or physical therapist. If appropriate for use on your arthritis pain, it must be determined which kind of temperature treatment should be used. Moist heat, such as a warm bath or shower, or dry heat, such as a heating pad, placed on affected joint for about 15 minutes may relieve the pain. An ice pack wrapped in a towel and placed on the sore area for about 15 minutes may help to reduce swelling and stop the pain. If you have poor circulation, do not use cold packs.

Joint Protection

A splint or brace can be used to allow joints to rest and keep them from being used, which can exacerbate the condition and may lead to additional injury. As with many other treatments, your physician or physical therapist can make recommendations and possibly provide you with the brace.

Massage

This method is associated with temporarily relieving one of the major symptoms associated with arthritis, joint pain, rather than treating the underlying cause, loss of cartilage. A massage therapist will lightly stroke and/or knead the painful muscle, which increases blood flow to the stressed area. It is important to realize that arthritic joints are very sensitive, so the massage therapist must be familiar with the disease and problems associated with the affected joints.

Exercise/Weight Reduction

Stretching exercises, swimming, walking, low-impact aerobic exercise, and range-of-motion exercises may reduce joint pain and stiffness while increasing joint mobility. In addition to alleviating some symptoms, the weight loss associated with an exercise program is beneficial in relieving the stress of extra weight on weight-bearing joints, especially the hips and knees. Studies have shown that overweight women who lost an average of 11 pounds substantially reduced the development of osteoarthritis in their knees. In addition, if osteoarthritis has already affected one knee, weight reduction will reduce the chance of it occurring in the other knee. A physical therapist or gym trainer can help plan an exercise program that will give you the most benefit with the least stress on the arthritis-stressed joints.

Medical-Related Methods

Transcutaneous Electrical Nerve Stimulation (TENS)

Transcutaneous electrical nerve stimulation (TENS) is a small device that is placed over the area afflicted with arthritis and directs mild electric pulses to nerve endings in and around the arthritic joint. TENS seems to work by blocking pain messages to the brain and by modifying the body’s perception of pain. It may relieve some joint pain associated with arthritis but doesn’t seem to offset the inflammation that is associated with arthritis.

Surgery

In advanced cases of patients with arthritis, surgery may be necessary. The surgeon may perform an operation to remove the synovium (synovectomy), realign the joint (osteotomy), or in extreme cases, replace the damaged joint with an artificial one (arthroplasty). Total joint replacement has provided not only dramatic relief from pain but also improvement in motion for many people with arthritis.

This Article is Originally Published here: Arthritis Remedy



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This page is provided for educational and informational purposes only and is not intended as a substitute for the advice of a medical doctor, nurse, nurse practitioner or other qualified health professional.