Medication to treat pain

Medication for pain will depend on the cause e.g. pain coming from active Paget's disease requires different medication to pain arising from a complication of Paget's such as osteoarthritis.

Bisphosphonates

When necessary, a group of drugs known as bisphosphonates are used to treat active Paget’s disease because they effectively reduce bone cell activity. In a small number of people, bisphosphonates may initially cause a slight increase in bone and muscle pain, but this usually subsides after a few days. Whilst individual responses may vary, pain, related specifically to active Paget’s disease, often responds well to bisphosphonates within a few months.

The bisphosphonates commonly used in the UK are:
- Zoledronic acid 5mgs – Given intravenously (directly into the bloodstream), in a clinic setting.
- Risedronate 30mgs – Taken orally for two months.
For further information regarding bisphosphonates, see our booklet ‘Paget’s Disease – The Facts’.

What other types of medication may be required?

Analgesics 

Some people with Paget’s disease require painkillers (analgesics) as well as bisphosphonates to control pain, especially if the disease has led to damage to the bones and/or joints. A variety of analgesics are used in the treatment of pain. Each type works in a different way to relieve pain and some products contain more than one kind of analgesic. Individual responses to analgesia vary considerably, both in terms of efficacy and side effects. Always start with small doses of weak drugs that can be gradually increased or changed to stronger drugs until you have the best possible pain relief.

Paracetamol
Paracetamol is one of the safest options that may prove beneficial. It is important to take paracetamol regularly (up to 8 tablets daily) and not wait until the pain becomes intolerable. When taken correctly, it has few side effects. An overdose, however, is dangerous, therefore, if you are taking any other analgesics or cold remedies, check them for paracetamol content so you know how much you are taking.

Non-steroidal anti-inflammatory drugs (NSAIDs)
Examples of NSAIDs include ibuprofen, diclofenac, naproxen, etoricoxib, and celecoxib. They can be used to reduce pain caused by osteoarthritis as well as a number of other painful conditions. Ibuprofen can be purchased without a prescription. It is important, however, that their use be discussed with your doctor, especially if you have had a stomach ulcer, asthma, heart, liver or kidney problem. To minimise the risk of serious side effects, you should take the lowest effective dose, for the shortest time. Some NSAIDs are available as creams, gels or suppositories.

Weak opioids 
Opioids should be considered carefully for short to medium term treatment when other therapies have not worked. Examples of weak opioids are codeine phosphate and dihydrocodeine. Tramadol is classified as a weak opioid in the UK, but in some countries is considered to be a strong opioid. 
Continuous longer-term use of opioids is not advised as tolerance and dependence on the medication can compromise both safety and effectiveness. 

Combination therapies 
Some tablets contain a combination of drugs, such as co-codamol, which contains both paracetamol and codeine.

Strong opioids
Occasionally pain associated with Paget’s disease, or its complications, can be so severe, such as following a fracture, that stronger opiate drugs, such as morphine, may be recommended. These would be used for short periods only as strong opioids are associated with dependence. Side effects can include nausea, vomiting and constipation, therefore other medication may be required to help with these effects. 
As an alternative to oral medication, patches can be used, which are applied to the skin (e.g., buprenorphine).

What can help pain from osteoarthritis?

- Make sure you are not carrying too much weight. If you are overweight, losing weight can help reduce the pain of osteoarthritis a great deal, especially when the knees and hips are affected.
- Muscle strengthening exercises can help reduce pain associated with osteoarthritis of the knees.
- Anti-inflammatory creams and gels, which are rubbed into the affected area can help ease the pain of osteoarthritis.
- When required, painkillers such as paracetamol may help, or if this doesn’t work, anti-inflammatory tablets, like ibuprofen, can be tried.
- If osteoarthritis becomes severe, particularly in your knees and hips, joint replacement surgery may be required. The most common reason for having a joint replacement is if the joint pain has not responded adequately to the measures listed above and it is having a negative impact on your quality of life. The results of joint replacement surgery for osteoarthritis in Paget’s disease are excellent.

Potential side effects

Any medicine can have side effects or interact with other medicines that you are taking. This will vary from one patient to another, but you can ask your pharmacist or GP for individual advice. A list of possible side effects, and how common they are, can be found on the information leaflet, which normally accompanies each medication. You should give your body a chance to get used to the side effects of a medication before deciding to stop taking it. Usually, its benefits are more important than its minor side effects, which sometimes go away after a short while. Some side effects, such as constipation, can be treated effectively and should not prevent you from taking the medication, therefore, ask your pharmacist or GP for advice. 

Contact your GP or pharmacist immediately if you experience a side effect that is listed as severe in the information leaflet, or you have a side effect that you think is serious. If you think that you or someone you are with may be having a serious allergic reaction to a medicine, telephone 999.