Osteoarthritis Pain Medicine: Risks and Benefits

Because there is no cure for osteoarthritis (OA), medications focus on pain relief. If you have OA, consider the following risks and benefits of different pain relievers to make the decision that is best for you.

Analgesics for Osteoarthritis Pain

Analgesics are a class of drugs designed specifically to relieve pain. They do not reduce swelling or inflammation associated with OA. However, they can be quite effective as pain medications.

 

One of the most commonly used analgesics is acetaminophen (Tylenol). Acetaminophen is inexpensive and a safe arthritis pain reliever when taken correctly. However, too much acetaminophen can cause liver damage. Adults should not take more than 3,000 milligrams of acetaminophen in a day. People with existing liver disease and people who drink more than three alcoholic drinks a day may not be able to take acetaminophen.

 

There are stronger types of pain medications called narcotic analgesics, which are available by prescription. Narcotic analgesics include codeine, hydrocodone, and oxycodone. Although narcotics are effective in treating moderate to severe arthritis pain, they do have side effects, including nausea, constipation, dizziness, and drowsiness. Some people build tolerance to narcotic drugs, leading to the need for an increased dosage. Narcotics also can be habit-forming.

 

Because some prescription pain drugs may contain a narcotic ingredient along with acetaminophen, it is important to monitor the total amount of acetaminophen taken in a day if you are taking both prescription and over-the-counter pain relievers.

Nonsteroidal Anti-Inflammatory Drugs (NSAIDs) for Osteoarthritis Pain

NSAIDs are also commonly recommended for arthritis pain relief. NSAIDs are available over the counter and by prescription. Over-the-counter NSAIDs help relieve pain but do not have a significant effect on inflammation and swelling at these lower doses. NSAIDs available over the counter include aspirin, ibuprofen, and naproxen.

Prescription NSAIDs have the ability to reduce swelling and inflammation caused by arthritis. There are many prescription NSAIDs, including diclofenac (Voltaren), ibuprofen (Motrin),  naproxen (Naprosyn), and oxaprozin (Daypro).   NSAIDs can increase the risk of heart attack or stroke, especially in higher doses. They can also cause kidney problems and liver problems as well as stomach issues in some patients, including ulcers with serious stomach bleeding. Taking the medicine with food is advised. Some research suggests that taking another medication called a proton pump inhibitor can greatly reduce the incidence of this problem. 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.

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Cox-2 inhibitors, a class of drugs that includes the prescription celecoxib (Celebrex), are NSAIDs created more recently to be safer for the stomach.

Certain people may be at greater risk for adverse effects when taking NSAIDs. Because the side effects of these medications can be serious, it is important to communicate any issues you notice to your doctor immediately. 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.

Antidepressants for Osteoarthritis Pain

Your doctor may recommend the use of antidepressant medication to help treat chronic OA pain whether or not you have depression. The exact way it helps curb pain is not known, 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. Some 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 of sedative effects. Other side effects include dry mouth, nausea, weight change, and constipation.

 

All antidepressant drugs carry a boxed warning of increased risk of suicidal thinking and behavior in children, adolescents, and young adults. All patients starting antidepressant drugs should be monitored closely for any unusual behavioral changes, suicidal thinking and behavior, or worsening of a psychiatric disorder.

Injectable Steroids for Osteoarthritis Pain

Injectable corticosteroids (also known as glucocorticoids or “steroids”) are injected directly into a joint to help ease joint inflammation and pain. The benefit of corticosteroids is that they act quickly and can be administered directly to the joints. Side effects may include allergic reaction but are mainly limited to the joint and include infection, bleeding, and skin changes. Because frequent injections to the same joint can cause damage to the joint structures, you generally should not have more than three injections in the same site per year. Injections should not be done if there is an overlying skin infection.

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Hyaluronan Injections for Osteoarthritis Pain

In viscosupplementation, the doctor injects the “lubricant” hyaluronan, a component of normal joint fluid into the knee joint. It may help ease pain and increase function in some people with mild to moderate OA. It may take four to 12 weeks to feel the full effect, and pain relief can last for up to several months in some people.

 

The potential side effects of hyaluronan injections include joint swelling or pain, and allergic reaction. Also, hyaluronan injections cannot be used by people with skin or joint infections. Examples of hyaluronan injections include Euflexxa, Hyalgan, Orthovisc, Supartz, and Synvisc-One.

Topical Pain Relief (Creams) for Osteoarthritis Pain

Arthritis pain relief does not always come in the form of a pill or shot. For people who cannot tolerate pain medications or who do not experience enough pain relief from other treatments, topical pain relievers in the form of creams, gels, and ointments are an important option. People may also use topical treatments in addition to other medications.

 

Topical treatments come in prescription and over-the-counter forms and may include topical NSAIDs, and capsaicin, an ingredient derived from hot peppers. You might experience some skin irritation, so 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.

Dietary Supplements for Osteoarthritis Pain

Many people also take the dietary supplements glucosamine and chondroitin for osteoarthritis relief, but it's unclear how effective these supplements are at easing pain. Research indicates that the supplements may help some people with moderate to severe pain. However, the supplements also pose little risk; the most common side effect is a mild upset stomach. So, people with osteoarthritis often give them a try.

WebMD Medical Reference Reviewed by David Zelman, MD on September 11, 2019

Sources

SOURCES:

 

News release, FDA.

 

American College of Rheumatology: Practice Guidelines: "Recommendations for the Medical Management of Osteoarthritis of the Hip and Knee."

 

The Arthritis Foundation: "What Can You Do About OA?" "2011 Drug Guide."

 

FDA: "Medication Guide for Nonsteroidal Anti-Inflammatory Drugs (NSAIDs)."

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