Painkiller woes highlight value of lifestyle changes

The withdrawal of yet another massively popular painkiller this week by the Food and Drug Administration provides an opportunity to give an important message to people who have significant osteoarthritis, according to Dr. Kenneth Brandt, professor of medicine and orthopedic surgery at Indiana University.

The chance any pain medication will be enough to relieve all symptoms is small, he said. The treatment of the disease needs to be more comprehensive than that, involving lifestyle changes.

"The keystone of management is nonpharmacologic and nonmedicinal," which hasn't changed, said Brandt, speaking on the issue as a member of the National Advisory Council of the National Institute of Arthritis and Musculoskeletal and Skin Diseases and as a member of the FDA's Arthritis Advisory Committee.

A drug program targeting pain may be an important part of treatment, Brandt said, but it is not the first step.

Osteoarthritis is a degenerative joint disease. Cartilage that covers the ends of the bones in the joint erodes. As bones rub against each other, someone who has the disease struggles with both pain and loss of movement, two issues best addressed by exercise, medication, heat/cold therapy, joint protection, surgery and weight control, according to the American College of Rheumatology.

Last week, the FDA withdrew Bextra from the market. Earlier, VIOXX was voluntarily withdrawn. And now 19 competitors, including Celebrex, Mobic and high-dose naproxen, must carry warning labels that they, too, may increase the risk of heart attacks and strokes. The warnings apply to all non-steroidal anti-inflammatory drugs (a class called NSAIDs), which form the foundation of American pain treatment.

People who have the disease need to protect their joints to avoid further damage.

"If grandmother has bad knees, her grandchildren will certainly love her as much sitting on the couch," Brandt said. "Wear proper shoes. Strengthen the joint. Lose weight if you're obese. There's a whole smorgasbord of things you can do."

For overweight people with knee osteoarthritis, the major cause of debilitation among the elderly, weight loss of just five or six pounds has been proven to significantly reduce symptoms, Brandt said.

Too many people believe osteoarthritis is an inevitable part of aging. It's not, he said.

"Clearly it's a disease. A disease that becomes more frequent as we age," Brandt said. "But it's treatable and maybe even preventable. Among women, those who are in the top 20 percent for obesity have more than a seven-fold risk increase compared to women of normal weight. If they lose weight before they get osteoarthritis, the risk goes down. Once you get symptoms, weight loss still benefits them."