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Arthritis medication and treatments

The choice of medication or treatment for arthritis will depend on the type of arthritis and individual symptoms and circumstances.

Topical pain relievers

Topical painkillers are applied to the skin covering a joint and are available as creams, salves or gels. The active ingredients of topical painkillers include:

  • Capsaicin. Found naturally in chillies, capsaicin in a cream is available as a prescription from your GP. Capsaicin works by blocking the transmission of a pain-relaying substance called substance P to the brain. It may also work as a counter-irritant.
  • Counter-Irritants. These make the skin feel warm and are thought to work by irritating the same nerves as those responsible for sensing muscle or joint pain. By irritating these nerves the pain sensation felt from the muscles or joints is lessened. Examples of counter-irritants include salicylates and menthol.
  • NSAIDs (Non-steroidal anti-inflammatory drugs). These work by inhibiting the cyclo-oxygenase enzymes that are responsible for triggering inflammation. Examples include ibuprofen and diclofenac.

Anti-inflammatory painkillers (NSAIDs)

These drugs, known as non-steroidal anti-inflammatory drugs (NSAIDs), are available over-the-counter and on prescription and can be used to relieve the symptoms of arthritis (joint swelling, stiffness and pain). Almost everyone with arthritis has taken or is taking one of these drugs. Possible side effects include indigestion, stomach ulcers and allergic reactions.

Narcotic or opioid pain relievers

There are a variety of strong pain relievers containing opioid medications that your doctor may prescribe to help relieve your arthritis pain.

Often, these pain relievers are combined with paracetamol. They include:

  • Morphine
  • Oxycodone
  • Codeine
  • Dihydrocodiene

Side effects of opioid pain medication for arthritis pain

If you're taking an opioid pain medication combined with paracetamol for arthritis pain, keep in mind that alcohol and medicines containing paracetamol don't mix. The combination of alcohol and paracetamol can increase your risk of liver damage.

When you take opioid pain medication you also run the risk of developing a dependence on them - that means that you need more and more of the drug in order to get the same pain relieving effect. Also, opioid pain medication can cause constipation, drowsiness, dry mouth and difficulty urinating.

How do opioid pain medications relieve arthritis pain?

Unlike ibuprofen, naproxen or other NSAIDs, opioid pain medication does not decrease the inflammation that occurs with arthritis. Instead, opioid pain medication works on pain receptors on nerve cells to relieve pain.

If you have pain that isn't relieved by an opioid pain medication or NSAIDs alone, speak to your doctor about combining the two. In some cases, an NSAID/opioid combination may relieve pain better than either alone.

Corticosteroids (steroids)

Steroids are powerful anti-inflammatory drugs that can treat many forms of arthritis, including rheumatoid arthritis and other forms of inflammation such as vasculitis.

Although effective, steroids can have potential side effects, especially when taken as a pill and used long-term. Doctors often try to avoid these problems by injecting the steroid directly into the affected joint or trying other medications in combination to keep the dose of steroids as low as possible.

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