More than 27 million Americans have osteoarthritis and many of them have chronic pain that limits daily activity. Along with things like physical therapy and weight loss if needed, medication is often a key part of an osteoarthritis treatment plan. Medicine can often help ease pain and help you live an active life. The challenge is to balance benefits against the risk of side effects. To do this, you and your doctor will look at your lifestyle, medical history and other medications you're taking.
Acetaminophen, often a first choice
Acetaminophen (such as Tylenol) is often the first medicine tried for osteoarthritis. It has fewer side effects than some other medications. But while it helps relieve mild to moderate pain, it does not reduce inflammation.
If you are taking acetaminophen, remember not to take more than your doctor suggests. Taking more than the recommended dose can cause liver damage. Don't drink alcohol if you are taking acetaminophen. If you have liver disease, talk to your doctor before taking it.
NSAIDS (Nonsteroidal anti-inflammatory drugs)
NSAIDs are often advised for moderate to severe osteoarthritis pain. NSAIDS can help reduce inflammation, joint swelling and redness. Ibuprofen, naproxen and aspirin are all NSAIDs that are sold over-the-counter. Stronger NSAIDs are available by prescription. All NSAIDs are linked with serious side effects, such as stomach bleeding, kidney disease and possibly heart attack.. Talk to your doctor about whether taking NSAIDs is safe for you. Certain NSAIDs may not be the best choice if you:
- Are 65 or older
- Have stomach bleeding or peptic ulcers
- Have liver or kidney disease or a bleeding disorder
- Drink more than three alcoholic drinks each day
- Have high blood pressure or kidney, liver or heart disease
- Take medicine for high blood pressure, aspirin to protect your heart or any sort of blood-thinning drugs
Aspirin or any aspirin-containing product should not be given to anyone age 18 or younger without a doctor's approval due to the risk of Reye's syndrome.
Corticosteroid joint injection
Corticosteroids are a type of steroid that can relieve inflammation. In osteoarthritis, they are sometimes used as injections into the affected joint. The injected corticosteroid can often give good short-term relief and can improve joint movement. But, too-frequent injections can lead to faster joint breakdown and eventual failure of the joint. For this reason, doctors don't normally give a corticosteroid injection more often than several times a year. Other possible problems from corticosteroid shots include pain related to the procedure itself, infection (on rare occasions) and worsening of arthritis. A temporary flare-up of symptoms is common after an injection and can be treated with pain medicine and a cold compress.
Hyaluronan is a drug formulated for injection directly into the joint. The drug replaces a component of the joint fluid involved in joint lubrication. Joint fluid may then be more effective at cushioning movement, which relieves pain. Hyaluronan treatment is a series of three to five injections. Studies of hyaluronan show it is at least as effective as a single injection of corticosteroid in relieving joint pain. Pain relief may also last longer than with a corticosteroid shot. Possible side effects of this drug include pain related to the injection, joint swelling and, rarely, infection or allergic reactions.
Topical pain relievers
Capsaicin-based topical pain reliever is a medicine put on the skin, usually in the form of a cream, to relieve pain. It is sold over-the-counter and also by prescription. Use this or any topical medicine only according to your doctor's instructions.
This is a prescription pain medicine that is similar to opioids, a stronger and potentially addicting class of drug. But studies have shown that the abuse potential of tramadol is lower than that of narcotics. Your doctor may prescribe this drug if you cannot tolerate NSAIDs or have tried other pain killers without success.
Narcotic pain killers
A narcotic medication contains an analgesic in the opioid class. Examples are codeine and hydrocodone. These may work well against osteoarthritis pain. But there is a potential for both physical and psychological dependence on these drugs. For this reason, they are usually saved only for short-term use and only after acetaminophen and NSAIDs have been tried or cannot be used.
What else do I need to know about medications for osteoarthritis?
The management of pain in osteoarthritis is a dynamic process that changes according to your needs. Over time, your doctor may need to:
- Change the dose or type of medication
- Make other changes to your treatment plan
Write down your questions before your visit. Be open about how the pain may be interfering with your life. Describe any side effects that you are having. Work with your doctor to optimize your medications and cut the risks of side effects. If your medication regimen is not helping, talk to your doctor about the possibility of taking part in a clinical trial. A number of drugs are being studied that may not only help control pain, but also slow the progress of joint damage from osteoarthritis.
Created on 06/08/1999
Updated on 03/10/2010
- Agency for Healthcare Research and Quality. Choosing pain medicine for osteoarthritis.
- Arthritis Foundation. Disease center: osteoarthritis.
- American College of Rheumatology. Subcommittee on Osteoarthritis Guidelines recommendations for the medical management of osteoarthritis of the hip and knee.
- U.S. Food and Drug Administration. Use caution with over-the-counter creams, ointments.
- National Institute of Arthritis and Musculoskeletal and Skin Diseases. Handout on health: osteoarthritis.
- Centers for Disease Control and Prevention. Arthritis basics: osteoarthritis.