All autoimmune rheumatic diseases cause pain and stiffness. NSAIDs and painkillers (analgesics) are used by many to achieve a better quality of life, while others almost consistently choose to refrain from using such drugs that do not affect the course of the disease itself. There is no general conclusion that provides answers to what is the proper use of NSAIDS and painkillers for the individual, but some guidelines may be helpful. When it comes to the use of addictive drugs have Norwegian Norwegian Directorate of Health guidelines. Useful patient information about many of the preparations is available in Norwegian here (NMA).
NSAIDs (Non-Steroidal Anti-Inflammatory Drugs)
NSAIDs are a group of medications that are widely used for rheumatic pain. These medicines are available as tablets, suppositories, injection and gel / cream. Nevertheless, paracetamol is usually the first choice for rheumatic pain and is preferred before NSAIDs. Neither paracetamol nor NSAIDs are addictive, but their use may be limited by the risk of other side effects.
NSAIDs do not affect the course of the disease, but reduce pain and discomfort, especially in rheumatic inflammation of the joints. NSAIDs do not contain cortisone (steroids) or addictive substances. Among the most common NSAIDs in the Norwegian market are: ibuprofen (Ibux), naproxen (Napren-E), diclofenac (Volraren), piroksicam (Brexidol). Among the subgroup COX-II inhibitors etherococcib (Arcoxia) is widely used. Some combinations between NSAIDs and a ulcer-protective agent is also used (Artrotec: diclofenac + misoprostol. Vivomo: naproxen + esomeprazole).
Before start of treatment assess whether there is a risk of side effects. These can be ulcer, serious asthma, kidney failure, liver failure, severe heart disease or allergy to the ingredients. One is also careful if blood-thinning drugs are used because the risk of bleeding can then increase. One should define a treatment goal before starting treatment.
Pregnancy and breast-feeding. NSAIDs can reduce the ability to get pregnant as long as the drug is used. NSAIDs can not be used throughout pregnancy and some should not be used at all. Ibuprofen can be used, except for the last two months before birth. In any case, the doses should be as low as possible during pregnancy. Please read information about pregnancy in rheumatic diseases on a separate page here and about NSAID and pregnancy here
Dosage. The dosage for children follows body weight and is in any case different for the different NSAIDs.
Prescription. Many NSAIDs can be purchased at pharmacies without a prescription. In chronic rheumatic diseases, the doctor gives a "blue" prescription.
Side effects. Side effects may occur and the risk must be compared with the indication for treatment. Common side effects:
- NSAID tablets and suppositories should not be used at risk ulcer. Concurrent use of Prednisone and other cortisone drugs increase the risk
- Take special care asthma and allergies that worsen in some cases
- General increased bleeding risk is seen with concomitant use of anticoagulants ("Blood Thinners" drugs) such as Marevan, Fragmin, Klexane, Albyl-E, Pradaxa, Xarelto, Eliquis and Lixiana
- NSAIDs can affect kidney and liver function
- Some suffer from visual disturbances and dizziness
- The drugs may increase the risk of heart attack, especially at high doses
Checks and follow-up. Medical examinations should rule out signs of side effects and whether the effect is as desired. In order to assess the effect (after, for example, three months of treatment), assessment of symptoms at the starting point and during treatment is important.
Patient information is available via the Norwegian Medical Associationa / Norwegian Rheumatological Association
Paracetamol (Pinex, Pamol, Panodil, Acetaminophen (U.S.) and more) are not addictive and usually well tolerated. Effect on pain caused by rheumatic inflammation, but little effect on chronic pain syndromes like Fibromyalgia. Paracetamol should not be used in severe liver disease. Can be bought without a prescription. In chronic rheumatic disease, one can get a "blue prescription" (reimbursement point -71 or on specific diagnoses).
Addictive, painkillers contains opium-like substances. These include Pinex Forte, Paralgin Forte, Nobligan, Oxycontin, Oxynorm, Tramadol, Durogesic patch, Norspan patch, Dolcontin and more. The drugs do not affect the disease activity and have side effects that always occur over time as well a large amount of potential side effects. However, short-term use on special indications is safe when precautions are taken, but they should not be used for a long time in chronic rheumatic diseases. The Norwegian Directorate of Health recommends:
- Prescribing of potentially addictive drugs should be done via a GP who keeps track of consumption.
- When starting in hospital, the indication and duration of treatment should be clearly agreed. The GP should be involved.
- Use over more than two to four weeks is not recommended.
- There is a risk of tolerance development (loss of effect over time), abstinence and dependence.
- Do not use with benzodiazepines ("sedatives") or with z-hypnotics (sleep medicines). Please read more here: (National Expertise Center for Sleep Disorders).
- In the elderly, the dose should be low and short-acting drugs are preferred.
Generally, one should not drive after taking medication. Rules on driving and medication here: (The Norwegian Medicines Agency).
For more information whether the individual drugs are recommended Felleskatalogen.no