Medications to Help Manage Arthritis Pain

What are non-prescription medications?

A non-prescription medication — sometimes called an over-the-counter or OTC medicine — is any medication that you can buy without a prescription. Some medications to help control arthritis pain can be bought over the counter without a prescription. You are probably familiar with many of these, such as acetaminophen (e.g., Tylenol®, Tylenol Arthritis®), ibuprofen (e.g., Motrin® or Advil®), naproxen (Aleve®) and acetylsalicylic acid (ASA) (e.g., Aspirin®, Entrophen®, Anacin®, Novasen®, etc.). 

Ibuprofen, naproxen and ASA belong to the group of medications called non-steroidal anti-inflammatory drugs (NSAIDs). Diclofenac gel (Voltaren Emulgel®) is an NSAID, available OTC, that can be applied topically to the skin to help relieve pain. Please speak with your doctor or pharmacist before starting any over-the-counter oral or topical NSAIDs. More detailed information on NSAIDs can be found starting on page .

There are a number of other OTC creams and rubs available to help with arthritis pain. Some of these products contain salicylate as the active ingredient, whereas others contain capsaicin, camphor or menthol. 

What are non-prescription medications used for?

Acetaminophen is most commonly used to treat osteoarthritis (OA), while NSAIDs are used for both inflammatory arthritis and OA. More detailed information on NSAIDs can be found in the Anti-Inflammatory Medications section starting on page.

Topical agents may be used to help manage pain associated with OA. They are not routinely used to manage inflammatory arthritis.

How are non-prescription medications administered? 

Non-prescription medications are typically taken orally in pill form; however, there are also a number of non-prescription topical creams and rubs that can be used to help lessen the pain of arthritis.  

Which non-prescription medication is right for you?

Acetaminophen is primarily used to help alleviate the pain of OA. Acetaminophen may also be used to help treat pain associated with inflammatory arthritis. The usefulness of acetaminophen in the treatment of inflammatory arthritis is limited as it does not help control the disease or prevent joint damage.

NSAIDs may be used to treat the symptoms of inflammatory types of arthritis (e.g., rheumatoid arthritis) and OA. 

Although acetaminophen is better in terms of safety, NSAIDs are often preferred for OA pain due to better pain relief. Your health-care provider may ask you to try a few different NSAIDs in order to find the one that works best for you.

Topical diclofenac and topical capsaicin are reasonable alternatives for OA pain that is not relieved with acetaminophen or for people who cannot tolerate or are reluctant to take oral medications. These particular topical therapies may also be tried in combination with oral medications where pain relief is not adequate. There is limited evidence to support the use of topical salicylate, camphor or menthol for treatment of OA pain.

How long will I have to take my non-prescription medication?

If you have pain from OA that is present most of the time, your health-care provider may recommend that you take non-prescription medications regularly. If your OA pain is not continuous, you may be able to take your non-prescription medications as needed, stopping when symptoms have improved. Inflammatory arthritis will likely require life-long treatment. This treatment may include non-prescription NSAIDs taken regularly; however, inflammatory arthritis typically requires the use of DMARDs.

Topical agents are typically used to provide symptomatic relief and are not routinely used for the long-term management of OA or inflammatory arthritis.

What are prescription medications?

Sometimes over-the-counter medications are not strong enough to treat the pain caused by arthritis. In this case, your health-care provider may recommend other prescription pain medications, such as tramadol, an opioid or duloxetine. 

What are prescription medications used for?

Tramadol, opioids and duloxetine may be used to treat osteoarthritis (OA) pain. Tramadol and opioids may also sometimes be used to treat short-term inflammatory arthritis. 

Tramadol is as an alternative treatment option for OA of the knee and hip for people who cannot take acetaminophen and/or non-steroidal anti-inflammatory drugs (NSAIDs) or for whom these medications were not effective. Tramadol may also be used in conjunction with acetaminophen or NSAIDs. 

Opioids are second-line medications reserved for moderate to severe knee and hip OA pain that does not respond to other therapies (acetaminophen, NSAIDs or tramadol). Opioids are not routinely used to treat OA pain as adverse effects limit their use in many patients. In some cases, an opioid may be a safer option than NSAIDs in elderly patients.

Duloxetine is a second-line agent that may be used to treat OA of the knee. Duloxetine has also shown benefit as an add-on medication for people who have had a partial response to acetaminophen or NSAIDs.
Opioids and tramadol may also be used for short periods of time to help treat pain associated with inflammatory arthritis.

How are prescription medications administered?

Tramadol and duloxetine are taken orally in pill form. Opioids are typically taken orally. One opioid medication (fentanyl, Duragesic®) is administered by a patch applied to the skin, but this medication is not routinely used to manage arthritis pain. 

Which prescription medication is right for you? 

For people living with OA, your health-care provider may recommend tramadol or duloxetine depending on your level of pain and response to acetaminophen and NSAIDs. Opioids are not routinely used to treat OA pain, but may be considered if pain relief is not achieved from other medications. The beneficial effects of opioids on OA are often outweighed by their increased risks of adverse events.

Tramadol and opioids may be used for short-term management of inflammatory arthritis pain.

How long will I have to take my prescription medication?

If pain from OA cannot be controlled by acetaminophen and NSAIDs, a prescriber may recommend taking tramadol or duloxetine regularly. Opioids are generally recommended for short-term use in the management of OA.

No data exists regarding the benefits and risks of tramadol or opioid use for inflammatory arthritis beyond six weeks. These agents may be used for short periods of time to help inflammatory arthritis pain.

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Arthritis Medications A Reference Guide
Arthritis Medication Guide

A comprehensive guide written by experts, designed to offer detailed information on medications used to treat arthritis.

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