jueves, 24 de enero de 2019

Where to turn for pain relief - acetaminophen or NSAIDs?


Harvard Medical School

Where to turn for pain relief - acetaminophen or NSAIDs?

Acetaminophen or NSAIDs
The first line of treatment for many knee and hip problems includes taking over-the-counter pain medications. Acetaminophen and non-steroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen and naproxen are the most common pain medication options. However, these pain medications have a variety of side effects, so it's important to discuss your personal health risks with your doctor when considering long-term use for chronic conditions such as osteoarthritis.
Acetaminophen (Tylenol and other brands) is usually effective for mild pain and is easy on the stomach. However, it is toxic to the liver at high doses. The recommended maximum per day is generally set at 4 grams (4,000 milligrams), which is the equivalent of eight extra-strength Tylenol tablets. But that dosage can still cause liver problems for some people. To be safe, aim for 3,000 milligrams or less, and be cautious of mixing multiple products containing acetaminophen, such as a pain reliever and a cold medication or a prescribed narcotic.
Get your copy of Knees and Hips: A troubleshooting guide to knee and hip pain 
Knees and Hips: A troubleshooting guide to knee and hip pain
Do your knees or hips hurt? Most people will at some point have knee or hip pain because these large joints have a demanding task: they must bear the full weight of your body while at the same time allowing for a wide range of motion. Wear and tear, injury, and simple genetic predisposition can all contribute to knee or hip pain. This Special Health Report, Knees and Hips: A troubleshooting guide to knee and hip pain, covers a wide range of knee and hip conditions and describes in detail treatments, preventive strategies, and surgeries.

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The FDA now recommends using products containing no more than 325 milligrams per pill or capsule (the equivalent of regular-strength Tylenol rather than extra-strength) in order to avoid excessive dosages. Don't take acetaminophen if you drink more than a moderate amount of alcohol on a regular basis or if you have liver disease.
NSAIDs such as aspirin, ibuprofen (Advil, Motrin), and naproxen (Aleve, Anaprox) may be more effective than acetaminophen for certain conditions because they reduce inflammation as well as relieve pain. But NSAID medications have side effects, the most common is stomach irritation. It can also cause stomach and intestinal ulcers, which can lead to internal bleeding. You can ask your doctor about taking a stomach acid inhibitor to reduce these risks. NSAIDs also carry an increased risk of heart attack, stroke, and kidney failure when taken at high doses or for long periods of time.
Taking acetaminophen along with an NSAID may provide equivalent pain relief with lower doses of both pain medications, thus minimizing side effects. You can also alternate between the two to reduce the risk from either type of medication.
For additional advice on reducing knee pain, review Knees and Hips: A troubleshooting guide to knee and hip pain, a Special Health Report from Harvard Medical School. 
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Surgery-free pain relief for hips and knees

surgery-free pain relief
Hip and knee pain can keep you from the activities you love, as well as make routine tasks difficult. But there are many ways to get you moving again pain-free, without surgery. Here are some of the treatments that can help relieve hip and knee pain.

Ultrasound, phonophoresis, and iontophoresis

Therapeutic ultrasound is a simple procedure that uses sound waves to increase blood flow, relax muscle spasms, and aid healing that leads to faster hip pain relief and knee pain relief. The therapist applies gel to your skin and moves an ultrasound wand over your skin around the painful area. In a special ultrasound technique called phonophoresis, medication (often hydrocortisone) is added to the gel. In a survey of orthopedic physical therapists, more than half said they would use ultrasound and phonophoresis to reduce soft-tissue inflammation (in tendinitis or bursitis, for example). These techniques are also used to manage pain, heal tissue, and help muscles stretch.
Iontophoresis uses electrical currents to speed the delivery of medication to damaged tissue, or simply to reduce muscle spasms and related irritation. Patches similar to Band-Aids are placed on the skin, and a painless, low-level current is applied for about 10 to 15 minutes. You may feel warmth or tingling during the treatment.

Therapeutic exercise

Strengthening the muscles around a damaged knee or hip can help reduce stress on a joint. For example, your hips have to do less work to support your body weight if your quadriceps, gluteals, hamstrings, and abdominal muscles are strong. Strong quadriceps can also take on some of the shock- absorbing work of the meniscus or cartilage in the knees. The proper balance of strength in the muscles can hold the joint in the most functional and least painful position. Flexibility exercises (to stretch and relax specific muscles) are also an important part of an exercise plan to improve joint function.

Gait retraining

Knee and hip problems can disrupt your normal walk by causing pain, restricting joint movement, or weakening muscles. And a person's normal pattern of standing, walking, or running may invite joint problems. It may take many years of walking with an abnormal gait before joint injury occurs. A physical therapist can analyze your gait and help you learn to move more efficiently. Initially, the "normal" gait may feel odd. It can take practice and continued instruction before it becomes comfortable, but it will eventually become natural for you. Physical therapists may also suggest a change in shoes or ways to strengthen muscles that can help restore a more aligned gait.
For more on strategies for pain-free knees and hips, plus a Special Bonus Section on knee and hip replacement, read Knees and Hips, a Special Health Report from Harvard Medical School. 
Image: Guillermo Iosio/iStock
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Knees and Hips: A troubleshooting guide to knee and hip pain

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