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cox-2 drugs; any work better for different needs?

post #1 of 15
Thread Starter 

So my PT recommended looking into possibly taking a cox-2 med for inflammation and pain for my knee (grade 4 chondro) but I hate taking meds.  Any Dr's or PTS that care to comment unofficially?  

post #2 of 15

I've been taking Voltaren (diclofenac) for about three years and it works better than any other NSAIDs that I've tried. I had my left shoulder replaced a year ago and now I'm dealing with arthritis in right shoulder and both knees. Unofficially I would think a cox-2 is worth a try.

post #3 of 15
Thread Starter 
Quote:
Originally Posted by pud View Post

I've been taking Voltaren (diclofenac) for about three years and it works better than any other NSAIDs that I've tried. I had my left shoulder replaced a year ago and now I'm dealing with arthritis in right shoulder and both knees. Unofficially I would think a cox-2 is worth a try.

Thanks! Appreciate the feedback
post #4 of 15
It's worth trying various general over-the-counter NSAIDs before prescription alternatives; people just seem to respond differently with respect to effectiveness and side effects. Then one can try Cox2 selective NSAIDs next if neither above helped.

If you want to geek out on the full load down of the scientific evidence, see page 1-16 page with executive summary table in pages 14-16 as key. http://www.effectivehealthcare.ahrq.gov/repFiles/AnalgesicsFinal.pdf

It also contains info on chondroitin/glucosamine.

Disclosure: speaking as a well trained Doctor of Pharmacy who is in and out of clinical practice in infectious diseases.

Finndog, message me if you need more detail info. More than happy to help my JH gathering neighbor : )
Edited by Rainbow Jenny - 5/5/15 at 12:50pm
post #5 of 15
Thread Starter 
Quote:
Originally Posted by Rainbow Jenny View Post

It's worth trying various general over-the-counter NSAIDs before prescription alternatives; people just seem to respond differently with respect to effectiveness and side effects. Then one can try Cox2 selective NSAIDs next if neither above helped.

If you want to geek out on the full load down of the scientific evidence, see page 1-16 page with executive summary table in pages 14-16 as key. http://www.effectivehealthcare.ahrq.gov/repFiles/AnalgesicsFinal.pdf

It also contains info on chondroitin/glucosamine.

Disclosure: speaking as a well trained Doctor of Pharmacy who is in and out of clinical practice in infectious diseases.

Finndog, message me if you need more detail info. More than happy to help my JH gathering neighbor : )

 

COOL STUFF but I have to read that on a clear head. I've been running reports and analyzing data all day :D  My Dr prescribed Celebrex but my insurance company shot me down...  Waiting to hear how the battle goes between a board certified OS and a desk jockey with no medical knowledge or knowledge of my case..  In the mean time, I will read up ASAP!  

post #6 of 15
Quote:
Originally Posted by pud View Post
 

I've been taking Voltaren (diclofenac) for about three years and it works better than any other NSAIDs that I've tried. I had my left shoulder replaced a year ago and now I'm dealing with arthritis in right shoulder and both knees. Unofficially I would think a cox-2 is worth a try.


I like the gel form of Voltaren that you rub on the painful part. It actually works.  I can't tolerate NSAIDS orally and this way you're not putting them everywhere.

 

Be careful with taking NSAIDs over a long period of time, they can rot your gut. And if you take the COX2 type of NSAID that doesn't hurt your gut so you can take it longer, it can do other nasty things. No doctor told my husband, for example, that long-term use of these drugs can lead to urinary retention and even urinary stoppage. AAAKKKK. Don't want to end up with a pocket full of catheters from taking too much of this stuff for too long. He was lucky but it was touch and go (or don't go as the case may be).

 

Just sayin' be careful; ask you doctor.

post #7 of 15
Quote:
Originally Posted by Finndog View Post

 

COOL STUFF but I have to read that on a clear head. I've been running reports and analyzing data all day :D  My Dr prescribed Celebrex but my insurance company shot me down...  Waiting to hear how the battle goes between a board certified OS and a desk jockey with no medical knowledge or knowledge of my case..  In the mean time, I will read up ASAP!  

 

It's not unreasonable for an insurance company to deny an expensive drug when there are cheaper prescription or OTC drugs with equivalent benefit that haven't been tried. I don't know the particulars of your case, of course.  Some docs will prescribe a new, expensive, heavily marketed drug to start, even if that drug offers no benefit over an older, less sexy alternative. If you want to make yourself lose all faith in the medical profession, do some reading on how drugs are marketed to individual physicians--how much published research is funded by the companies, how much negative research is suppressed by the company funding it, how doctors are paid to give favorable talks about the drug to other MD's, and how freebies, often expensive freebies, are given to docs, along with free samples. Mind you, I have no idea if any of this has any bearing on your case and your OS--my remarks are general. (Where I practiced we weren't allowed to take so much as a pen from a drug rep. Docs are like politicians--we all claim the money, gifts, etc, don't influence us, but of course they do.)

Quote:
Originally Posted by Mom View Post
 
 

Be careful with taking NSAIDs over a long period of time, they can rot your gut. And the COX2 type of NSAID that doesn't hurt your gut so you can take it longer, it can do other nasty things. No doctor told my husband, for example, that long-term use of these drugs can leadif you take  to urinary retention and even urinary stoppage. AAAKKKK. Don't want to end up with a pocket full of catheters from taking too much of this stuff for too long. He was lucky but it was touch and go (or don't go as the case may be).

 

Just sayin' be careful; ask you doctor.

Cox 2 inhibitors can cause ulcers, perhaps less often than nonspecific nsaids, but still a significant risk. As far as other nasty things--both kinds--how about heart attacks? BTW I'm taking naprosyn on a regular basis myself, but I'm certainly aware of the risk. 

post #8 of 15

Finn, since osteoarthritis is a degenerative process and not an inflammatory process, NSAIDs (COX-1 or 2) are not the gold standard medication. Its actually Tylenol for the day to day aches. Have you tried taking two extra strength Tylenols in the am (1000mg) and again at night? 2000mg/day of Tylenol is safe to take on a long term basis without fear of liver damage. However, this would not help you as much as the NSAIDs when you do get inflammation/swelling after heavy activity. During those periods, a short course of the NSAIDs can be helpful. Im not a huge fan of taking NSAIDs for long term. Im more of a fan of taking high doses for a short period of time with the purpose of removing swelling along with the other common measures (RICE).

 

ps disregard everything above if you are a heavy drinker or have a history of liver damage from other causes

post #9 of 15
Thread Starter 
Quote:
Originally Posted by agreen View Post

Finn, since osteoarthritis is a degenerative process and not an inflammatory process, NSAIDs (COX-1 or 2) are not the gold standard medication. Its actually Tylenol for the day to day aches. Have you tried taking two extra strength Tylenols in the am (1000mg) and again at night? 2000mg/day of Tylenol is safe to take on a long term basis without fear of liver damage. However, this would not help you as much as the NSAIDs when you do get inflammation/swelling after heavy activity. During those periods, a short course of the NSAIDs can be helpful. Im not a huge fan of taking NSAIDs for long term. Im more of a fan of taking high doses for a short period of time with the purpose of removing swelling along with the other common measures (RICE).

ps disregard everything above if you are a heavy drinker or have a history of liver damage from other causes

Appreciated. The goal here is an attempt to control the pain and inflammation in my knee . I am unable to walk up or down stairs/inclines or sit with a bent leg without significant pain. I can't do any pt It's not a matter of heavy use. This was suggested by my pt which was when I started the thread. I have since had a conversation with my OS as a measure until I can get back to the OS in CO.
post #10 of 15
Thread Starter 
]. The OS didn't "just" suggest Celebrex Long story short, we discussed several possible meds but this one seemed to make the most sense

Just to be clear, I'm not going to die and I will find a solution! 😀. I am just trying to be a s proactive as possible.
Edited by Finndog - 5/6/15 at 5:25am
post #11 of 15

Re: insurance/celebrex, there is a less expensive generic version available. My vial says, CELECOXIB, (not sure if that's the generic name or pharmacy code).

 

For me, Celebrex worked noticeably better then any of the others I had tried but in time the pain relieving effects wore off. I began with 100mg 2x/day as needed which has recently been upped to 200mg. I try to take it as little as possible but there are times when I require the full dose for days or weeks.

post #12 of 15
Thread Starter 
Quote:
Originally Posted by neonorchid View Post
 

Re: insurance/celebrex, there is a less expensive generic version available. My vial says, CELECOXIB, (not sure if that's the generic name or pharmacy code).

 

For me, Celebrex worked noticeably better then any of the others I had tried but in time the pain relieving effects wore off. I began with 100mg 2x/day as needed which has recently been upped to 200mg. I try to take it as little as possible but there are times when I require the full dose for days or weeks.

 

oh, its a generic!  My insurance co Anthem always uses generics. I don't have any issue with them for the most part.   CELECOXIB is the generic name, Celebrex is the Pfizer name. 

post #13 of 15
Quote:
Originally Posted by Finndog View Post

Appreciated. The goal here is an attempt to control the pain and inflammation in my knee . I am unable to walk up or down stairs/inclines or sit with a bent leg without significant pain. I can't do any pt It's not a matter of heavy use. This was suggested by my pt which was when I started the thread. I have since had a conversation with my OS as a measure until I can get back to the OS in CO.

 

Wow, Im sorry to hear that. So what you are saying is that your knee is chronically inflamed/always swollen due to bone on bone arthritis? If that is the case, then I agree with your PT. Im sure if you had is aspirated (remove the fluid) it would just come right back. This becomes a managing treatment until inevitable knee replacement. I think I remember you inquiring about Hyaluronic acid injections in the past?

post #14 of 15
Thread Starter 
It's not terribly swollen but enough. The Vastus medialus is inflamed as are other surrounding areas. The plica is inflamed again which flips if I bend the knee under any kind of load. Wakes me at night too so some relief would be welcomed. It wasn't this bad while skiing ironically. So I think I just need to ski more. 😊
Edited by Finndog - 5/6/15 at 9:49am
post #15 of 15
Quote:
Originally Posted by agreen View Post
 

Finn, since osteoarthritis is a degenerative process and not an inflammatory process, NSAIDs (COX-1 or 2) are not the gold standard medication. Its actually Tylenol for the day to day aches. Have you tried taking two extra strength Tylenols in the am (1000mg) and again at night? 2000mg/day of Tylenol is safe to take on a long term basis without fear of liver damage. However, this would not help you as much as the NSAIDs when you do get inflammation/swelling after heavy activity. During those periods, a short course of the NSAIDs can be helpful. Im not a huge fan of taking NSAIDs for long term. Im more of a fan of taking high doses for a short period of time with the purpose of removing swelling along with the other common measures (RICE).

 

ps disregard everything above if you are a heavy drinker or have a history of liver damage from other causes

Good advice. For that matter, mixing Tylenol (acetominophen) and an NSAID is another approach that might allow you to take less of each. Less risk of side effects that way, since they have different side effects. NSAIDs, while they are anti-inflammatory, are also good pain relievers in the absence of inflammation. This is also the advice I would give someone taking narcotics--use NSAID and narcotic both (but not tylenol if the narcotic is mixed with it, like Tylenol#3 or Vicodin.).

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