What is the Best Painkiller For Arthritis?

Author: Analgesia team Reviewed by: Dr. Ngozi Ekeigwe

Last Updated on March 31, 2025 by Analgesia team

Oral nonsteroidal anti-inflammatory drugs (NSAIDs)

NSAIDs work by blocking the production of prostaglandins, chemicals responsible for pain and inflammation in the body. 

Common oral nonsteroidal anti-inflammatory drugs (NSAIDs) used to treat arthritis include

• Diclofenac (Voltaren): May be more effective for severe arthritis pain, but can have a higher risk of side effects
• Celecoxib (Celebrex): Considered a COX-2 inhibitor, potentially causing less stomach irritation compared to traditional NSAIDs, but may have increased cardiovascular risks.
• Indomethacin (Indocin, Indocin SR, Tivorbex, Indocin IV): Used to treat mild to moderate acute pain and relieve symptoms of arthritis (osteoarthritis and rheumatoid arthritis) or gout, such as inflammation, swelling, stiffness, and joint pain
• Piroxicam (Feldene): Piroxicam is considered a strong painkiller for many types of arthritis.
• Ibuprofen (Advil, Motrin):  Considered a good first-line option for mild to moderate arthritis pain.
• Naproxen (Aleve):  Offers longer-lasting pain relief compared to ibuprofen

The above drugs can help alleviate pain and inflammation associated with various types of arthritis; however, it’s crucial to consult a doctor before taking any NSAID due to potential side effects depending on individual health conditions. 

Side effects: Potential side effects include stomach upset, heartburn, increased bleeding risk, kidney problems, and increased risk of cardiovascular events, especially in high-risk patients. 

Topical NSAIDs

“Topical” in the context of pain creams means that the medication is applied directly to the skin at the site of pain, allowing it to be absorbed locally rather than being taken orally and traveling through the bloodstream to reach the affected area; essentially, it’s a cream you rub on the skin where you feel pain. 

Topical nonsteroidal anti-inflammatory drugs (NSAIDs) are a common treatment for mild to moderate arthritis pain. They can be applied to the skin as a gel, cream, spray, or plaster. 

Some examples of topical NSAIDs

• Diclofenac: Available over-the-counter as Voltaren Arthritis Pain, or by prescription as Pennsaid
• Ibuprofen: Available as a topical gel
• Ketoprofen: Available as a topical gel
• Felbinac: A topical NSAID that may be recommended by a doctor
• Piroxicam: A topical NSAID that may be recommended by a doctor

How are topical NSAIDs used? 

• Topical NSAIDs can be used as needed or every day
• They work best when combined with exercise
• For knee osteoarthritis, weight loss may also be important

The American College of Rheumatology (ACR) recommends topical non-steroidal anti-inflammatory drugs (NSAIDs) as a first-line treatment for knee and hand osteoarthritis (OA). The ACR also recommends topical NSAIDs for people over 75 years old with knee OA.

Injections for arthritis can include 

• corticosteroids,

• hyaluronic acid,

• platelet-rich plasma (PRP), and

• autologous conditioned serum (ACS). 

Corticosteroids

• Also known as steroid injections, these anti-inflammatory medications can treat arthritis, joint pain, and other conditions. 
• Cortisone shots are often the first-line treatment for arthritis. They can be effective for reducing inflammation and pain in the joint. 
• Corticosteroids can be toxic to cartilage and may cause side effects over time. 

Hyaluronic acid 

• Also known as knee gel injections, these injections are made of a thick substance that mimics the fluid that cushions joints.
• They can help with knee pain, especially mild to moderate arthritis.
• The effects of hyaluronic acid injections usually last 6 to 12 months.

Platelet-rich plasma (PRP)

• A type of cell therapy that involves injecting platelets into a joint. 
• Platelets are separated from red blood cells using a centrifuge machine. 
• PRP injections are a newer treatment that may help stimulate regeneration. 

Autologous conditioned serum (ACS) 

• Made from your blood, which is incubated to increase the concentration of anti-inflammatory molecules.
• ACS injections are usually given by an orthopedic surgeon or sports medicine doctor.

Like any treatment, these injections carry certain risks and side effects. Most are mild or temporary, but some can be serious or long-lasting. They include

• Pain and swelling (Cortisone flare)
• Skin discoloration
• Elevated blood sugar
• Tendon injury
• Cartilage loss
• Infection
• Allergic reaction and
• sex-related side effects

Opioid painkillers for severe arthritis

While opioids may be prescribed for severe arthritis pain in some cases, they are generally considered a second-line treatment option due to their limited effectiveness and potential for significant side effects. Pain management strategies like nonsteroidal anti-inflammatory drugs (NSAIDs) and physical therapy are usually preferred first for most arthritis patients. 

Key points about using opioids for severe arthritis:

• Limited benefit: Studies show that opioids provide only small improvements in pain relief for arthritis, often not significantly better than a placebo, and may not improve function significantly. 
• Significant risks: Opioids can have serious side effects like addiction, dependence, respiratory depression, and increased risk of falls, especially when used long-term. 
• Considered last resort: Due to the potential risks, opioids should only be used for severe arthritis pain when other treatments like NSAIDs, acetaminophen, physical therapy, and lifestyle modifications have not been effective. 

Examples of opioid painkillers that might be prescribed for severe arthritis include: oxycodone, morphine, hydromorphone, fentanyl, codeine, methadone, and tramadol; however, due to potential side effects, opioids are typically only used for severe arthritis pain when other treatments are not effective and should be carefully monitored by a doctor. 

Key points to remember:

• Stronger opioids: For very severe arthritis pain, doctors might prescribe stronger opioids like oxycodone, morphine, or fentanyl. 
• Weaker opioids: In some cases, a weaker opioid like codeine or tramadol may be used initially, especially if the pain is not as intense. 
• Important considerations: Opioids can have significant side effects like addiction, constipation, drowsiness, and nausea, so their use should be carefully managed by a healthcare professional.

If you are considering using opioids for arthritis pain:

• Consult your doctor: Always discuss your pain management options with your doctor to determine if opioids are appropriate for your specific situation and to discuss potential risks and side effects. 
• Monitor usage closely: If your doctor prescribes opioids, follow their instructions carefully and be aware of potential side effects. 
• Explore alternative treatments: Consider non-medication options like exercise, weight management, heat therapy, and assistive devices to manage arthritis pain