Medications for the Management of Osteoarthritis

Not everyone with osteoarthritis needs medication, but several drug treatments are available that may help to reduce pain associated with osteoarthritis. In the following few paragraphs we summarised the information that is currently available on the drug treatments of osteoarthritis.

Painkillers

To relieve pain associated with osteoarthritis, the use of paracetamol is commonly recommended. To manage the bouts of inflammation that patients with osteoarthritis often experience,  your GP may consider treatment with anti-inflammatory drugs called  non-steroidal anti-inflammatory drugs (NSAIDs)  and COX-2 inhibitors. NSAIDs include medications such as  Aspirin, Ibuprofen and Naproxen. These are available as either topical preparations or as tablets. Topical pain relief creams containing NSAIDs and/or paracetamol are normally used ahead of oral NSAIDs, COX-2 inhibitors or opioids. NSAIDs medication can cause digestive problems, therefore your GP should also prescribe a drug called a proton pump inhibitor (or PPI for short) to prevent these side effects. If you are taking an anti-inflammatory drug for pain relief, you should take the lowest effective dose for the shortest possible time, to reduce the risk of side effects. If you are already taking low-dose aspirin for another condition, your GP may offer you another type of pain relief rather than an anti-inflammatory drug. This is to prevent possible digestive problems.

Creams

For topical pain relief your doctor may suggest the use of creams or gels containing NSAIDs such as ibuprofen 5% or alternatively capsaicin, in addition to core treatments for people with knee or hand osteoarthritis. 

Stronger Painkillers and Injections

In more severe cases, or when the pain does not respond well to other treatments, stronger painkillers called opioids may be prescribed. The use of opiods can lead to feeling drowsy and/or dizzy. These side effects can increase the risk of falls and falls related injuries therefore it is important to use opioids with caution. 

Depending on the severity of the pain, corticosteroid injections into the affected joint may be offered. Studies suggest that the duration of the benefits of these range from 0-7 weeks and confirmation of its efficacy and long term side effects still require further research.  

For more information on the recommended treatments for Osteoarthritis, please see NICE Osteoarthritis Information Booklet.

For further information and for information for healthcare professionals please see NICE Pathways the Management of Osteoarthritis

Treatments You Should Not Be Offered

You should not be offered any of the following treatments for osteoarthritis; because there is little evidence that these treatments are effective in improving symptoms:

  • Glucosamine or chondroitin products
  • Acupuncture
  • Creams containing substances called rubefacients
  • Injection of a substance called a hyaluronan into the affected joint.

It is worth remembering that NICE recommends exercise as a core treatment for osteoarthritis, as the pain associated with the condition is often the result of joint instability and muscle weakness.