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What substitutes are there for non-steroidal anti-inflammatory drugs (NSAIDS)?

Q) I have had osteoarthritis for many years and have taken Celebrex for over 10 years. An endoscopy last month revealed a duodenal ulcer caused by the drug despite taking omeprazole (a stomach-protecting drug) the whole time. I was taken off the Celebrex and I am now in quite a bad way as a result. I had never been completely convinced that Celebrex was doing much good but now I know that it did!

My doctor has prescribed pain patches in addition to the Zapain (paracetamol and codeine) I was already taking but this does not deal with the severe pain in shoulder, neck, wrists etc. I am awaiting a knee replacement (I’ve already had both hips and one knee done) and do not know how I will cope as things are. This must have happened to lots of people with arthritis. What substitutes are there for non-steroidal anti-inflammatory drugs (NSAIDs)? I am desperate for a solution to my problem.
Sheila, Cheshire (Winter 2012)

A) Stomach (and duodenal) ulceration is an unfortunate side-effect of all NSAIDs. Some are considered worse than others. Celebrex is one of the new generation (the so-called COX2 inhibitors) that were designed to minimise this side-effect. Not only do the drugs differ in their ability to cause ulcers, but, so do people in their likelihood to develop ulcers in response to taking the drugs. In addition, if infection with a bug called helicobacter is present ulcers are more likely to occur (and less likely if this infection is treated).

Ulcers can be ‘silent’ or cause indigestion symptoms but not all indigestion is due to stomach ulcers. Drugs such as omeprazole help prevent this complication. Having said all that, what about your situation? Pure painkillers of the sort you have been prescribed are unlikely to cause ulceration but may not be as effective. Fish oil, and for some people glucosamine, may help.

Other drugs that control pain by acting directly on the nerves may also be of benefit – these include drugs such as amitriptyline, gabapentin and pregabalin. And you may be able to use an NSAID gel to rub on your painful joints as very little of this gets through into the blood stream. Above all try to keep your joints going as we know that normal movement can help the pain from arthritis.

This answer was provided by Dr Philip Helliwell for the Winter 2012 edition of our magazine, Arthritis Today, and was correct at the time of publication.

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