Osteoarthritis Medications and Surgery

Your osteoarthritis treatment depends on how severe your pain is and how much it limits your activities. Treatment plans will include non-medication therapy, but medications are often needed as well. Usually doctors will first suggest over-the-counter pain medicines. If these don't help enough, your doctor can prescribe more powerful medications that help treat the symptoms of osteoarthritis.

There are many effective medications for OA. If one does not work well for you, talk to your doctor about trying another.

Medications for Osteoarthritis Treatment

Over-the-Counter Painkillers for OA
Osteoarthritis often gets worse slowly, with periods of little or no change. If you have mild to moderate OA, you may be able to control your symptoms with one of these non-prescription pain relievers.

  • Acetaminophen: Drugs containing acetaminophen relieve mild to moderate pain and cause few side effects in most people. But large doses can damage your liver. So it's important to follow the instructions carefully. Be sure your doctor knows if you are taking acetaminophen regularly.
  • Nonsteroidal anti-inflammatory drugs (NSAIDs): NSAIDS like aspirin, ibuprofen, and naproxen relieve pain and are generally safe. But they can cause stomach irritation and gastrointestinal bleeding in some people. Be sure your doctor knows if you are taking NSAIDs regularly.  
  • Topical pain relievers: Certain creams, ointments, or gels can relieve mild pain on joints that hurt. You can use the following creams on your skin over the joint while also taking pain relievers for general aching and stiffness.
    • Capsaicin (Capzasin and Zostrix) is found naturally in cayenne peppers. It works by interfering with the release of a substance in your body that helps you feel pain.
    • Salicylates (Aspercreme and Bengay) contain a substance similar to that found in aspirin. They may stimulate or irritate nerve endings, distracting your brain away from pain.
    • Menthol (Icy Hot and Biofreeze) is a counter-irritant. It produces a hot or cold sensation that draws your attention away from pain.
  • Glucosamine and chondroitin supplements: These substances are naturally found in healthy cartilage and joint fluid. Some studies show they work. But further study is needed to confirm a benefit.

Prescription Drugs for OA
If over-the-counter medicines don't ease your joint pain, your doctor may recommend one of these prescription pain relievers for osteoarthritis.

  • Prescription NSAIDs: These NSAIDs are stronger than OTC pain relievers, and are prescribed when lower-dose medicines don't help. There are many types of prescription NSAIDs, including celecoxib (Celebrex), diclofenac (Voltaren), ibuprofen (Motrin), naproxen (Anaprox, Naprosyn), piroxicam (Feldene), and sulindac (Clinoril). They are generally safe for most people. But in some people they can cause stomach bleeding and increase the risk of heart attack or stroke. Your doctor may want to keep an eye on you while you take prescription NSAIDs.
  • Steroid injections: Corticosteroids, injected directly into an affected joint, can reduce inflammation and swelling and offer quick, short-term pain relief for people with OA. The benefit usually lasts several weeks to several months. Some people can get pain relief for up to 6 months or longer. These injections are usually given no more than three or four times a year in a single joint. The risk of side effects is small, but can include damage to tendons, bleeding, color changes in the skin, and infection.
  • Hyaluronic acid injections: Hyaluronic acid (HA) is found in the natural synovial fluid in joints. It helps to lubricate joints and serves as a shock absorber. But natural amounts of HA are decreased in people with osteoarthritis. When HA is injected into a joint, it may help lubricate the joint and increase mobility. Injected forms of HA include Euflexxa, Hyalgan, Orthovisc, Supartz, and Synvisc. Hyaluronic acid injections may help ease pain from osteoarthritis of the knee. It isn't clear if it helps other joints. Side effects can include swelling in the joint and a temporary increase in pain. 
  • Antidepressants: Your doctor may recommend an antidepressant to help ease chronic pain. In some people, antidepressants can cause thoughts of suicide or agitation and restlessness. Typically these medications are started at low doses and gradually increased. It's important to work with your doctor to taper off these drugs gradually if you want to stop taking them.
  • Opioid pain relievers: Opioid pain relievers, or narcotics, are strong and typically combined with acetaminophen. Common types of narcotics -- used for moderate to severe OA pain -- contain ingredients such as codeine, hydrocodone, and oxycodone. Examples of narcotic pain relievers include Norco, OxyContin, Percocet, Ultram, and Vicodin. These medications reduce the pain signals in your body, as well as your brain's reaction to those signals. Side effects can include constipation, nausea, and drowsiness. Short-term use is preferred over long-term use. If taken regularly, your body can develop a higher tolerance to these medications over time.

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Osteoarthritis Surgery: The Next Stage

If you have severe joint damage, severe pain, or very limited motion, you may need surgery for your osteoarthritis. These procedures can relieve pain and allow for better mobility.

  • Arthroscopic surgery: This is a common outpatient procedure for knees and shoulders. It allows surgeons to repair the surfaces of damaged joints -- removing loose cartilage, repairing cartilage tears, and smoothing bone surfaces.
  • Joint replacement surgery: When nothing else has worked, damaged joints can be replaced with artificial joints. Hips and knees are most commonly replaced, but artificial joints are now available for shoulders, fingers, elbows, and back joints.
  • Osteotomy: When someone is too young for joint replacement, this procedure can increase stability in knees or hip joints. It involves cutting bone to redistribute weight on a joint and make it more stable.
  • Joint fusion: Also called arthrodesis, this surgery involves fusing two bones on each end of a joint -- thus getting rid of the joint itself. It is used when joints are severely damaged and causing significant pain. It is also done when joint replacement is not effective, as with the ankle.Though a fused joint is not flexible, it is more stable, can bear weight better, and will no longer cause pain due to osteoarthritis.
WebMD Medical Reference Reviewed by David Zelman, MD on January 11, 2017

Sources

SOURCES:

Arthritis Foundation: "Osteoarthritis: Treatment."

Arthritis Today: "Osteoarthritis Medications."

American Academy of Family Physicians: "Intra-articular Hyaluronic Acid Injections for Knee Osteoarthritis."

American Academy of Orthopaedic Surgeons: "Osteoarthritis Treatment."

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