Because prostaglandins not only cause inflammation and pain, but may also protect the stomach lining from destructive acids, NSAID use at higher doses can cause severe gastrointestinal problems, including bleeding. COX-2 specific inhibitors, a newer class of NSAID, was developed a little more than a decade ago to block only one prostaglandin, COX-2, that causes inflammation, but to leave the others to protect the stomach.
Only one COX-2 NSAID is still on the market, celecoxib (Celebrex), as others were found to increase the risk of cardiovascular events.

Read more about NSAIDs.

Analgesics
Analgesics are drugs used to fight pain, but not inflammation. Analgesics work on the peripheral and central nervous system, so the nerves and the brain sense less pain. Pain may be caused by inflammation or injury in joints, bones or tissues, but you sense pain in your brain, and pain signals travel to the brain via nerves and neurotransmitters. Analgesic drugs help to block that process.

Analgesics include over-the-counter and prescription drugs. Analgesics may be taken orally as pills or liquids, or absorbed through the skin via a transdermal patch. The most common analgesic drug is acetaminophen (Tylenol), which is recommended by the American College of Rheumatology as the first-line treatment for osteoarthritis pain.

Opioids, including narcotic drugs derived from opium, are stronger analgesics used for severe arthritis pain or flares, preferably for short-term use only. Many analgesics are pills combining either acetaminophen or NSAIDs with opioids. Opioids carry their own serious side effects, including constipation and physical dependence.

For most arthritis pain, acetaminophen is the first recommendation, says Dr. Hsu. “If you’re having moderate to severe pain, then maybe I’d add an opioid for short-term relief of pain,” he says.

That’s because dependency is a major concern of long-term opioid use. Recently developed, slower-acting opioid patches containing buprenorphine (BuTrans) may be good for chronic arthritis pain, says Dr. Hsu. “They can work on the same opiary receptors in the body, but in very small doses.”

These patches are changed once a week. “They won’t reduce side effects completely, but since the patch bypasses the gastrointestinal system, and because it’s continuous delivery at a tiny dose, it’s a good alternative.”

Analgesics may be appropriate for people whose pain isn’t caused by inflammation, or those who’ve experienced major gastrointestinal side effects from NSAIDs. However, some analgesics can cause liver problems if used in high doses over time.

Read more about analgesics.

Corticosteroids
Also known as steroids or glucocorticoids, corticosteroids fight inflammation that causes pain. Corticosteroids mimic the naturally produced hormone cortisol, which helps regulate the immune system to fight inflammation. These prescription drugs are taken orally as pills, absorbed through the skin as topical agents, or injected directly into inflamed joints.