Prescription Analgesics

Physiotherapy / Structure Exercise Programmes Braces & Wedges


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What is it and why?

  • Stronger analgesics or pain relief techniques may be required when the pain from arthritis is not controlled with simple techniques.

  • These can include the local application of Capsaicin or Transcutaneous Electrical Nerve Stimulation (TENS).

  • These methods may be appropriate when the patient is not yet ready to undergo operations and has not tried all of the non-operative methods.


  • Treatment involves Home/self-help
    Home/self-help
  • Treatment involves Hospital
    Hospital
  • Treatment involves Daycase procedure
    Daycase procedure
  • Treatment does not involve Inpatient procedure
    Inpatient procedure
  • Treatment does not involve Local anaesthetic
    Local anaesthetic
  • Treatment does not involve General anaesthetic
    General anaesthetic
  • Treatment does not involve Regional block / Spina
    Regional block / Spina
  • Pain
    Pain

    Improves

  • Mobility
    Mobility

    None

  • Daily activities
    Daily activities

    None

  • Driving
    Driving

    None

  • Leisure activities
    Leisure activities

    None

  • Light exercise
    Light exercise

    None

  • Heavy exercise
    Heavy exercise

    None

  • Light work
    Light work

    None

  • Heavy work
    Heavy work

    None

  • Intimate
    Intimate

    Caution in pregnancy


Overview

What stage?

  • Generally used before surgery, but can be used after an operation for short term pain control.

What does it involve?

  • Stronger painkillers tend to be prescription-only medications.

  • TENS can be trialled after recommendation by a physiotherapist or GP.

  • Medication, such as Paracetamol or Ibuprofen, may also help if used for a short period (one or two weeks).

  • You must be aware of contraindications for taking the medications. Read the information leaflets carefully and do not exceed the recommended dose.

  • Using walking sticks will help off-load forces going through the joint. If using for hip arthritis, use it in the opposite hand. For knee arthritis, use the walking stick on the same side as the affected joint.

Effort/burden

  • Effort is required to find the right combination of external applications and occasional tablets.

  • Getting the walking stick at the right height and overcoming the ‘stigma’ associated with using a walking stick.

Benefits

  • There is fair to good evidence to support the use of a TENS device for pain management.

  • Modest to moderate drop in pain, improvement in activities of daily living (ADL) and mobility in the long term.

  • Local anti-inflammatory gels have similar benefits as oral anti-inflammatory tablets. Capsaicin cream application can also bring down pain levels.

  • A walking stick will help improve walking distances.

Chances of cure

  • These measures are unlikely to cure arthritis on their own.

  • However, they can improve the symptoms of arthritis, activities of daily living and mobility.

Limitations and side effects

  • There are minimal side-effects for external physical methods.

  • Oral anti-inflammatory tablets have gastrointestinal side effects.

  • Generally, Paracetamol is less effective with moderate to severe arthritis.

Risks

  • No major risks identified.

  • You may experience skin irritation from local application of medications.

  • Be aware of bleeding ulcers, exacerbation of acidity symptoms or asthma.

  • Excessive use of medications can affect renal or liver functions.

Cost

  • Low cost option for both the patient and the NHS.

  • Patient: cost of over-the-counter medication and/or the purchase of a walking stick.

What if no treatment is done?

  • Arthritis will continue to deteriorate.

  • Symptoms will get worse; sometimes rapidly.

  • Will have a negative influence on other management options, e.g. surgery, in the future.


Physiotherapy / Structure Exercise Programmes Braces & Wedges