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NSAID Alternatives???

on 8/28/10 12:39 pm - Westport, MA
Hi everyone!

A few years ago I had problems with my left knee and after several x-rays and MRIs found out that the cartilage in my knee joint has several tears. Luckily they were not bad enough to need surgery to correct it, so my Orthopedic doctor recommended Ibuprofen and Naproxen as needed for pain and swelling when inflamed. 

I haven't had any flare ups since late 2008 but this week it has been bothering me fiercely to the point I can't bend my knee.

I will be calling my doctor on Monday to make an appointment but want something to help me with the pain until then.

What do you recommend? Is there anything we RNY patients can take that would have the same effect as Ibuprofen and Naproxen?


~Starting Weight: 261 lbs~~Pre-Op Weight: 241 lbs~
~Current Weight: 160 lbs~

"Just when the Caterpillar thought her life was over, She began to fly..." 


on 9/3/10 2:24 pm
There's nothing you can get OTC that RNYers can take that will have an anti-inflammatory effects. Sorry! You might ask your docs about Lidoderm pain patches---still not an anti-inflammotory, but they do help a bit with the pain.
on 9/3/10 4:35 pm - Silver Spring, MD
RNY on 03/22/10 with
"tears in the cartilage" means that you most likely have osteoarthritis in the knees which is a non-inflammatory arthritis; so you don't necessarily need an NSAID (which actually have very weak anti-inflammatory effects anyways).  What you can do until you see your doctor is:

- Take acetaminophen (Tylenol) 650 mg, 2 tablets a day around the clock three times a day (works much better than taking it just as needed)... and it takes about a week at this dose before you get the full effect.  However, don't do this if you have liver disease or drink more than one serving of alcohol a day (otherwise it is absolutely the safest analgesic there is).  Also make sure you don't have any "hidden" acetaminophen in any other medicines you are taking (usually prescription pain meds).

-  Apply capsaicin cream to your knees around the clock three times a day (just as needed won't work).  Wash your hands very well afterwards and don't apply heat to your knees as this is made from the pepper plant.

Good luck, I hope that this helps.
on 9/6/10 3:28 pm - New Orleans, LA
There is nothing that replaces the anti inflammation effect  of  these drugs.  Inflammation IS the problem with osteoarthrtis.  Tylenol does not decrease this condition  but may dull it slightly.

Having years of experience with OA and really needing a replacement, I can tell you that it will not help.   Drugs such a VOLTAREN , ARTHOTEC,  IBUPROFEN, etc,  should be used daily , so that the effect does build up.  But if you cannot take them,  then this is not going to be a help for you.
Many people have changed their choice of WLS just because of this.  I think the sleeve allows one to use the NSAIDS.   I am presently planning to have incisionless WLS Oct 5, and am awaiting the decision whether I will be able to take NSAIDS.  I cannot do without them since I have extensive OA, so it will be the deciding factor. 
on 9/7/10 9:20 am, edited 9/7/10 9:22 am - Silver Spring, MD
RNY on 03/22/10 with
Sorry, but I must respectfully disagree (I'm a rheumatologist). Inflammation is not the primary problem with OA. There is some mild inflammation when one looks at tissue under a microscope from a joint with OA, but it is mild. OA is primarily a degenerative process accompanied by some mild inflammation (as opposed to rheumatoid and other artitides which are primarily inflammatory diseases). The synovial fluid also usually has a normal number of white blood cells and is classified as non-inflammatory. Although many folks do better on NSAIDs compared to Tylenol, it is not clear that it is due to the anti-inflammatory effects at all since NSAIDs decrease pain through other mechanisms besides decreasing inflammation (they are very weak anti-inflammatories at best.)

Because of this lack of significant inflammation, many folks do fantastic on Tylenol. Therefore it is considered the first drug of choice in treating OA due to it being markedly safer than NSAIDs and many folks respond to it. If someone doesn't respond to Tylenol, then that is when we increase treatment to an NSAID, tramadol, or other stronger therapies.

If you had such severe OA that you needed a joint replacement, that means you had severe OA. You should not tell someone that Tylenol will not work for them just because it didn't work for you (everyone's body is different in their response to medicines.) In fact, I even have patients who do have severe bone-on-bone OA who actually are doing fantastic on Tylenol. I hope you are doing better after your surgery, but I would recommend not telling someone Tylenol won't work for them just because it didn't help you.
on 9/7/10 8:43 pm
Thanks, Don!

I'm glad to know about this. I finally broke down and took some steroids over the weekend because of the bad trapezium bone in my hand. Hate taking those things!

I'm going to definitely try the Tylenol.
on 9/9/10 4:05 pm - New Orleans, LA
As a person with osteo arthritis literally from head to toe,  I can say from experience and  the advice given by my rheumatologist, neuro-surgeon,   and numerous orthopedics and sports medicine specialists , drugs like acetominophen have had almost no effect on arthritis pain and stiffness.    It was explained to me long ago that taking drugs which were not anit-inflammatory could possibly mask pain, as in narcotic drugs, but would do nothing for the stiffness and the resulting pain of severe arthritis.  I am not talking about occasional pain.  I am referring to pain resulting from cervical and lumbar spinal stenosis,  bone on bone both knees, and spondylolesthesis.    Taking Tylenol on a reg basis in large doses would just destroy my liver without any significant pain relief.    Anyone with severe arthritis knows this and has tried just about everything.  Each person knows what works for them, and what allows them to function at a minimal level.  When I have to go to acetomenohen for a week or two prior to surgery my life becomes almost unbearable, but I do it because there is no choice.  Period..  Even an occasional narcotic pain killer does not improve the situation the way even ibuprofen does.  It is a big issue is deciding which surgery to have for weight loss.  Orthopedic says he cannot see a time when I will not need some type of n-said, even with both knees replaced, and back surgery for the stenosis.  Weight loss will definitely help and may lessen the need for any pills, but i have to get to that point first.
on 9/10/10 12:30 pm - Silver Spring, MD
RNY on 03/22/10 with

I think this is simply a case of miscommunication... note that I did not say anything about your treatment... my message was directed towards the general quesion of treatment of OA in a a WLS patient.  Clearly your arthritis does not respond to Tylenol.  Everyone is different.  Some people do not respond to Tylenol.  However, it is incorrect to transpose your experience onto everyone else and say if it didn't work for you, it won't work for anyone.

Tylenol is regarded as the first drug of choice to treat OA for the reasons I mentioned above.  Many patients do get significant relief from it, and it is so safe... that is why we use it.

Tylenol very rarely causes any liver problems, by the way.  (The only times I've seen it happen was from purposeful overdose, and the medical literature shows it happening in people taking too much Tylenol, or from drinking too much alcohol and taking Tylenol).  It is actually much safer than NSAIDs from which we doctors see side effects all the time such as bleeding ulcers, elevated blood pressure, kidney dysfunction (the list goes on and on).  I see it every day in my practice... yet I have never had a patient get any significant side effects from Tylenol when used correctly.  The only folks who run into problems are alcoholics and people taking too much Tylenol inadvertantly (usually due to being "hidden" in their pain meds) and hence the reasons for public announcements regarding being careful with Tylenol.

On a public forum such as this, it is very important that appropriate guidelines and options be given to people based upon what medical studies show over all and what is medically appropriate... they should not just be based upon one's own experience. ...  for you Tylenol will not work... but for many others, it absolutely can potentially work.  If it doesn't work after 1 week of usage... then it is time to try something different.

In medicine we say that the first law of medicine is "first do no harm"... Tylenol causes markedly less harm than any other systemic arthritis medicine.  If it doesn't work... then therapy is stepped up in a particular patient.

I hope you do well!
on 9/12/10 1:50 pm
Do you personally suffer from OA? I do, and like GDEL, I get zero relief from Tylenol. For many of us, giving up NSAIDs is a bad, bad thing.
on 9/12/10 2:37 pm, edited 9/12/10 2:46 pm - Silver Spring, MD
RNY on 03/22/10 with

Actually, I do have OA. Fortunately I do well with acetaminophen and glucosamine.

Please remember and read my posts above closely... I am giving general treatment outlines for OA patients, nothing for one particular patient. I have many patients like you and GDEL who have failed numerous therapies before finding the best treatment for them; that goes for all types of arthritides. There is no one magic treatment for one disease... if there were, then there would be little need for experienced doctors to treat them, you could just ask your pharmacist.

The drug of first choice still is acetaminophen, and unlike some like you and GDEL, many OA patients do well with it and glucosamine... others need NSAIDs, tramadol, cortisone injections, hyaluronic acid injections, surgery or opioids.

Just to illustrate another point... a study came out a few years ago where they looked at how many patients continued on NSAIDS after a year. Only 50% continued their NSAID due to problems with efficacy or tolerability, meaning that even with what is considered a good medicine for OA (NSAIDS) much of the time they are not effective for a particular patient or are not tolerated. That is also why we end up often times having to try various treatments and combinations of treatment before we hit that best treatment for anyone patient.

I hope your OA is doing OK since your surgery. Certainly your choosing the DS over RNY was a very shart choice to allow you to still use NSAIDs postop.
on 9/13/10 8:56 am
I've had everything you mention, except surgery---and since I'm only 52, they're telling me I really should hold off on the knee replacements as long as possible. (I've already held off seven years longer than I'd have thought possible, pre-op.)

Tramadol doesn't really seem to help much, either, strangely. I don't tolerate it well---enough to kill the pain makes me foolish in the head. (*grin*) Cortisone doesn't help for long, either, but I have had good experience with hyaluronic acid---it's what's allowed me---well, that an losing weight---to keep my knees this long.

I've been taking daily NSAIDs for, oh, 30 year now. Tylenol won't even help me with a headache.
on 11/22/10 11:22 pm - NY
My first dose of tramadol was two times a day and it was a total of too much then the Doc gave me a total dose that was less than the two but more than the single dose but once a day (I take it at bed time) It works well and I can stay awake !
I had synvic injections in both my knees a few months ago as they started to bother a year ago, I think they helped me , my Rheumatoligist said I was a good canadate because my knees weren't extreemly bad.  I am hoping to put off surgery as long as possible.  I am noticing less noise coming from my knees ? (ya know the poping ect).
Good Luck,
Lyn Batt
on 11/10/10 11:12 am - GA
RNY on 11/05/10 with
Detj, thanks for all the information on OA.  I also have it in both knees and my left hip.  Right now I have only the 500 Tylenol, instead of the 650, but I am going to get the 650 to see if that works.  You mentioned Tramadol, can I take that with RNY?  My groin hurts most than my hip, so I just want to get some immediate relief from that, I was taking meloxicam before surgery and the two weeks before, I had to stop and they pain was almost unbearable!  When I can home I has the pain meds and that realley helped, but if course I can't take that always...
Any other suggestions?

Thanks again for any help, I have only had RNY since 11/5 so I have not lost enough weight to make an immediate difference. 
on 11/10/10 2:24 pm - Silver Spring, MD
RNY on 03/22/10 with
AM Hutch:  Tramadol is completely safe after RNY surgery.  It is prescription.  A way to approach it is to see your doctor, let them know you are not allowed to take any NSAIDS what so ever and you heard that tramadol may be a good alternative (the only  other prescription analgesics would be scheduled narcotics, so this would be a much better alternative.)

btw... groin pain can be possibly due to several possibilities (hernia and hip arthritis being at the top).  If you have OA of the hip, then the joint lies right underneath the groin and that is where it would hurt.

on 11/22/10 1:02 pm - New Zealand
I've been taking glucosamine and chondroitin for years now for problems with my left knee. It takes about 2 weeks to start helping. If it hadn't worked for my Rottweiler who blew out a knee and had surgery, I probably wouldn't have tried it. But jus****ching him, and seeing that he was moving more easily, thought I would give it a try.

I admit readily that I take up to 800 mg of ibuprofen at times to help with some OA pain and stiffness with no problems - and have never had a problem. (I'm a nurse and work in a small but busy hospital in New Zealand, so often spend a whole shift on my feet, and moving people around.) Sometimes I overdo it a bit - like digging around the property to put in the wire for an invisible fence. Ouch.

I had gastric bypass 8 years ago, and I'm 54 now, and I think this whole avoiding NSAIDs entirely is suspect. Never have seen any research that shows gastric bypass people to be at high risk for ulcers from using it - especially if used on an occasional basis.

on 11/22/10 3:00 pm - Westport, MA
Thank you everyone for all the helpful information and tips. I really love this site and all the support we get from people like us.

Thanks again!

~Starting Weight: 261 lbs~~Pre-Op Weight: 241 lbs~
~Current Weight: 160 lbs~

"Just when the Caterpillar thought her life was over, She began to fly..."