Nonsteroidal Anti-inflammatory Agents (NSAIDs)

• Naproxen (Naprosyn, Anaprox, Aleve)
• Ketoprofen (Orudis)
• Ibuprofen (Motrin, Advil, Nuprin)
• Indomethacin (Indocin)
• Sulindac (Clinoril)
• Meclofenamate (Meclomen)
• Ketorolac (Toradol)
• Piroxicam (Feldene)
• Diclofenac sodium (Voltaren, Cataflam)

Although many NSAIDs are available as over-the-counter medicines, you may be given a prescription for a higher dose. Nonsteroidal anti-inflammatory agents help decrease inflammation, swelling, and joint pain.

Always take NSAIDs with food to decrease the chance of stomach irritation.

Drinking alcoholic beverages or taking other NSAIDs while you’re already using an NSAID can increase your risk of side effects.

Possible side effects include:

• Stomach upset
• Stomach ulcers
• Kidney damage
• Liver inflammation
• Confusion, dizziness, lightheadedness
• Severe allergic reaction (hives, difficulty breathing, swelling around the eyes)
• Increased risk of bleeding – Always inform your healthcare providers that you’re taking a NSAID before having any medical or dental procedures or surgeries.

A study looked at topical vs. oral ibuprofen to relieve chronic knee pain. Comparing the two groups, there were no significant differences in pain, stiffness, or difficulty. Those in the oral group, however, experienced more side effects.

Cyclooxygenase-2 or COX-2 Inhibitors

• Celecoxib (Celebrex)
• Meloxicam (Mobic)

COX-2 inhibitors work in a way similar to NSAIDs, helping to decrease inflammation, swelling, and joint pain. In addition, they have the benefit of causing less stomach irritation. In particular, COX-2 inhibitors cause far fewer stomach ulcers than do NSAIDs.

Drinking alcoholic beverages or taking NSAIDs while you’re using a COX-2 inhibitor can increase your risk of side effects.

Possible side effects include:

• Liver inflammation
• Confusion
• Severe allergic reaction ( hives, difficulty breathing, swelling around the eyes)
• Stomach upset
• Heart attack
• Stroke

Opioids

• Oxycodone (OxyContin)
• Morphine (MS-Contin)
• Hydrocodone (Dilaudid)
• Fentanyl (Duragesic)
• Methadone
• Hydrocodone (Vicodin, Norco)
• Tapentadol (Nucynta)

If you have severe pain from osteoarthritis, your doctor may prescribe opioids. This type of drug works by acting on the central nervous system to relieve pain. Opioids can be very effective. They may cause dependence, though. So, your doctor will closely monitor your use.

Possible side effects include:

• Feeling lightheaded, sleepy, having blurred vision, or a change in thinking clearly
• Feeling dizzy
• Nausea or vomiting
• Constipation
• Itching
• Dry mouth
• Liver damage (in rare cases)

Acetaminophen

Common brand names include:

• Tylenol

Acetaminophen can be helpful in relieving some of the pain associated with osteoarthritis. Do not take a larger dose than is recommended by your healthcare provider. Do not drink alcoholic beverages if you are taking acetaminophen on a daily basis.

Side effects are rare. A few people may experience an allergic reaction after taking the drug. If you develop a rash, swelling, or difficulty breathing, stop taking the acetaminophen and get medical attention.

Acetaminophen should be considered the first-line drug treatment in most osteoarthritis patients. In a study, 80% of patients were unable to distinguish between the effects of sustained-relief acetaminophen and celcoxib for overall symptom improvement.

Capsaicin Cream

Common brand names include:

• Zostrix

Capsaicin cream is a rubbed on the skin of an affected joint to relieve the pain and inflammation of osteoarthritis.

Capsaicin cream is made from the active ingredient of hot chile peppers. Some people prefer to wear rubber gloves while applying the cream. If you don’t, be sure to wash your hands thoroughly with soap and water after using the cream. Be very careful not to get the cream near your eyes, as it will burn and sting. If you do get some in your eyes, flush them thoroughly with cool water.

Possible side effects include:

• Burning, stinging, or warm sensation when first applied to the skin.