When you experience your first gout attack, you’re bound to be full of questions. Most immediately, you’ll want to know how to relieve the excruciating joint pain and swelling that has erupted overnight – probably in your big toe, the site of 50 percent of initial gout attacks. You’ll also want to know what your doctor is likely to do for you in both the short and long term. Here’s a brief overview of what you can expect.

What Caused Your Gout Attack?

Gout attacks occur when excess uric acid crystallizes in the joints. The acid is a byproduct of the breakdown of purines, substances in plants and animals, during the digestive process. Some people’s systems can’t process uric acid efficiently; others produce too much. The buildup results in the pain and inflammation that characterize a gout attack.

How to Handle a Midnight Gout Attack

You may be in so much pain that dashing off to the emergency room is unthinkable. That’s OK – the immediate goal is to relieve pain and to lessen swelling and inflammation. You can begin that process by taking nonsteroidal anti-inflammatory drugs (NSAIDs). 

Commonly used over-the-counter NSAIDs such as ibuprofen (Advil), and naproxen sodium (Aleve) help relieve both pain and inflammation often within 24 hours and are usually the first line of defense. Unfortunately, when taken orally, they can have side effects such as stomach upset or ulcers, headaches, skin rashes, fluid retention, kidney problems or heart disease risk. That means people with gastrointestinal, kidney, or heart problems shouldn’t take them.

Most doctors suggest taking the highest recommended dose for at least the first 24 to 36 hours to handle the pain. Don’t take aspirin – although it is an NSAID, it can change uric acid levels, worsening a gout attack.

An ice pack wrapped in a dish towel and placed on the affected joint for 15 to 20 minutes at a stretch can also relieve pain and inflammation.

See Your Doctor the Next Day

It’s important to see your doctor as soon as possible. He will likely give you a blood test to measure uric acid levels. And he may draw fluid from the affected joint to examine for urate crystals. He will also likely prescribe one or more of the following drugs that can help stop the pain and inflammation: