OriginalDrugs

Pain Medications for Arthritis and Joint Pain

There are more than 100 forms of arthritis. The word arthritis comes from Greek arthro- (joint) and -itis (inflammation) and means "joint inflammation." With arthritis, the tissues in or around a joint become inflamed, causing pain, stiffness, and, sometimes, difficulty moving.

The most common forms of arthritis:

  • Osteoarthritis
  • Rheumatoid arthritis
  • Gout and pseudo-gout
  • Ankylosing spondylitis

Analgesics (painkillers)

Analgesics act specifically against pain and don't reduce inflammation.

Acetaminophen is effective in many arthritic conditions and is recommended for mild to moderate pain.

Tramadol, a centrally acting analgesic, is often used in osteoarthritis. It can decrease moderate to severe pain, improve stiffness and joint function.

Nonsteroidal Anti-Inflammatory Drugs (NSAIDs)

Nonsteroidal Anti-Inflammatory Drugs (NSAIDs) are the cornerstone of arthritis and joint pain management. The most well-known NSAID is aspirin, or acetasalicylic acid, first synthesized in 1899.

NSAIDs are effective in managing pain, inflammation, swelling, and stiffness. They act through blocking of enzymes necessary for the synthesis of prostaglandins - hormone-like chemicals that promote inflammation and pain.

The major potential risks of NSAIDs include:

  • Can damage the stomach lining and cause ulcers. Some NSAIDs affect stomach prostaglandins less than others, and, therefore, have a lower risk of causing ulcers.
  • Can harm the kidneys by reducing the flow of blood to the kidneys and impairing their function.
  • All NSAIDs produce a blood-thinning effect, therefore their use in conjunction with blood-thinning medications may be dangerous.

Common NSAIDs:

  • Ibuprofen (Advil, Motrin, Nuprin, Rufen)
  • Naproxen (Aleve, Naprelan, Naprosyn)
  • Indomethacin (Indocin)
  • Fenoprofen (Nalfon)
  • Ketoprofen (Orudis, Oruvail)
  • Diclofenac (Voltaren)
  • Piroxicam (Feldene)
  • Nabumetone (Relafen)
  • Meloxicam (Mobic)

What is the best NSAID?

The sure way to determine which NSAID is best for you is to try different options.

Ibuprofen is one of the safest and least expensive and is available over-the counter3.

Diclofenac is one of the safest and most potent NSAIDs 5 and is often used for chronic conditions.

Naproxen is widely used for various forms of arthritis. It appears to be risk-neutral with regard to cardiovascular side effects4, but has a greater potential to increase blood pressure than other NSAIDs2.

COX-2 inhibitors

COX-2 inhibitors (coxibs) are NSAIDs that selectively block the COX-2 enzyme, which produces prostaglandins that promote inflammation and pain. They are less likely to cause ulcers than traditional NSAIDs, but have higher risk of cardiovascular problems.

The only COX-2 inhibitor on the market is celecoxib (Celebrex). It is indicated for the relief of symptoms of osteoarthritis, rheumatoid arthritis, and ankylosing spondylitis.

Corticosteroids

Corticosteroids are powerful anti-inflammatory medications. Corticosteroids are not themselves painkillers but, by reducing inflammation, they also reduce the pain. The most commonly prescribed corticosteroid for arthritis:

  • Cortisone
  • Prednisolone
  • Methylprednisolone
  • Hydrocortisone

Topical pain medications for aching joints

Topical pain medications are best used on joints that are close to the skin's surface, such as the joints in your hands and knees.

Capsaicin. Capsaicin is effective in the management of osteoarthritis pain of the knee, ankle, wrist and shoulder1. Capsaicin works by decreasing a substance in the nerves called "substance P," which sends pain signals to the brain.

Menthol. Menthol produces a sensation of hot or cold that may temporarily interfere with the ability to feel arthritis pain.

Salicylates. Salicylates are the main ingredient in topical analgesics, which offer pain relief and reduced joint inflammation.

References

  • 1. Altman RD, Auen A, Holmburg CE, Pfeifer LM, Sack M, Young GT. Capsaicin cream 0.025% as monotherapy for osteoarthritis: a double-blind study. Semin Arthritis Rheum. 1994;23(suppl 3):S25–33.
  • 2. Pope JE, Anderson JJ, Felson DT. Arch Intern Med. 1993 Feb 22;153(4):477-84.
  • 3. Bjarnason I. Ibuprofen and gastrointestinal safety: a dose-duration-dependent phenomenon. J R Soc Med. 2007;100 Suppl 48:11-4.
  • 4. Kearney PM, Baigent C, Godwin J, Halls H, Emberson JR, Patrono C. Do selective cyclo-oxygenase-2 inhibitors and traditional NSAIDs increase the risk of atherothrombosis? Meta-analysis of randomized trials. BMJ. 2006; 332: 1302–8.
  • 5. Maier R, Menassé R, Riesterer L, Pericin C, Ruegg M, Ziel R. The pharmacology of diclofenac sodium. Rheumatol Rehabil. 1979;Suppl 2:11-21.

Author: OriginalDrugs Team
Last reviewed: October 27, 2012

Interesting facts

  • Codeine is usually the first-line opioid for managing chronic pain because it is the least potent opioid. However, up to 10% of white people lack the enzyme that converts codeine into its active metabolite morphine, so stronger opioids might be required.
  • Fentanyl, synthetic narcotic analgesic, is the most potent narcotic in clinical use. Fentanyl is approximately 80 times more potent than morphine. Its potency is so great that the standard dose is in micrograms, not milligrams like most other narcotics.
  • Ohmefentanyl (OMF) is the most potent analgesic, 6000 to 10000 times stronger than morphine.