The goal of medical treatment for osteoarthritis (OA) is to reduce joint pain and stiffness and make it easier for you to remain active. There is no known cure for OA, but there are many medications available to help you maintain or improve joint mobility and feel better.

Medicines for osteoarthritis may be taken by mouth, injection, or applied directly to the skin. They include:  

  • Analgesics
  • Nonsteroidal anti-inflammatory drugs (NSAIDs)
  • Topical pain relievers
  • Corticosteroid injections
  • Hyaluronic acid injections

Analgesics

Analgesics are drugs designed to relieve pain, including pain from osteoarthritis and related conditions. They do not fight inflammation. Analgesics taken by mouth include acetaminophen (Tylenol), opioids (narcotics) and an atypical opioid called tramadol.

The American College of Rheumatology recommends acetaminophen for the treatment of mild or moderate pain caused by osteoarthritis. You should not take more than 3000mg/day of acetaminophen unless otherwise directed by your doctor. Too much acetaminophen can cause serious liver damage or death. Keep in mind that acetaminophen can also be found 600 or more other prescription and over-the-counter medications, including cold and flu preparations, sleep aids and opioid analgesics, including hydrocodone (Vicodin). (Find out how your pharmacist can help you juggle multiple meds.)

"Despite potential danger in overdose, acetaminophen is by far the safest choice compared to alternatives, including NSAIDs," says Donald Miller, Pharm.D., professor and chair of the pharmacy practice department at North Dakota State University, Fargo, N.D.

Hydrocodone and other opioids are increasingly being prescribed for chronic pain, such as arthritis-related joint pain. They are also used to ease severe, acute pain after joint surgery or a bone fracture due to osteoporosis. "Opioids are best used for short periods, if possible, as pain bad enough for chronic opioids may be an indication for joint replacement," adds Miller. Opioids can cause physical dependence and has been linked to an increased risk of falls resulting in fractures in older adults. For more details on opioids and other medicines used to treat arthritis, see the Arthritis Today Drug Guide.

Nonsteroidal anti-inflammatory drugs (NSAIDs)

NSAIDs are the mostly commonly used drugs to ease arthritis-related pain, swelling and stiffness. They interfere with the body’s production of hormone-like chemicals called prostaglandins. Prostaglandins are one of the biggest contributors to inflammation in the body. NSAIDs are available over-the-counter or with a prescription. They include aspirin, ibuprofen, naproxen and celecoxib (Celebrex). 

NSAIDs aren’t for everyone. These drugs have been linked to an increase in gastrointestinal bleeding, stomach ulcers, heart attack and stroke. Your doctor may recommend other medicines if you have a history of stomach ulcers, high blood pressure, asthma or kidney or liver disease.

Topical pain relievers

Topical pain relievers are creams, ointments or salves that are applied directly to the skin on the painful area to help relieve mild joint and muscle aches. Some common ones used to treat arthritis are described below.  

  • Voltaren Gel is a type of topical NSAID. It is available by prescription. The American College of Rheumatology guidelines, published in 2012, recommend that people over age 75 use topical NSAIDs such as Voltaren Gel instead of those taken by mouth.
  • Capsaicin is natural ingredient found in cayenne peppers. When it touches your skin, it tells your nervous system to release a chemical called substance P, which sends pain messages to the brain. (That is why you feel burning when you bite into a hot pepper.) However, regularly applying capsaicin to an area of skin causes a drop in substance P levels, and therefore reduces the feeling of pain. (That is why some people report having a tolerance to hot peppers.) Capsaicin pain relievers are available over-the-counter and may be sold under the brand names Capzacin-P, Bengay Ultra Strength, Zostrix-HP and others.
  • Counterirritants stimulate or irritate the nerve endings to distract the brain’s attention from musculoskeletal pain. (Like stubbing your toe might take your mind off a headache.) Such products may contain menthol, oil of wintergreen, camphor, eucalyptus oil, and others. Brand names ArthriCare, Eucalyptamint, Icy Hot and Therapeutic Mineral Ice, among others.
  • Salicylate topical preparations are another type of counterirritant. However, these products contain the same ingredient as aspirin. Brand name examples include Aspercreme, Bengay, Flexall, Mobisyl and Sportscreme. You should not use salicylate products if you take blood thinners, including aspirin.