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Understanding Arthritis Painkillers

Weighing the Risks and Benefits

Common Medicines for Arthritis Pain continued...

Narcotics

Prescription narcotic painkillers -- such as codeine, fentanyl, morphine, and oxycodone -- are used for severe pain that is not relieved with other medications. The drugs work on the nerve cells' pain receptors and are very effective in controlling severe pain.

In rare cases, White prescribes a narcotic for arthritis pain relief, she says. "If the only way to get someone up and out of bed is a mild narcotic, then I'll do it. I do it only to help people get over a hump, and only rarely. There are a lot of side effects."

Narcotics are particularly dangerous for elderly patients, because of the risk of falls, White adds. "Most people don't want to take narcotics. I don't think it's the dependency issue as much as it clouds their thinking, and they get constipated. There are a lot of issues that people don't want to put up with."

DMARDs (Disease-Modifying Anti-Rheumatic Drugs)

In rheumatoid arthritis, DMARDs such as methotrexate can help prevent the serious joint damage that is caused by inflammation (they are not used to treat osteoarthritis). Because DMARDs take weeks to really start working, steroids or painkillers are sometimes used until they kick in.

"These drugs are revolutionizing the field of rheumatology," White tells WebMD. "They really have something important to offer people, a chance to not be disabled and out of work. They also offer a chance to do basic lifestyle changes that relieve pain."

There is a downside to many DMARDs: They work by suppressing the immune system, so there is greater susceptibility to infection while taking these drugs. Also, there is risk for liver problems, low blood count, and a slightly increased risk of cancer.

White says she advises her patients to weigh the benefits versus the risks. A person with painful progressive rheumatoid arthritis could face serious disability without treatment.

Biologics (Biological Response Modifiers)

If DMARDs like methotrexate don't help stop rheumatoid arthritis, biologics are the next course of action, says Hadler.

Biologics are a more aggressive, targeted therapy that can actually significantly slow progression of rheumatoid arthritis within a few weeks -- rather than just treating the symptoms. However, biologics can cause flare-ups of other chronic diseases that are in remission, particularly infections like tuberculosis. Biologics may also cause an increased risk of cancer.

"It's something we have to consider," says White. As always, White asks her patients to weigh the risks and benefits given the stage and severity of their rheumatoid arthritis.

Hadler calls biologics "impressive drugs," but usually waits a few months before prescribing them, and is wary about prescribing them for patients in their 20s, 30s, 40s.

"We have had the drugs for a decade, so we know about toxicities for that time frame," Hadler tells WebMD. "But we don't know what these drugs will do if you're taking them for longer than 10 years or for five years and stop for awhile."

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