Treating Common Arthritis Pain: What Can Work, What to Avoid

Over-the-counter pain relievers

​They can help with intermittent pain, but talk to your doctor first

More than half (66 percent) of poll respondents who have joint pain report taking over-the-counter pain relievers to quell it. Short-term use of these medications can be helpful, but Koenig says patients should talk to their doctor first before popping open a pill bottle. The reason: These drugs, while available without a prescription, are “not always safe for everybody,” he says.

For example, nonsteroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen (brand names Advil, Motrin) and naproxen (Aleve), can reduce pain caused by inflammation common with arthritis. But chronic use carries heart, kidney and bleeding risks, especially in people with certain underlying conditions. “These are not drugs you want to be on for your entire life,” Rajaee says.

Similarly, too much of the pain reliever acetaminophen (Tylenol) can cause liver damage. Topical NSAIDs such as diclofenac (Voltaren) “can be a low-risk way to deliver anti-inflammatory” effects, Koenig says. Creams containing capsaicin may also help for knee pain.

Dietary supplements and CBD​

They may or may not help your joints, and may hurt your pocketbook

Twenty-six percent of poll respondents say they turn to supplements like glucosamine and chondroitin to help manage joint pain, but osteoarthritis guidelines don’t recommend them, due to scant scientific evidence. A 2016 study published in Arthritis & Rheumatology found these supplements, when given in combination, had the opposite effect: Patients reported worse symptoms than those taking a placebo.

That said, there’s little danger in trying these supplements, doctors interviewed for this article say. Supplements can interact with other drugs you’re taking, so talk to your doctor first to make sure you’re in the clear. (For example, both glucosamine and chondroitin can interact with blood thinners like warfarin, increasing the risk for serious bruising and bleeding.)

They can also be expensive, so “if you’re using an expensive version and you’re trying to choose between other important things to purchase and this, then there probably is not enough evidence to suggest [the supplements] are going to help you [enough] that it makes it worth it,” Koenig says.

When Sterling sees a patient who is interested in trying supplements — turmeric and fish oil are others commonly marketed for osteoarthritis improvement — he usually gives them the green light. “I tell them to try it for about six weeks. And if they feel like it’s helping, then it’s helping. And if they don’t feel like it’s helping, then don’t keep spending money,” Sterling says.

Just be sure to look at the ingredient list on the bottle and make sure you know everything that is in that pill or capsule to avoid potential medication interactions, Wallace says. Dietary supplements aren’t regulated like over-the-counter medications and are not approved by the Food and Drug Administration (FDA) before hitting store shelves. “I strongly discourage people from taking any supplement where you don’t have the whole ingredient list,” she adds.

Similar to supplements, “we just don’t have enough evidence” on the effectiveness of cannabidiol, or CBD, Sterling says. Still, 11 percent of survey respondents have turned to CBD to help relieve joint pain, the National Poll on Healthy Aging found; 9 percent use marijuana, which Sterling says may worsen outcomes if used routinely before surgery. (Surgery, often joint replacement, is typically the final treatment option when joint pain is no longer manageable.)

Studies are underway to learn more about the safety of CBD, including potential drug interactions, so again, be sure to talk to your doctor before giving it a try. The FDA has more information for consumers on CBD products.

Steroid injections ​

An option for some osteoarthritis patients if other therapies fail

When exercise, bracing and over-the-counter pain relievers stop working, many patients turn to steroid injections before exploring surgery. Nearly 20 percent of poll respondents said they get steroid injections to help manage joint pain. This is not to be confused with oral steroids, which come with more side effects and are not recommended to treat osteoarthritis. (Oral steroids may be prescribed for other types of arthritis, such as rheumatoid arthritis.)

There is a menu of joint injections available these days, but steroid injections are often the first line for hip, knee and hand osteoarthritis “because they are generally effective” — though the effects can vary — “and they’re very cost-effective,” Sterling says.

When the steroid is injected into the joint, “it basically shuts down inflammation,” Rajaee says. “It does not bring cartilage back. No injection actually brings any cartilage back.”

If your joint pain is in the knee and steroid injections don’t work, or if you’re not a good candidate for them, your doctor may talk to you about hyaluronic acid injections (also known as viscosupplementation therapy), which can help to lubricate the knee joint. The scientific evidence behind hyaluronic acid injections is less consistent, Sterling says, and the shots are more expensive than steroid injections.

What’s more, insurance companies, including Medicare, often require certain conditions be met before they will cover them. Still, doctors say they can help some people, even if the improvement is minor.

Two other alternatives that are less common but gaining popularity are platelet-rich plasma and stem cell injections. The evidence, many health experts say, needs to catch up.

“We just don’t have enough good, longer-term studies to show how well these will or will not help patients avoid joint replacement surgery,” the last rung on the treatment ladder, says Sterling. He notes that these injections are often not covered by insurance.

When considering your options, just beware of any injection that claims to restore cartilage in the joint, Koenig warns. “The idea of injecting stem cells or platelet-rich plasma into your joint for relieving your pain, that may or may not be a useful strategy … but it is not going to give you a new knee. So that just needs to be really clear,” he says.

Non-opioid prescription pain medications​

These are prescribed for some people with osteoarthritis

Some people with osteoarthritis take prescription NSAIDs for their osteoarthritis pain. Celecoxib (Celebrex) is a common one; it’s known for having fewer gastrointestinal side effects than other commonly used NSAIDs. Other patients may benefit from duloxetine (Cymbalta), which is an antidepressant that has been approved to treat chronic pain, including osteoarthritis.

Still, Wallace says, most of the drugs that are used to treat osteoarthritis and have strong evidence for doing so are over-the-counter medications.

Opioids​

Generally not recommended for osteoarthritis pain

According to the CDC, there is limited evidence on the long-term effectiveness of opioids, also referred to as narcotics, when used for chronic conditions such as arthritis, and emerging data suggests over-the-counter pain relievers are safer and more effective. The National Poll on Healthy Aging, however, found 14 percent of respondents reported taking opioids for joint pain.

Guidelines from the American College of Rheumatology say there are instances when tramadol, an opioid, may be considered for knee, hip or hand osteoarthritis, and that’s when a patient can’t take other pain relievers like NSAIDs and acetaminophen, or when surgery isn’t an option. (This may be more common among older populations who have other health conditions and face higher risks with surgery, Wallace explains.)

Still, Sterling says the number of patients he sees that are taking narcotics for their joint pain and haven’t been counseled about surgery is “shockingly high.”​