Pain Medication for Arthritis

Arthritis refers to a group of diseases that result in joint inflammation and chronic pain. In the United States alone, arthritis affects about 58.5 million adults. Zeroing in further, 24 million reported that their ability to carry out daily activities is limited by the condition, while one in four adults said their arthritis has left them with severe pain. Usually, a combination of medications are used to treat the pain and discomfort caused by arthritis. Here is an overview of the different classifications of pain relievers prescribed to treat arthritis pain, from weakest to strongest.

Acetaminophen

Acetaminophen is a non-opioid analgesic used for mild to moderate pain. It is also an antipyretic that can lower a person's fever. This drug is an active ingredient in countless over-the-counter medications and prescriptions, including Excedrin, Tylenol, and Tylenol Arthritis. It is commonly used for arthritis relief because it doesn't possess the same heart and gastrointestinal risks of NSAIDs. It's seen as a safer alternative.

Unfortunately, acetaminophen isn't an anti-inflammatory medication. The swelling and inflammation reduction that is a feature of NSAIDs is not available with acetaminophen.

NSAIDs

Nonsteroidal anti-inflammatory pain medications (NSAIDs) are the most commonly prescribed drugs to treat inflammation and pain from arthritis, bursitis, and tendonitis. They can be taken by mouth or rubbed over joints. NSAIDs prevent the enzyme cyclooxygenase (COX) from creating prostaglandins, which are hormone-like chemicals that play the biggest role in inflammation. The body makes COX-1, which protects your stomach lining, and COX-2, which contributes to inflammation.

Many NSAIDs impact both forms of cyclooxygenase, combating inflammation but also contributing to bleeding in your stomach and ulcers. There is a targeted form of NSAID, COX-2 inhibitor, that block the inflammation-causing enzyme more than the stomach-protecting one. Celebrex (celecoxib) is the only COX-2 inhibitor available in the U.S. market.

Here's an overview of some common NSAID options:

• Voltaren (diclofenac) is something you need a prescription for if you want it in its tablet form, otherwise over-the-counter topical forms are available. For osteoarthritis relief, 100 to 150 mg per day in divided doses is recommended, while the recommended dosage for rheumatoid arthritis is 150 to 200 mg per day in divided doses.
• Naprosyn (naproxen) is commonly used to treat inflammation and pain as well as menstrual cramps and fevers.
• Advil (ibuprofen) is available by prescription or over-the-counter. Motrin IB and Advil are both ibuprofen and can temporarily relieve minor arthritis pain.
• Durlaza (aspirin) can be used to treat mild to moderate pain and inflammation. Prescription aspirin is often used to treat symptoms of arthritis.

Side effects of NSAIDs may include:

• Stomach aches
• GI bleeding
• Ulcers
• Allergic reactions

Corticosteroids

Corticosteroids, or steroids, are a type of drug that can suppress the immune system and reduce inflammation. They are prescribed to treat rheumatologic conditions, including rheumatoid arthritis. They come in different forms. Some may be applied to a specific site of pain, such as joint injections or skin creams, while others like oral and IV steroids work systematically.

Below is a list of common corticosteroids from weakest to strongest:

• Cortef (hydrocortisone) tablet doses will vary from 20 mg up to 240 mg each day. The dosage depends on the severity of the condition being treated.
• Rayos, Prednisone Intensol (prednisone) are short-acting, potent corticosteroid products. Prednisone is usually prescribed for short-term relief of inflammation and pain.
• Depo-Medrol, Medrol, (methylprednisolone) are corticosteroids similar to natural hormones made by the adrenal glands, supplementing this chemical when your body isn't making enough. It comes in tablets as well as intramuscular and IV forms, and your healthcare provider will devise the best dosing schedule that works for you.
• Dexamethasone is used for treating acute and chronic conditions. It mimics the effects of glucocorticoids, which are natural steroid hormones produced by the adrenal glands. It's long-acting and about 25 times more potent than its short-acting corticosteroid counterparts.

Side effects increase with the dose and may include:

• Increased appetite
• Weight gain
• Irritability
• Round face
• Fluid retention

Increased blood sugar or diabetes, hypertension, bone mass loss or osteoporosis, and gastritis are also possible. Consult your healthcare provider if you experience more serious side effects like blurred vision, seizure, or unusual mood changes.

Opioids

Opioids are powerful painkillers (analgesics) that block pain signals to the brain. All natural opioids are derived from the opium poppy plant, but synthetic opioids like fentanyl are made in a lab. They are prescribed by a healthcare provider or medical professional to be used as part of a carefully supervised pain management plan. Some opioids like heroin are illegal substances. Opioids can lead to addiction and, if misused, can result in a fatal overdose.

This class of drugs has long had a role in treating surgical and cancer pain. In recent years, they've increasingly been prescribed for chronic pain from arthritis. For example, up to 40% of rheumatoid arthritis patients are regular opioid users. The use of opioids for this type of pain remains controversial, however, and the benefits of these medications are unclear.

Here's a list of opioids from weakest to strongest:

• Demerol (meperidine) was common in hospital settings for moderate to severe pain. It is used less frequently today to treat pain because the duration of its pain relief is shorter than similar drugs and possesses a number of potentially dangerous interactions.
• Codeine is commonly found in prescription cough syrup but can be used for mild to moderate pain relief in a tablet combined with Tylenol, known as Tylenol #3. There is still a possibility of misuse, but it is less potent than other opioids.
• Morphine is administered for both short-term and chronic pain. Its potency is similar to that of oxycodone, and it comes in both tablet and injection form.
• Oxycontin, Roxicodone, and Xtampza ER (oxycodone) are used for moderate to severe acute and chronic pain. Dosage forms include liquids, tablets, and capsules.
• Oxymorphone is prescribed to treat moderate to severe pain.
• Dilaudid (hydromorphone HCl) can be given to treat moderate to severe pain. In a hospital setting, it can be administered through IV or a patient-controlled analgesia pump (PCA pump). At home, it can be given in the form of a pill. It is considerably stronger than morphine.
• Fentanyl is a synthetic opioid used for treating severe pain. It is very potent and is reported to be up to 100 times stronger than morphine. It requires a prescription from a healthcare provider, but is also a common illicit substance, often dangerously mixed with heroin, which can result in fatal overdose.
  

It's important to take these medications exactly as prescribed. They can cause serious, life-threatening breathing problems, most likely during the first 72 hours of treatment and at any point when dosage increases. Your healthcare provider may need to carefully monitor your use of the drug.

A Word From Verywell

The chronic pain associated with arthritis can be debilitating and limiting. It can hinder your ability to carry out normal daily tasks and go about your life with ease. That's why it's important to seek the treatment that's right for you. While many medications can offer pain relief, they each come with specific recommendations and risks. Whether you are looking for short-term pain relief or more robust long-term treatment, be sure to discuss with your medical provider what the best medication regimen might be for you.