Before you consider medication, the National Institute of Arthritis and Musculoskeletal and Skin Diseases (NIAMS) recommends that you:
Rest and avoid activities that cause pain.Exercise to strengthen the muscles that support joints affected by osteoarthritis.Lose weight, if necessary, to take stress off arthritic joints. When researchers reviewed data from 4,769 adults with osteoarthritis, they found that the more a person weighed, the more pain they experienced, according to a study in the November 2014 issue of Rheumatology.
Options to try first, according to NIAMS: Acetaminophen (Tylenol, Panadol). Generally, the first medication recommended for osteoarthritis treatment is acetaminophen. It relieves pain but does not reduce inflammation in the body. Acetaminophen is relatively safe, though taking more than the recommended dosage can damage your liver, according to the Food and Drug Administration (FDA). If you take acetaminophen regularly, you should also take care to avoid consuming more than two alcoholic drinks a day because the combination of acetaminophen and alcohol can increase your risk for liver damage. Nonsteroidal anti-inflammatory drugs (NSAIDs). For people who don’t respond to acetaminophen, an NSAID is often prescribed at the lowest effective dose. Common over-the-counter NSAIDs include Advil and Motrin (ibuprofen) and Aleve (naproxen). NSAIDs relieve pain and reduce inflammation, but they can trigger more side effects than acetaminophen. NSAIDs may lead to stomach upset and, with prolonged use, stomach bleeding and kidney damage may occur, warns the FDA. In addition, NSAIDs other than aspirin can increase the risk for heart attack and stroke. In July 2015, the FDA strengthened the existing heart attack and stroke risk warnings associated with these drugs. Drug manufacturers now must change warning labels to reflect findings that these risks increase with the strength of the dose and the length of time you take NSAIDs. The risks also are higher for people who have heart disease or risk factors for heart disease when they start on an NSAID, but they can affect anyone. Cyclooxygenase-2 inhibitors. COX-2 inhibitors like Celebrex are prescription-strength NSAIDs that have been designed to produce less stomach irritation. If you experience stomach irritation with other NSAIDs, acetaminophen doesn’t do enough to relieve your pain, and you have a low risk for heart disease, this may be your best option, according to recommendations published in BMC Medicine by the International NSAID Consensus Group in March 2015. However, although COX-2 inhibitors may lead to less stomach upset, they have the same risk of kidney damage. These medications must now carry the same warning of increased risk for heart attack and stroke as over-the-counter NSAIDs, according to the FDA. COX-2 inhibitors should be taken only at the lowest dose needed to relieve your pain.
Medications for Severe Osteoarthritis Pain
There are also many treatment options for pain that get more intense, as can be seen in more advanced stages of osteoarthritis. These include: Opioid analgesics. If you’re experiencing severe pain, your doctor may recommend an opioid medication. These are medications that act like (or are made from) opium, a narcotic drug made from the opium poppy. They relieve pain by blocking pain receptors in the brain. Although opioids are powerful pain blockers, they also have many side effects and can be addictive, according to NIAMS. When opioids are taken as prescribed for pain relief, the drugs are usually safe, though drowsiness may occur, making it unsafe to drive or operate machinery while using them. It’s also important that you take them exactly as prescribed and not in excess, the FDA states. Misuse has become more common over the years; in 2013, the most recent year for results from the National Survey on Drug Use and Health, the number of Americans misusing painkillers was about 6.5 million in any given month. Corticosteroid injections. If oral medications aren’t working or are causing too many side effects, your doctor may try injecting medicine directly into your joints. These provide short-term relief, and you might need more than one injection over the course of a year, according to NIAMS. Hyaluronic acid injections. Hyaluronic acid is a naturally occurring substance inside joints, according to the Arthritis Foundation. These injections for hip or knee joints affected by osteoarthritis have been approved by the FDA for osteoarthritis treatment, but their usefulness is still being debated. Some studies show good results, but others don’t. Side effects can include allergic reactions and pain or swelling at the injection site. When all else fails, your doctor may recommend surgical osteoarthritis treatment, according to the American Academy of Orthopaedic Surgeons. Managing osteoarthritis can be a big challenge, but prescription and over-the-counter medications do work for many people. The best way to help osteoarthritis treatments work better is to learn as much as you can about this disease and make lifestyle changes that include exercise and weight loss. Article updated by Madeline Vann, MPH.
