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It is estimated that 27 million US adults suffer from osteoarthritis - that's 70% of adults between 55 and 78 years of age. It is a disease of the joints with both degenerative and inflammatory components. In my case the causes are both hereditary (my mother had arthritis) and trauma-related. Ten years ago I  injured my back in a fall, leaving me with a form of spinal arthritis related to degenerative disc disease. I have two lumbar discs that are completely gone, so I have bone-on-bone contact. I was also on crutches for two years, and as a result my thumbs have severe osteoarthritis.

You would think Big Pharma would be all over new treatments for osteoarthritis, given the huge number of suffering patients. Unfortunately, that is not the case. Our medication choices are limited to acetaminophen, which does not reduce the pain caused by inflammation, aspirin and other NSAIDs, the one remaining COX-2 inhibitor (Celebrex), and narcotics.

NSAIDs were wonderful - but I can't take them any more. Celebrex hurts my stomach even more than aspirin and NSAIDs.  Tylenol doesn't help much, and it's problematic because of its effect on the liver. Oxycodone in doses high enough to lower my pain makes me stupid. Dexamethasone injected into the facet joints didn't help (although it's extremely effective for pain caused by spinal stenosis and inflamed SI joints).

Side note: You've probably seen TV ads touting Cymbalta, an antidepressant, as the "latest and greatest thing" for osteoarthritis. Even if I were willing to chance the side effects reported by hundreds of users, my pain doc is not impressed with Cymbalta. He says it has some effect on nerve pain but he scoffs at the claims it helps musculoskeletal pain.

So what's a girl to do?

I have some past experience with using drugs transdermally: Lidoderm patches and Flector patches both helped, the former some and the latter a lot. I was thinking about the Flector patches, which are infused with an NSAID, and I wondered if there might be a transdermal patch infused with a steroid. (How to explain that train of thought? "NSAID = non-steroidal anti-inflammatory drug. Might there be a steroidal anti-inflammatory drug with the same effect?" I asked myself.)

When I found there's no transdermal steroid patch available, I asked a compounding pharmacist what she could do for me. They don't work with the patches, at least not locally, but she said she could make up a cream with whatever I wanted. I emailed my doc and asked him to call in a script for a compound containing dexamethasone (the steroid I was looking for),  lidocaine (local numbing), and cyclobenzaprine (muscle relaxant for those pesky back muscles which like to spasm). Once I had my magic cream™ in hand, I wanted to slather it on and keep it there for the first 24 hours. How to keep it on my skin and off my clothes? I made an "apron" of 4" x 6" plastic wrap, taped the long end to my waist with paper tape, raised it up, and applied the cream to my lumbar spine. Then I lowered the apron, carefully slipped on some granny panties, and Bob's your uncle!

I reapplied the cream from time to time that first 24 hours, not expecting to see any effect - if any - for several days. I was amazed to wake up after 18 hours of treatment to find less pain and more flexibility than I've had since stopping NSAIDs in November! I dispensed with the apron after 24 hours and now just rub some in 2-3 times a day.

Meds do get into your system through the skin. I can't swear it's the magic cream™, but I can report my arthritic thumbs are hurting much less for the first time in weeks.

Is it safe? I don't know - and, quite frankly, I don't care. Two weeks ago I was staring at a future filled with a narcotic haze and, perhaps, a wheelchair. Today I'm planning my summer garden.

I am not a doctor and I am not a pharmacist. I am a patient who has been abandoned by the pharmaceutical industry, and I am sick and tired of being offered crap like Cymbalta and Tylenol for a disease that is destroying my quality of life. I've done my part and then some: I keep my weight down, I do yoga and stretching exercises, I have weekly massage therapy, and I employ every other non-pharmaceutical intervention I can think of. Heat is good. Acupuncture rarely helps. Supplements are tried.

I want something else!


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