If osteoarthritis (OA) causes you pain, you don’t have to grin and bear it. Several types of medications and other treatments can bring you relief. They may not get rid of your pain totally, but they can often ease it enough for you to do the things you want and need to do.
There are many types of medicines to choose from, but like all drugs, each has its pros and cons. Talk to your doctor about them to decide what’s best for you.
Treatments Without Medicine
Nondrug treatments are the first option for relieving OA pain. They have many benefits and few, if any, risks. Even if you need medication, it’s still important to make lifestyle changes, too.
Exercise relieves joint pain and stiffness. One study of people with knee OA showed exercise worked as well as anti-inflammatory pain relievers. But you have to do it regularly. Like most treatments, if you don’t stick with exercise, the benefits go away.
Your routine should include cardio to keep your heart and lungs strong. Good low-impact options include walking, swimming, biking, tai chi, and yoga. Also include resistance exercises to build your muscles so they can support your joints. And stay flexible with stretching moves. Check with your doctor or a physical therapist to make sure you’re doing the right type of exercise for you.
If you’re overweight, slimming down will make a big difference in your OA. Weight loss greatly lowers the stress on your joints, especially in the knees and hips. It also relieves pain and helps your joints work better. Losing at least 10% of your body weight (20 pounds in a 200-pound person) can cut your pain in half.
Walking aids, such as canes, and knee braces also help, especially if your knee is out of alignment. Splints can help with OA of the thumb. Ask your doctor or physical therapist about any other devices that may help.
Over-the-Counter (OTC) Pain Medications
Pain relief drugs you can buy at the pharmacy, like acetaminophen (such as Tylenol) and nonsteroidal anti-inflammatory drugs (NSAIDs, such as Advil or Motrin), are usually easy to get and don’t cost a lot.
Acetaminophen can ease mild arthritis pain. But you have to take it carefully. Many other types of medications also have acetaminophen, so it’s easy to take too much without realizing it. Make sure you don’t take more than 3,000 milligrams per day. Too much acetaminophen can cause liver damage. People with liver disease and people who drink more than three alcoholic drinks a day may not be able to take acetaminophen.
NSAIDs also lower swelling and ease pain but do not have a significant effect at these lower doses. Most healthy people can safely take them for short periods without any problems. But NSAIDs can raise your odds of having a heart attack, stroke, high blood pressure, and kidney disease. The FDA says people who’ve had a heart attack should be careful using NSAIDs because it raises their chances of having another heart attack.
Also, NSAIDs keep your stomach from making substances that protect it from acids. After a long time, some people can get side effects like stomach irritation and bleeding. Your doctor may recommend you take a medication that decreases stomach acid to protect your stomach. Your odds for side effects are higher if you’re over age 65, take higher doses of NSAIDs, take them for a long time, or are on medications to prevent blood clots.
Other OTC Pain Relievers
Along with medications, there are supplements and creams that you can buy at the drugstore to relieve arthritis pain. People may also use topical treatments along with other medications.
Many people with OA use the supplements glucosamine and chondroitin. For those with moderate to severe OA knee pain, the combination of the two may ease aches, although medical studies have not shown clear proof that they help a lot. If you choose to try it, take it for at least 3 months before you decide if it helps.
There don’t seem to be any major side effects from glucosamine and chondroitin supplements, but because they are supplements, the FDA doesn’t regulate them in the same way as drugs. That means it’s tough to be sure of the content and quality of supplements you see in stores.
Though the benefit is still unclear, one study showed long-term use of fish oil supplements improved pain and function.
Skin creams made from capsaicin, an extract from chili peppers, may help relieve mild arthritis pain. You may notice a mild stinging or burning feeling when you rub it on your skin, but it usually fades over time. Test the medication on a small part of your skin to make sure you’re not sensitive to any of the ingredients.
You should never apply a topical ointment to broken or irritated skin, and keep them away from your eyes and mouth. Never combine a topical ointment with any sort of heat therapy, such as a heating pad or hot towel, because the combination could cause severe burns.
Cold or warm compresses on a painful joint a few times per week may also improve pain, swelling, and range of motion. Cold therapy may also help you feel better right after you exercise.
Prescription Drugs: NSAIDs
You can ask your doctor for prescription NSAIDs -- stronger than those you buy over the counter -- to treat arthritis pain and inflammation. Besides ibuprofen and naproxen, other examples of prescription NSAIDs include diclofenac (Cambia, Cataflam, Voltaren), etodolac (Lodine), meloxicam (Mobic), oxaprozin (Daypro), and piroxicam (Feldene).
Like over-the-counter NSAIDs, taking these medications for a long time may cause serious side effects like a heart attack, stroke, kidney disease, and stomach irritation and bleeding for some people, especially in those who are older. If you take a daily aspirin, you should also talk with your doctor about whether it’s safe for you to take other NSAIDs.
NSAIDs you rub on your skin, such as diclofenac cream, also work well for hand and knee arthritis and are less likely to cause side effects than pills that you swallow.
Another type of NSAID is celecoxib (Celebrex). It relieves pain as well as other NSAIDs and also lowers inflammation. Some studies have shown that the drug is less likely to cause stomach bleeding. But like other NSAIDs, it can raise your chances for heart disease, and higher doses are riskier for your health.
You might want to take the medicine with food or along with another medication called a proton pump inhibitor to help prevent stomach bleeding. Other medications include an NSAID and a drug to help protect the stomach in one pill, such as diclofenac sodium/misoprostol (Arthrotec) and naproxen/esomeprazole magnesium (Vimovo), though they can be taken separately at a lower cost.
Certain people may be at higher risk of side effects when taking NSAIDs. Because the side effects of these medications can be serious, it’s important to tell your doctor right away about any problems. Also, certain people respond to different NSAIDs better than others, so be patient. You might have to try a few before finding the one that works for you.
In special cases, strong pain drugs such as codeine, hydrocodone, or oxycodone can help people with OA pain. Due to their side effects, doctors prescribe them only for those with severe pain who can’t take NSAIDs or for those waiting for joint replacement.
Your doctor will decide if you need these drugs to treat your pain. Keep in mind that they can cause some serious side effects if you use them for a long time, including nausea, constipation, dizziness, drowsiness, dependence, and addiction. Yet when you take them exactly as prescribed, these pain relievers can be safe and work well against pain.
Opioids can make you drowsy, cloud your thinking, and cause constipation. You should not drive or operate dangerous equipment when you first take these medicines, and you may need to avoid these activities if you take them long-term.
Because some prescription pain drugs may have a narcotic ingredient along with acetaminophen, it’s important to monitor the total amount of acetaminophen taken in a day if you are taking both prescription and over-the-counter pain relievers.
Prescription Drugs: Steroids
If over-the-counter or prescription NSAIDs don't help you, there are other prescription treatments you can try.
Steroid medications ease pain by lowering inflammation, but they help for only a short time. You usually get them as a shot into the affected joint, such as your knee. The benefit of corticosteroids is that they act quickly.
Steroid shots do have side effects, but they’re often less than those from pills. They include infections, allergic reactions, bleeding, skin discoloration, and, rarely, the rupture of a tendon near where the needle went in. Because frequent injections to the same joint can damage the joint structures, you generally should not have more than three shots in the same site per year. Injections should not be done if you have a skin infection.
Prescription Hyaluronan Injections
A substance called hyaluronan, which is part of your normal joint fluid, helps to lubricate and cushion the joints and keep them working properly. Shots of hyaluronic acid into joints may help relieve pain in some people with mild to moderate knee OA. It may take 4 to 12 weeks to feel the full effect, and pain relief can last for up to several months in some people.
The most common side effect is pain where the needle went in. Also, hyaluronan shots cannot be used by people with skin or joint infections. Examples of hyaluronic acid injections include Euflexxa, Hyalgan, Orthovisc, Supartz, and Synvisc.
If your OA reaches a point where you can’t do the things you want and need to do, and none of the pain relief options give you enough relief, then it may be time to talk with your doctor about other options such as surgery.
Antidepressants for Osteoarthritis Pain
Your doctor may recommend the use of antidepressant medication to help treat chronic OA pain even if you don’t have depression. It’s not clear how it works, but brain chemicals affected by antidepressant medications may play a role.
One antidepressant, duloxetine (Cymbalta), is FDA-approved for the treatment of chronic musculoskeletal pain, including chronic osteoarthritis pain. Common side effects include nausea, dry mouth, sleepiness, and constipation.
Doctors sometimes prescribe a tricyclic antidepressant such as amitriptyline, desipramine (Norpramin), and nortriptyline (Pamelor) for chronic pain. These are most often taken near bedtime because they can make you sleepy. Other side effects include dry mouth, nausea, weight change, and constipation.
All antidepressant drugs carry a boxed warning of higher risk of suicidal thinking and behavior in children, adolescents, and young adults. Anyone starting antidepressant drugs should be monitored closely for any unusual behavioral changes, suicidal thinking and behavior, or worsening of a psychiatric disorder.