Many TGCT patients report swelling, stiffness, and pain which can be intermittent, gradual, or chronic. Often, part of being a TGCT patient is finding a method of pain management. Additionally, for patients on drug treatments, side effect management becomes a critical part of your daily life.
Pain Management
Symptoms of TGCT usually includes stiffness, swelling, pain, and limitations in range of motion. Due to the chronic progression of TGCT in some patients, pain often persists. Pain management often refers to the use of analgesics, anti-inflammatories, and steroids to reduce swelling, inflammation, and overall pain. To help manage these symptoms, your provider may prescribe one or more of these types of drugs.
Anti-inflammatory drugs come in over-the-counter and prescription forms. Majority of anti-inflammatory drugs prescribed will fall into a class called Non-Steroidal Anti-Inflammatories (NSAIDs). These drugs work by blocking a chemical that sends pain and inflammatory signals to the site of injury. Commonly used over-the-counter anti-inflammatory medications are Aleve (Naproxen), Advil or Motrin (ibuprofen), and Exederin (aspirin). Prescription NSAIDs are more powerful against inflammation and pain, however, carry more risks and require doctor consultation prior to use.
Nerve pain medication, also called GABA analogues, are available by prescription from a healthcare provider. These medications work by binding to signal sites in nerve cells and hinder pain associated with nerve damage. The most commonly prescribed nerve pain medications are gabapentin, duloxetine (Cymbalta), and pregabalin (Lyrica). These drugs can aid in nerve damage and the pain associated.
Muscle relaxants are available by prescription from a healthcare provider. These medications work by reducing stiffness in muscles. This relaxation can reduce pain and discomfort. Some drugs in this family work directly on the muscles to lead to relaxation, other members of this medication family work on the brain, signaling the muscles to relax. Two of the most commonly prescribed are baclofen and Flexeril (cyclobenzaprine). Baclofen works by reducing the transmission of messages between the spinal cord nerves and muscles. Flexeril primarily works at the brain stem and reduces the pain signaling sent to the brain.
Pain medications are available in over-the-counter and prescription forms. The most commonly used over-the-counter medication for pain is acetaminophen (Tylenol). These drugs work by blocking your brain from releasing signals telling your body that its in pain. These drugs do not reduce swelling or inflammation like NSAIDs do. Prescription-strength pain medication, such as narcotics, work by attaching themselves to pain receptors in your brain and block the sensation of pain. However, a major challenge of treating chronic pain is that narcotics, while effective, are extremely addictive and tolerance builds over time. Due to the addictive features of these drugs, long-term use is not recommended. Please Note: Consult with your healthcare team for the proper duration, dose, and type of pain management strategy appropriate for you.
Cortisone steroids, called corticosteroids, are given as an injection to reduce inflammation. TGCT patients commonly report getting at least one of these injections at some point in their treatment journey with mixed reviews on the effectiveness. Cortisone steroids resemble a hormone called cortisol. These steroids work to decrease inflammation by reducing the activity of the immune system and the production of collagen. The injection reduces collagen production in the joint and tendon it is locally administered to, calming the nerves and reducing pain directly related to inflammation. The use of steroids in TGCT is decreasing in popularity with the shift in the literature that shows TGCT works as a tumor disease with an immune component rather than solely an immune disease (1). Cortisone injections have risk of infection and degeneration of connective tissue, please consult with your doctor about your risks.
Cannabidiol oil, often referred to as CBD oil, is extracted from the cannabis plant, then diluted into an oil with coconut or hemp seed oils. Although CBD oil is one of the main extracts from the marijuana plant, it does not create any intoxication like the other marijuana component, THC. The body produces endocannabinoids that bind to the cannabinoid receptors in the brain, relieving inflammation and pain. It is thought these CBD oils works by mimicking the brains signaling similar to endocannabinoids already present in the body (2). The full impact of CBD oil on pain remains unclear, although, some studies have been able to show that CBD and CBD-THC combinations can reduce pain in patients with multiple sclerosis and arthritis (3,4). Please note: Talk to your healthcare provider before using CBD oil as it is not approved by the FDA and can carry side effects.
References
1. Gelhorn HL, Tong S, McQuarrie K, et al. Patient-reported Symptoms of Tenosynovial Giant Cell Tumors. Clin Ther. 2016. doi:10.1016/j.clinthera.2016.03.008 2. Darkovska-Serafimovska M, Serafimovska T, Arsova-Sarafinovska Z, Stefanoski S, Keskovski Z, Balkanov T. Pharmacotherapeutic considerations for use of cannabinoids to relieve pain in patients with malignant diseases. J Pain Res. 2018. doi:10.2147/JPR.S160556 3. Russo M, Calabrò RS, Naro A, et al. Sativex in the Management of Multiple Sclerosis-Related Spasticity: Role of the Corticospinal Modulation. Neural Plast. 2015. doi:10.1155/2015/656582 4. Blake DR, Robson P, Ho M, Jubb RW, McCabe CS. Preliminary assessment of the efficacy, tolerability and safety of a cannabis-based medicine (Sativex) in the treatment of pain caused by rheumatoid arthritis. Rheumatology. 2006. doi:10.1093/rheumatology/kei183
