Your doctor will talk to you about medicines to help control symptoms of osteoarthritis, including painkillers. Often a combination of therapies, including medicines, devices or surgery, may be needed.
The type of painkiller (analgesic) your GP may recommend for you will depend on the severity of your pain and other conditions or health problems you have.
If you have pain caused by osteoarthritis, your GP may suggest taking paracetamol to begin with. This is available over the counter (OTC) in pharmacies without a prescription. It is best to take it regularly rather than waiting until your pain becomes unbearable.
However, when taking paracetamol, always follow the dosage your GP recommends and do not exceed the maximum dose stated on the pack.
Non-steroidal anti-inflammatory drugs (NSAIDs)
If paracetamol does not effectively control the pain of your osteoarthritis, your GP may prescribe a stronger painkiller. This may be a non-steroidal anti-inflammatory drug (NSAID). NSAIDs are painkillers which work by reducing inflammation. There are two types of NSAID and they work in slightly different ways. These are traditional NSAIDs (such as ibuprofen, naproxen or diclofenac) and COX-2 inhibitors, often called coxibs (such as celecoxib and etoricoxib).
Some NSAIDs are available as creams (topical NSAIDs) that you apply directly to the affected joints. Some topical NSAIDs are available over the counter (OTC) without a prescription. They can be particularly effective if you have osteoarthritis in your knees or hands. As well as helping to ease pain, they can also help reduce any swelling in your joints.
Your doctor will discuss with you the type of NSAID you should take and the benefits and risks associated with it. NSAID tablets may not be suitable for people with certain conditions, such as asthma, a peptic ulcer or angina, or if you have had a heart attack or stroke. Do not take over-the-counter ibuprofen or diclofenac if you have had any of these conditions. If you are taking low-dose aspirin, ask your GP whether you should use an NSAID.
If your GP recommends or prescribes an NSAID to be taken by mouth, they will usually also prescribe a medicine called a proton pump inhibitor (PPI) to take at the same time. NSAIDs can break down the lining in your stomach that protects it against stomach acid. PPIs reduce the amount of acid produced by the stomach, reducing the risk of damage to your stomach lining. COX-2 drugs have a lower risk of causing stomach problems, but still need to be used with a PPI if you take them regularly.
Opioids, such as codeine, are another type of painkiller that may ease your pain if paracetamol does not work. Opioids can help relieve severe pain, but can also cause side effects such as drowsiness, nausea and constipation.
Codeine is found in combination with paracetamol in common preparations such as co-codamol. Other opioids that may be prescribed for osteoarthritis include tramadol (brand names include Zamadol and Zydol), and dihydrocodeine (brand name DF 118 Forte). Both come in tablet form and as an injection. Tramadol is not suitable if you have epilepsy, and dihydrocodeine is not recommended for patients with chronic obstructive pulmonary disease (COPD). Pregnant women should not take any opioids.
If you need to take an opioid regularly, your GP may prescribe a laxative to take alongside it to treat any constipation.
If you have osteoarthritis in your hands or knees and topical NSAIDs have not been effective in easing your pain, your GP may prescribe capsaicin cream.
Capsaicin cream works by blocking the nerves that send pain messages. You may have to use it for a while before it has an effect. You should experience some pain relief within the first two weeks of using the cream, but it may take up to a month for the treatment to be fully effective.
Apply a pea-sized amount of capsaicin cream to your affected joints four times a day, but not more often than every four hours. Do not use capsaicin cream on broken or inflamed skin and always wash your hands after applying it.
Be careful not to get any capsaicin cream on delicate areas, such as your eyes, mouth, nose and genitals. Capsaicin is made from chillies, so if you get it on sensitive areas of your body, it is likely to be very painful for a few hours. However, it will not cause any damage.
You may notice a burning sensation on your skin after applying capsaicin cream. This is nothing to worry about, and the more you use it, the less it should happen. However, avoid using too much cream or having a hot bath or shower before or after applying it, because it can make the burning sensation worse.
If your osteoarthritis is severe, treatment using painkillers may not be enough to control your pain. In this case, you may be able to have a type of treatment where medicine is injected into the parts of your body affected by osteoarthritis. This is known as intra-articular treatment and is injected inside your affected joints.
If you need intra-articular injections, it is likely that you will have injections of corticosteroid, a medicine that reduces swelling and pain. However, the National Institute for Health and Clinical Excellence (NICE) does not recommend intra-articular injections of hyaluronic acid for osteoarthritis.
If you get a prolonged response to the injection, it may be repeated. If you do not respond to the injection, or have a joint like the hip, which needs a guided injection, then your doctor can refer you for a guided injection locally.
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