Oral, Injected and Topical Medications
1. Disease-modifying medications. If you have an inflammatory form of arthritis such as rheumatoid arthritis (RA) or psoriatic arthritis, an important route to relieving pain is controlling the underlying disease. Fortunately, a variety of medications — many developed in recent decades or years — make disease control possible. Drugs that can control the disease process include:
• Traditional disease-modifying antirheumatic drugs or DMARDs, such as methotrexate or leflunomide (Arava).
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• Biological agents or biologics, which are drugs genetically engineered to inhibit or modify components of the immune system, including B cells, tumor necrosis factor (TNF) and interleukin (IL) 1.
• Janus kinase (JAK) inhibitors, a class of drugs that block signaling molecules called JAKs to curb cellular processes that lead to the progression of RA.
It is important to work with your doctor to find the right drug, or combination of drugs, to control your disease.
2. Oral pain-relieving medications. Some medications are designed to relieve pain and some developed for other reasons have been found to relieve pain. Some are available over-the-counter while others require a doctor’s prescription. They include:
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• Acetaminophen (Tylenol). An over-the-counter (OTC) analgesic, acetaminophen may be sufficient for mild to moderate osteoarthritis pain. Prescription versions, which combine acetaminophen and a narcotic analgesic, may be used short term to relieve pain after joint surgery.
• Nonsteroidal anti-inflammatory drugs or NSAIDs. OTC doses of these drugs, including ibuprofen (Advil, Motrin IB) and naproxen sodium (Aleve), may be useful for relieving pain. At higher prescription doses they may also relieve inflammation.
• Duloxetine (Cymbalta). Developed as an antidepressant, duloxetine is also approved for treating chronic pain related to osteoarthritis (OA).
• Tramadol (Ultram). Available only by prescription, tramadol is an opioid pain reliever prescribed for OA pain not relieved by other medication. Although the risk of addiction and abuse with tramadol is less than that of other opioids, its use is still tightly regulated.
3. Joint injections are used for acutely painful, inflamed joints.
• Corticosteroids injections — strong anti-inflammatory drugs similar to the cortisol made by our bodies — can quickly relieve both pain and inflammation.
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• Hyaluronic acid injections can relieve painful osteoarthritis. Typically given in a series of injections, hyaluronic acid is a substance that gives joint fluid its natural viscosity. Hyaluronic acid injections are given a week apart in a series of three or four injections.
4. Topical Medications. Topical analgesics are drugs which are applied directly to the skin over the painful joint to relieve pain. They include sprays, creams, ointments and patches, and work by one or a combination of the following ingredients:
• Capsaicin, a chemical compound in hot chili peppers, which depletes the nerve cells of substance P, a chemical important for transmitting pain messages.
• Salicylates, the same ingredients that relieve pain in aspirin and aspirin-like drugs.
• Counterirritants, ingredients such as menthol and camphor, which create a burning and cooling sensation that distract your mind from your pain.
• Diclofenac, a prescription NSAID, which may act similarly to oral NSAIDs to relieve pain.
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