Oct 22, 2012

By Trevor Shewfelt, Pharmacist at the Dauphin Clinic Pharmacy

Dad, what does ragged ass mean? Questions like that from my daughter Emily often come out of left field. This one was more straight forward. We were listening to an interview on the radio with a gentleman from Yellowknife, NWT who lived on Ragged Ass Road. Apparently he has to be very careful trying to order anything over the phone to be mailed to his house as telephone sales people often hang up on him when he gives his address. Ordering online is even harder as the filters wont let him type in his address. He has resorted to using Ragged Azz Road. The Canada Post Employees in Yellowknife seem to understand. And recently in the news, a Westjet flight attendant asked a BC man to remove his Ragged Ass Road souvenir t-shirt as it wasnt family friendly. So when Emily asked about ragged ass, at least I knew what she was talking about. I settled on old and worn out as in old and worn out clothes from my definition of ragged ass for Emily. After playing hockey, I think I should just use my painful, old, worn out body as my example of ragged ass.


Besides beer league hockey players, two other common, painful conditions we see in the pharmacy are osteoarthritis of the knee and diabetic neuropathy. There was some new information that came up in my reading this week on both of them.


Osteoarthritis of the knee is when the knee joint wears out. The nice smooth cartilage that lines the joint becomes worn. The cartilage gets ragged ass and bone rubs on bone. Usually we treat osteoarthritis with acetaminophen (or Tylenol) and non-steroidal anti-inflammatory drugs (NSAIDs) like ibuprofen or naproxen. For non-drug measures you can use physiotherapy, weight loss and exercise to help osteoarthritis. Another drug just got approval for treating osteoarthritis of the knee. It is called cymbalta or duloxetine. This drug was originally marketed as an antidepressant.


The theory behind using an antidepressant like duloxetine for osteoarthritis of the knee goes like this. To feel pain in your knee the pain signal has to go up the spinal cord and get to your brain. Duloxetine affects the brain chemicals serotonin and norepinephrine which may be involved in pain transmission. So duloxetine might make you knee hurt less by affecting the nerves that bring the pain signal to your brain. However, duloxetine doesnt seem to be very effective. About 1 out of every 7 patients with osteoarthritis of the knee treated with duloxetine for 13 weeks will have 30% or more improvement in pain. But about 1 out of every 10 patients will have to stop duloxetine due to side effects. And duloxetine is expensive. So I dont think you should run to your doctor and demand duloxetine for your osteoarthritic knee as a first line therapy.


Diabetic neuropathy is when the high blood sugar of diabetes damages nerves in your body. These damaged nerves can cause pain that is very difficult to treat. Not only can this condition by painful but it can affect the patients sleep and mood. On September 18, 2012 Julia Boyle et. al published a comparison between three common treatments of diabetic neuropathy in Diabetes Care. They looked at amitriptyline, duloxetine and pregabalin (Lyrica). It was a small trial with only 83 patients in it, but it was double blinded which means neither the subjects nor the researchers knew which drug was being taken. The other thing that peaked my interest was it was a head to head trial. Most trial pit a medication versus a placebo. That is because most trials are paid for by drug companies. They dont want to risk proving their medication isnt as good as their competitions drug in a head to head trial. So, they usually pay for trials with a medication versus a sugar pill. This means we never really have a good answer to the question of which drug in a class is better than the other.


So between amitriptyline, duloxetine and pregabalin which is better? None of them! They are all equally good at treating diabetic neuropathic pain! The reason Im so excited is that means the older and much cheaper amitriptyline is just as good as the new, expensive duloxetine and pregabalin. Thats great news! Its not that duloxetine and pregabalin dont have their uses. Duloxetine might be a little bit better when it comes to having the patient be awake and sharp during daytime activities. Pregabalin might be a little bit better at helping people sleep, but it might make sleep apnea worse. But when it comes to pain, amitriptyline is just as good as either of them.


Ragged Ass Road t-shirts shouldnt be banned from Westjet flights, because sometimes Ragged Ass Road is a family friendly land mark. Ragged ass sometimes isnt bad when it refers to something being old and worn out. Acetaminophen may be ragged ass compared to duloxetine, but it is a better, cheaper choice for osteoarthritis of the knee in most people. Amitriptyline may be ragged ass compared to pregabalin, but it is just as good at treating diabetic neuropathy and it is much cheaper.



As always if you have any questions or concerns about these or other products, ask your pharmacist.


The information in this article is intended as a helpful guide only. It is not intended to be used as a substitute for professional advice. If you have any questions about your medications and what is right for you see your doctor, pharmacist or other health care professional.


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Ragged Ass Road news clip:

Diabetes Care article:


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