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Your GP will discuss what pharmaceutical options are available to alleviate the symptoms of osteoarthritis (OA). Most treatment regimes will include a combination of exercises and assistive devices or surgery alongside medicines. There are a number of different pills, creams, salves and injections that can be taken to reduce pain, swelling and stiffness, including:

Painkillers

Painkillers are most commonly used, as the name suggests, for pain therapy. They are fast acting but can cause nausea, regurgitation, abdominal pain and diarrhoea, and should not be used on patients with a known heart condition. For that reason, painkillers should not be taken over a long period of time. If you are ever in doubt with what is listed on the label then you should seek professional advice.

The list of medications available can be endless

Medication usually prescribed includes:

Paracetamol

Your doctor may suggest primarily taking paracetamol for OA pain relief. It is available over the counter and should be taken regularly according to the instructions on the pack.

Non-steroidal anti-inflammatory drugs (NSAIDs)

If paracetamol fails to reduce the pain, a non-steroidal anti-inflammatory drug (NSAID) may be prescribed in its place. There are two types of NSAIDs, both which act in slightly different ways:

  • Traditional NSAIDs, such as ibuprofen, naproxen or diclofenac
  • COX-2 inhibitors or coxibs, such as celecoxib and etoricoxib

As well as being taken orally, there are NSAID creams available that you apply directly to the affected joint. They can be particularly effective for those suffering from hand or knee OA as they reduce swelling and ease pain.

If you are prescribed NSAID tablets, you should also be prescribed a proton pump inhibitor (PPI) to take at the same time. This is because they reduce the risk of damage to your stomach as NSAIDs have been known to damage the stomach lining, which protects the body from stomach acid.

Opioids

Opioids are another alternative to paracetamol. Like most drugs, they come with side effects, including drowsiness, nausea and constipation. Types of opioids that may be prescribed include:

  • Codeine
  • Tramadol – unsuitable for patients uncontrolled epilepsy
  • Dihydrocodeine – unsuitable for patients with chronic obstructive pulmonary disease (COPD)

If you are required to take an opioid for a sustained period of time, your GP may also prescribe a laxative to counter constipation.

Gels and Salves

Gels and salves may be beneficial to some patients to reduce inflammation, as they are less likely to cause side effects. However, they are less effective than pills.

An example of a cream prescribed for OA is capsaicin cream. It is usually prescribed to those with hand or knee OA or to those who have found NSAIDs to be ineffective. The cream works by blocking the nerves in the treated area from sending pain signals to the brain. Unfortunately, it can take some time before you fully begin to feel the benefits - usually two weeks for some pain relief and a month for everything else.

When you first start using the cream, you may feel a burning sensation on your skin but this tends to go the more you use it. To avoid making this worse, avoid applying the cream before or after taking a bath or shower.

Injections

For severe cases of inflammation, intra-articular injections may be prescribed as an alternative treatment option to painkillers. Firstly, pressure is relieved from the joint and then an injection of medicine, usually corticosteroid, is made directly into the affected joint. Injections have fewer side effects than pills and only needs to be done a maximum of four times a year.

If you have tried all other non-surgical solutions without success, viscosupplementation may be prescribed. The process involves receiving up to five injections of hyaluronic acid, which can be found in synovial fluid in joints and acts as a lubricant and shock absorber.

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