Prescription Drugs: NSAIDs continued...
Like over-the-counter NSAIDs, long term use of these medications may cause serious side effects like heart attack, stroke, kidney disease, and stomach irritation and bleeding, particularly in elderly and other at-risk people. If you take a daily aspirin, you should not take ibuprofen and you should talk with your doctor about the safety of taking other NSAIDs.
Topical NSAIDs, such as diclofenac (Voltaren) cream, have been shown to be effective for hand and knee arthritis, and have a lower risk of side effects than oral versions.
Another class of NSAIDs is called Cox-2 inhibitors. The only drug in this class on the market is celecoxib (Celebrex). It relieves pain as well as other NSAIDs; Cox-2 drugs also reduce inflammation. Some studies have shown that Celebrex poses less risk of stomach bleeding; however, like other NSAIDs, it can increase your risk for heart disease, and higher doses are associated with a greater risk of toxicity.
Prescription Drugs: Narcotics
A variety of prescription narcotic medications such as codeine may be prescribed to help reduce osteoarthritis pain. These can be used in cases when patients with severe pain cannot use or tolerate NSAIDs or Cox-2 drugs. In some instances, narcotics are combined with acetaminophen to provide added pain relief. Examples include prescription drugs that contain hydrocodone (Lortab, Norco, Vicodin) or oxycodone (Endocet, Percocet, Tylox).
A narcotic-like medication called tramadol (Ultram) may also be used to provide osteoarthritis pain relief in those who do not respond to other treatments.
Your doctor will determine if narcotics are appropriate to treat your pain. Keep in mind that long-term use can result in physical dependence. Yet, when taken exactly as prescribed, narcotic pain relievers can be safe, can manage pain effectively, and rarely cause addiction. Narcotics can cause drowsiness, difficulties in thinking clearly, and constipation. However, the drugs methylnaltrexone (Relistor) and naloxegol (Movanik) are approved to treat constipation specifically due to opioid use. You should not drive or operate dangerous equipment when first taking narcotics, and you may need to avoid these activities if you take narcotics long term.