What is the best pain medication for severe osteoarthritis

Pain relief is the most important goal of treating osteoarthritis (OA). When joints don’t hurt, it’s easier to move, manage everyday activities, and exercise. There are many options for treating OA pain, including over-the-counter (OTC) and prescription medications and procedures for treating inflammation that will relieve pain.

This article describes each treatment for managing osteoarthritis pain. It can help you to understand the differences among them so you and your doctor can decide which are most likely to work for you.

Over-the Counter (OTC) Treatments

Analgesics are medications that relieve pain. They work by blocking pain signals to the brain or by interfering with how the brain interprets pain signals.

Analgesics that can be bought OTC without a prescription often are strong enough to relieve pain from OA. They are available in oral forms (to be swallowed) or topical forms (to be applied directly to skin).

Oral Drugs

The American College of Rheumatology (ACR) recommends nonsteroidal anti-inflammatory drugs (NSAIDs) as the first oral medications for treating osteoarthritis. These drugs relieve inflammation as well as pain. They work by blocking an enzyme called cyclooxygenase, also known as COX.

There are two forms of cyclooxygenase—COX-1 and COX-2. Most NSAIDs affect both forms.

Two OTC oral NSAIDs can be taken for osteoarthritis:

• Ibuprofen (Motrin, Advil, and generic versions), which can be purchased as a tablet, chewable tablet, liquid, or drops
• Naproxen (Naprosyn, Aleve), which comes as a tablet or a gelatin-coated tablet

Acetaminophen is only “conditionally recommended” by ACR, as research suggests it may not be effective.

There are many brands of acetaminophen. The most well-known is Tylenol. It has several strengths and forms, including tablets, extended-release tablets, capsules, caplets, gel tabs, gel caps, and liquids.

Topical Treatments

Topical analgesics are creams, ointments, gels, and other products that contain pain medication. They are rubbed directly onto joints and other affected areas.

There are a variety of OTC topical pain relief products:

• Diclofenac topical is an NSAID sold under the brand name Voltaren Arthritis Pain and as a generic product. Both come as a 1% gel and can be used on one or two body parts four times daily.
• Counterirritants, which contain ingredients like wintergreen oil, camphor, menthol, and eucalyptus, create sensations in the skin that distract from the pain. Icy Hot and Biofreeze are two counterirritant products sometimes used to relieve OA pain.
• Salicylates contain the same type of pain reliever as aspirin. Topical salicylates include some formulations of Bengay and Aspercreme.
• Capsaicin is the active ingredient in chili peppers that creates a burning sensation on the skin. Several topical pain relief products contain capsaicin, such as Zostrix.

Recap

Medications for treating pain caused by osteoarthritis (OA) include several oral and topical products that can be purchased without a prescription. Over-the-counter (OTC) treatments for OA include oral acetaminophen and non-steroidal anti-inflammatory drugs and topical treatments such as Voltaren, Bengay, Aspercreme, and Zostrix.

Prescriptions

When over-the-counter treatments are not strong enough to relieve osteoarthritis pain, a doctor may prescribe a stronger medication. Several classes of drugs are effective for OA.

NSAIDs

Prescription-strength non-steroidal anti-inflammatory medications relieve pain and inflammation in the same way OTC versions do. Some are stronger versions of over-the-counter NSAIDs, such as ibuprofen, but there are many others.

Some prescription NSAIDs have brand names, others are available only as generic medications. Several may be given by injection. Examples of both include:

• Indocin (indomethacin)
• Nalfon (fenoprofen)
• Diflunisal
• Flurbiprofen
• Ketoprofen
• Meclofenamate
• Tolmetin
  

COX-2 Selective Inhibitors

COX-2 selective inhibitors are a type of NSAID that are less likely to have gastrointestinal side effects. They differ from other NSAIDs in that they block the activity of COX-2 rather than COX-1.

Celebrex (celecoxib) is the only such medication approved by the Food and Drug Administration. It comes in capsules ranging from 50 to 400 milligrams (mg). If your doctor prescribes Celebrex to treat your OA, they will base your dose and how often you should take it on factors such as the joints affected and the amount of pain and inflammation you have.

Serotonin-Norepinephrine Reuptake Inhibitors (SNRIs)

SNRIs are antidepressants that work by increasing how much of the neurotransmitters serotonin and norepinephrine are available in the brain. Not only does this regular mood, but it can also help to relieve physical pain.

Only one SNRI is approved by the FDA: Cymbalta (duloxetine). It’s used most often to help treat osteoarthritis of the knee. In clinical trials, 60 mg of duloxetine per day improved both pain and joint function after around four weeks of use.

Anti-Convulsants

Gabapentin (brand names Gralise, Horizant, and Neurontin) is a medication used primarily to prevent seizures. Research findings suggest it can also effectively treat knee arthritis.

A 2019 comparison of gabapentin (300 mg/day), duloxetine (30 mg/day), and acetaminophen (1,000 mg/day) revealed that gabapentin and duloxetine worked better than acetaminophen. The main difference between the two was it took a bit longer for pain relief from gabapentin to kick in—around three months.

When used to treat OA, gabapentin is prescribed off-label.

Recap

OTC treatments sometimes are effective in relieving osteoarthritis pain. In those cases, there are many options: prescription-strength acetaminophen or NSAIDs; Celebrex (a COX-2 inhibitor ); an antidepressant called Cymbalta; or the anti-seizure medication gabapentin (Neurontin and others).

Procedures

Severe osteoarthritis pain that doesn’t respond well enough to medication can sometimes be relieved with an intra-articular corticosteroid injection, also known as a cortisone shot.

Typically, a local anesthetic is injected into the area to numb it before the shot is given. This treatment can last for several months but should not be given more than three times a year or so.

Steroids used for OA include Medrol (methylprednisolone acetate), Kenalog (triamcinolone acetonide), and Celestone (betamethasone).

Summary

Osteoarthritis pain can be both uncomfortable and make it hard to function, but there are many effective ways to treat it. When pain is relatively mild, an oral or topical analgesic from the drugstore may bring relief. More severe pain may need more aggressive treatment in the form of prescription pain relievers or other types of medications or injections of steroids directly into affected joints.

What is the most prescribed medication for osteoarthritis?

What helps excruciating arthritis pain?

What are three of the newest drugs for arthritis pain?

What is the latest drug for osteoarthritis?