Medication for treating joint pain

Joint pain is common and can have many causes, not always arthritis, but it is usually the first symptom of arthritis. Whether you know if it is arthritis or not, you will be looking for pain relief. As with all health advice, it is always important to ask your health team, particularly a pharmacist and prescribing doctor or specialist in the case of medications.

Topical rubs and creams

Once you decide you want to try medicine to treat your joint pain, you can start with something to rub in. This works better if it is a small area or one small joint. There are many rubs and creams to choose from; some have anti-inflammatory properties, and some could interact with other medications, like warfarin, so be sure to check with your pharmacist. 

Medication

When you need to try a medication for the pain, the first choice of medication for joint pain is usually a non-steroidal anti-inflammatory (NSAID) drug like naproxen, ibuprofen or diclofenac. These relieve the inflammation in the joint that is causing the pain. 

NSAIDs

• Do not take within 48 hours of a broken bone, as the inflammatory process is needed to start the healing process.
• Can interact with some medicines. Check with your pharmacist or doctor before starting these.
• Not suitable for some people, depending on other health conditions. Check with your doctor or pharmacist.
• It can affect your kidneys or heart if taken long-term. Best not to take any over-the-counter medicine long term without talking to your doctor.
• Low-strength NSAIDs can be purchased from your pharmacy.
• Higher-strength and slow-release NSAIDs usually need a prescription.
• The NSAIDs that are least likely to cause stomach upset require a prescription. These are called these Cox-2 inhibitors.
• You might feel reduced pain within a few hours, but the full anti-inflammatory effect can take up to 3 weeks. It is worth persevering for a while to get the best effect. 

Paracetamol

The second choice of medicines for joint pain is paracetamol. It tends to be less effective for joint pain than NSAIDs, but it does provide some relief for most people. It is a safer drug with fewer interactions and side effects. The main consideration is to take only the recommended dose. Be careful not to take too much. It can be taken while you are taking NSAIDs to provide additional pain relief. The two medicines work in different ways, so they will give you more pain relief than either alone. Talk to your pharmacist about how to space the medicines to get the best pain relief. 

As with NSAIDs, long-term regular use is more effective than taking an occasional tablet when you are already in considerable pain. Take paracetamol regularly every day for at least a month before deciding if it is working for you. If you are taking paracetamol regularly, it is probably worth asking your doctor to prescribe it for you. 

• NSAIDs reduce the amount of pain-producing chemicals that your body makes. Examples are ibuprofen and diclofenac
• Paracetamol slows the rate at which those pain messages travel along the nerves
• Tricyclic antidepressants interfere with the way the pain messages are passed along the nerves. The pain message is reduced as it passes each junction in the nerve, so your perception of pain is less. Amitriptyline and nortriptyline are commonly used for nerve pain, especially pain that keeps you awake at night
• Gabapentin, pregabalin or carbamazepine are for nerve pain. These medicines were originally introduced to manage seizures and are believed to interfere with how the messages are transferred from one set of nerve fibres to the next
• Steroids like steroid injections or a course of prednisone can reduce the inflammation that starts the pain signals
• Opiates include tramadol, codeine, fentanyl, and oxycodone work in your brain to reduce your perception of pain. These tend to be less useful for arthritis or long-term pain but might be used short-term like after a joint replacement
• Nefopam is a strong pain relief that works ‘centrally’ to reduce the pain sensation so works a bit like codeine but is not an opiate
• Topical non-steroidal anti-inflammatory (Voltaren gel) works like other anti-inflammatories by reducing the amount of pain-producing chemicals that your body makes in response to damage. These might be appropriate if you only have a few joints affected by arthritis
• Topical capsaicin work as counter-irritants and nerve desensitizers. With counter-irritants, the burn messages and the pain messages compete with each other on the nerve endings so the amount of pain that can be transmitted is reduced. New research shows that capsaicin has an additional way of working that involves desentisizing some types of nerve endings. Some people find topical capsaicin helpful, though others find the burning sensation too much to cope with

All medicines have multiple names. A generic name and a brand name. The generic name is the name of the medicine itself. The brand name is the name that a particular company calls its medicine. Many people know ‘paracetamol’ (the generic name) and ‘Panadol’ or ‘Pamol’ (two different brands). All of these contain the same drug and might be different strengths, so be really aware of what you are taking. NSAIDs like Nurofen and Voltaren can be purchased by brand name in a pharmacy, but on prescription might be called by their generic name, ibuprofen or diclofenac.

Make sure you always know the generic name of all your medicines and the dose. This makes it easier to check if you buy anything off the shelf in the pharmacy. If you have a head cold and buy cold medicines, they often have paracetamol in them or an anti-inflammatory (NSAID). Always read the packets and make sure you are not doubling up on any of the medicines you are taking, as this could make you sick. Also, look at the list below so you know all the currently funded NSAIDs. You should not be taking more than one NSAID at any time. If you are unsure, please check with your pharmacist. It is best to always use the same pharmacy if at all possible, as they have your current medicine list. That way you can always ask the pharmacist to check it’s safe when you want to buy any medicine or natural product in the shop.

Knowing the generic name also means it’s easier to understand when Pharmac start funding a different brand compared to what you were on e.g. Voltaren years ago changed to diclofenac Sandoz or Dr Reddy diclofenac; but we still have Voltaren D as a dispersible form of diclofenac and Voltaren brand of suppositories. There are constant changes in what is funded in New Zealand. If you think your medicine has changed but the pharmacist hasn’t told you, always check.

The final word from a pharmacist is: Don’t share medication. The specific medication that work for you will be different from other people. Your dose is likely to be different than your friend or neighbour for lots of reasons: other health conditions, other medicines, kidney function, age, ethnicity. Some specialists believe some anti-inflammatories have less side effects on your heart; others say they are all fairly similar. What is safe for you might not be safe for your neighbour.

Written by Linda Caddick, Registered Pharmacist. 2024.