Osteoarthritis

Medicine can often help you to relieve the symptoms of osteoarthritis and allow you to continue daily activities. But pain relief medicine does not cure arthritis or decrease the rate of cartilage breakdown and should be used along with home treatment and other treatments, as recommended by your doctor.

• You can often manage mild to moderate arthritis pain with nonprescription pain relievers, such as acetaminophen or nonsteroidal anti-inflammatory drugs (NSAIDs).
• Moderate to severe pain may require stronger pain relievers, such as opioids. Your doctor may also prescribe opioids if you cannot tolerate NSAIDs.

Medication Choices

Medicines doctors use to treat osteoarthritis include:

• Acetaminophen, which may help relieve pain.
• Nonsteroidal anti-inflammatory drugs (NSAIDs), which reduce inflammation and relieve fever.
• Corticosteroid injections in the joint (intra-articular), which reduce inflammation.
• Hyaluronan injections, which may relieve pain.
• Opioids, which may relieve moderate to severe pain.

For some people, acetaminophen and nonsteroidal anti-inflammatory drugs may work equally well for mild to moderate joint pain. Acetaminophen is usually the first medicine tried for pain relief because it has few side effects when it is taken as directed. And studies show that acetaminophen is better than no treatment. But most studies suggest that NSAIDs are more effective than acetaminophen for osteoarthritis.⁹

Topical (applied to the skin) agents may provide short-term pain relief.¹ These include topical NSAIDs, capsaicin, and pain-relieving creams.

What To Think About

Pain relief is important, not just for quality of life and for your mood, but for maintenance of joint function and rehabilitation. If you limit or decrease the movement of your joints because of pain, you will develop tightening, shortening, and weakness of the ligaments, tendons, and muscles that move the joint. This leads to less mobility and function.

When you use pain medicine, your goal is to find relief without side effects. Acetaminophen has the fewest side effects of any pain medicine for osteoarthritis. In some studies it is as effective as nonsteroidal anti-inflammatory drugs (NSAIDs) and in some studies it is not. But because it has the fewest side effects, it is the medicine to try first for pain relief.

If you have no history of gastrointestinal bleeding (such as stomach ulcers), kidney insufficiency, or heart failure and if you are not taking blood thinners, you can try nonprescription NSAIDs, including ibuprofen (such as Motrin or Advil) or naproxen (Aleve). Take the lowest possible dose that controls your pain. It may take a couple of weeks before NSAIDs can relieve your pain well.

In addition to relieving pain, NSAIDS also reduce inflammation. But inflammation does not commonly occur with osteoarthritis, so most cases of osteoarthritis do not require an anti-inflammatory drug (NSAID). Even so, many people with osteoarthritis say that NSAIDs work well for them. Just remember that NSAIDS do not stop joint tissue from breaking down as osteoarthritis progresses.

If you are taking NSAIDs every day, especially for longer than 1 month, your doctor may want to check a blood count or a blood test for kidney function. He or she may also suggest that you take omeprazole to protect you from stomach ulcers. If NSAIDs are not effective, contact your doctor, who may prescribe a higher dose, a different NSAID, or an opioid.

Doctors may prescribe opioid pain relievers (such as codeine or hydrocodone) for people who cannot take NSAIDs or whose pain is unrelieved by other therapies. Used correctly, opioids can be a safe and effective means of pain control. Studies show that you can discontinue opioids without withdrawal difficulties if the opioid is tapered off.¹⁰

Talk to your doctor about what medicines may be best for you. The effectiveness of medicines and the risk of side effects are different for different people. You can try different medicines until your symptoms are controlled.

Medicines that are being studied for osteoarthritis include diacerein and doxycycline. Diacerein helps reduce inflammation. Doxycycline is an antibiotic, but it may help keep the joint space from getting smaller in osteoarthritis. These medicines are not available yet for use with osteoarthritis.