The Pros & Cons of Pain Medication for Osteoarthritis

Oral Painkillers

Dr James Davidson is a former junior doctor who founded MedCourse, a medical education platform for UK junior doctors. We asked him for his pros and cons list when it comes to painkillers.

Pros of oral painkillers

• Fairly fast acting (30-60 mins) and usually formulated so that you can treat a whole days-worth of pain. (e.g. twice daily and lasting 12 hours, four times daily and last 4-6 hours etc.)

• Many types and formulations are available, so you can find the perfect fit for you.

• They act on the whole body, which is great if you have OA in multiple joints

• Easy to take and painless.

• You can use different types to manage routine pain as well as flares of arthritis pain (under the supervision of a doctor)

Cons of oral painkillers

• Oral painkillers aren’t limited to the site of arthritis, as they act on the whole body.

• Gastrointestinal side effects are common as oral painkillers are taken orally.

• People with other health conditions must be cautious, as there is a greater chance of oral medication interacting with their other medications or health conditions.

• Stronger oral medications can cause addiction.

How does Ibuprofen work?

“Ibuprofen works in arthritis by not only treating your pain, but also by reducing the inflammation and swelling that osteoarthritis can cause,” says Dr James Davidson.” As an NSAID (“Non-Steroidal Anti Inflammatory Drug”) it stops your body from producing certain chemicals to reduce the inflammation, but without many of the side effects you might see from steroid medication.”

Ibuprofen also reduces your body’s ability to make prostaglandins, which are natural chemicals that trigger pain, inflammation and fever.

Pros of Ibuprofen

• Reduces both pain and inflammation, as well as fever.

• Can treat the pain throughout the whole day if taken at the correct intervals.

• Not addictive.

• Relatively cheap.

Cons of Ibuprofen

• Not as effective as some stronger NSAIDs in moderate to severe arthritis.

• Can cause serious harm if you have health conditions (bleeding in the gastrointestinal system, kidney damage, heart damage).

• Shouldn’t be taken long term for arthritis due to risks of stroke, heart attacks, kidney failure, and stomach ulcers.

How to take Ibuprofen

Ibuprofen is often taken in tablet or capsule form, and it is also available as a liquid or in granular form. Ibuprofen tablets or capsules usually contain 200mg, 400mg or 600mg of ibuprofen. Follow the instructions on your packet leaflet, and don’t take more than the dosage specified on the instructions.

If you’re living with chronic pain, your doctor or pharmacist may recommend slow-release tablets or capsules, which are usually taken once a day in the evening or twice a day with a 10-12 hour gap in between.

According to the NHS, the usual dose for adults is one or two 200mg tablets or capsules three times a day. In some cases, your doctor may prescribe a higher dose of up to 600mg to take four times a day if needed. Please speak to your doctor or pharmacist if you feel that you would benefit from a higher dose of ibuprofen.

If you have been taking ibuprofen for more than six months, speak to your doctor as they may prescribe a medication to protect your stomach. Ibuprofen can be dangerous if overdosed.

How does Paracetamol work?

“We still don’t know precisely how paracetamol (acetaminophen) works, but scientists believe it works by reducing the production of chemicals called prostaglandins,” says Dr James Davidson. “This reduces the strength of pain signals to the brain, lowering the amount of pain you feel.”

Paracetamol is typically used to relieve moderate pain such as headaches, toothache, or to reduce fevers caused by colds and flu.

Pros of Paracetamol

• It is cheap and readily available over the counter.

• Less side effects and safer than NSAIDs.

• Usually available over the counter.

• Not addictive.

Cons of paracetamol

• Thought not to be particularly effective at treating arthritis pain.

• It is toxic at higher doses, so can cause significant liver damage if you accidentally take more than you’re supposed to.

• Doesn’t reduce any inflammation in your joints.

How to take paracetamol

Paracetamol can be taken as a tablet or capsule, in liquid form, as a soluble tablet (tablets which dissolve in water), as suppositories (small, round or cone shaped tablets which are put in the body, often in the bum, and releases the medication that way), and an an injection (which is only available in hospitals).

Adults can usually take 1 or 2 tablets at 500mg strength every 4-6 hours, but shouldn’t take more than 4g (8 x 500mg tablets) in 24 hours. Don’t take more than the recommended dose, as overdosing on paracetamol can be very dangerous. If you have taken more than the stated dose, you should go to A&E as soon as possible, even if you feel fine.

Paracetamol can be taken with ibuprofen, but always double check if you’re taking it alongside any other medication, particularly medication for colds and flu, as that medication may also contain paracetamol. Check the package leaflet on any other medication you may be taking, to see if it is safe with paracetamol. Speak to your doctor or pharmacist if you have any concerns.

How do pain relieving injections work?

“Joint injections work by treating your arthritis at the site of your symptoms, and can get right inside the joint that you’re treating,” says Dr James Davidson. “There are different forms of medication available as joint injection, such as corticosteroids, hyaluronic acid, and platelet rich plasma. These injections work by treating the OA itself, rather than just blocking pain.”

These injections often work by reducing inflammation as well as relieving pain. Joint injections may include various medications depending on your needs, and are usually a combination of local anaesthetic and steroid medication.

Pros of joint injections

• Localised delivery of medication means any side effects on the rest of the body are limited

• Can reach deep joints (such as the spine, hip, and shoulder) better than topical gels

• Long-lasting, meaning these only need to be repeated every few months rather than daily medications

• Good evidence for improvements in both pain and symptoms in some formulations (for example, corticosteroids)

Cons of joint injections

• Requires a referral to a specialist, which can have large waiting lists in public health systems and can be expensive if performed privately

• Hyaluronic acid and regenerative medicines injection techniques (PRP, stem cells) are still an emerging medication, and currently don’t have solid evidence of long term improvement for all types of osteoarthritis

• Can be uncomfortable if you are needle-phobic
  
  

Pain relieving injections are done by a doctor or other healthcare professional. The procedure is usually quick and easy, and involves the physician cleaning the area and administering the injection. Speak to your doctor if this is something you’re interested in.

How do topically applied gels work and what are the pros and cons of using it to treat the pain of osteoarthritis?

“Topical gels are a formulation of painkillers which are applied directly onto your joint, releasing the medication into your joint via the skin,” says Dr James Davidson.

Depending on the topical gel, it may contain drugs (pharmaceuticals) (such as ibuprofen or diclofenac), counterirritants (such as methyl salicylate, menthol or capsaicin) or a medical device FlexiSEQ is a drug free topical gel containing a medical device, which uses joint lubrication technology to lubricate the cartilage in joints. Flexiseq is available in max strength which is specially designed for relieving the pain of osteoarthritis

Remember to read the packet instructions and speak to your doctor or pharmacist if you have any questions or concerns.

Pros of topically applied gels

• Act locally on the joint, meaning fewer side-effects across the body (such as in the stomach and kidneys).

• Generally safer than oral medications

• Easy to apply by yourself to top up your pain relief

• Take effect roughly twice as quickly compared to oral medications

• Available in drug-free formulations such as FlexiSEQ

Cons of topically applied gels

• Only act near the surface, meaning this is less effective for joints that are deep beneath the surface of the skin (e.g. Hip, Shoulder, Spine)

• Limited long term effects for topical NSAID gels

• Help to treat pain but not the underlying cause

• Counterirritants only distract the body from one pain to another

• Most topical pharmaceutical gels shouldn’t be used for more than seven days

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