Few events are more painful than a gout attack. You wake in misery with a big toe that’s tender, swollen, red and radiating heat. Because most gout attacks occur in the wee hours, it’s wise to know how you can best manage symptoms until you see a doctor. An attack can last from hours to days, if treated, and weeks, if untreated. To best alleviate pain, gout must be treated within 36 hours.

Use medication already on hand. Nonsteroidal anti-inflammatory drugs (NSAIDs) such as indomethacin (Indocin), ibuprofen (Advil), and naproxen sodium (Aleve); corticosteroids; and colchicine are the three most common anti-inflammatory drug choices when it comes to easing or stopping an attack. 

Colchicine, an alternative for those who can’t tolerate NSAIDs, works by relieving inflammation and preventing the build-up of the uric acid crystals that form in joints. (See “Treatments for Acute Gout.”) Do not take aspirin; it can affect your uric acid level, worsening the attack. If you’ve never had an attack, you’ll likely only have over-the-counter anti-inflammatories such as ibuprofen and naproxen on hand.

Call your doctor. Make an appointment for immediate gout treatment. Plan on discussing medication and lifestyle changes such as a low-purine diet. Purines are substances in animal and plant foods that the body converts to uric acid. They are the offending substance that has crystallized and lodged in your joints, causing your pain. Ask your physician what measures you can take if an acute attack occurs again.

Protect the joint. During an attack, get plenty of overall rest and protect the affected joints.

Drink plenty of fluids. Staying hydrated helps flush out uric acid and prevent kidney stones, a possible complication of gout. Aim for eight to16 cups of fluids a day, at least half of them water.

Ice down. Applying an ice pack to the painful joint may help ease pain and inflammation. Wrap a pack (a bag of crushed ice or frozen peas will also do), in a dish cloth and apply to the area for 20 to 30 minutes at a stretch several times a day.