Oral Medications

Overview of Oral Pain Medications

Oral medications are often the first treatment people try for joint pain. While they can provide significant relief, understanding the differences between options helps you use them safely and effectively.

No oral medication cures arthritis or repairs cartilage. They manage symptoms while you pursue other treatments like physical therapy, weight loss, or injections that may provide longer-lasting benefits.

Acetaminophen (Tylenol)

How It Works

Acetaminophen reduces pain signals in the brain. Unlike NSAIDs, it doesn’t reduce inflammation, making it less effective for inflammatory conditions but safer for many people.

Benefits

• Generally safe for most people
• Doesn’t cause stomach bleeding
• Safe for those with kidney disease (at appropriate doses)
• Can be used with most other medications
• Available without prescription

Limitations

• Less effective than NSAIDs for arthritis pain
• No anti-inflammatory effect
• Can cause liver damage at high doses or with alcohol
• Maximum daily dose: 3,000-4,000 mg (check with doctor)

Who Should Be Careful

• People with liver disease
• Heavy alcohol users (3+ drinks daily)
• Those taking other acetaminophen-containing products
• People with certain genetic conditions affecting liver metabolism

NSAIDs (Non-Steroidal Anti-Inflammatory Drugs)

How They Work

NSAIDs block enzymes (COX-1 and COX-2) that produce prostaglandins, chemicals that cause pain and inflammation. They reduce both pain and swelling.

Over-the-Counter Options

Ibuprofen (Advil, Motrin)

• Dose: 200-400 mg every 4-6 hours
• Maximum: 1,200 mg/day (OTC) or 3,200 mg/day (prescription)
• Shortest acting NSAID
• Good for acute flares

Naproxen (Aleve)

• Dose: 220-440 mg every 8-12 hours
• Maximum: 660 mg/day (OTC) or 1,500 mg/day (prescription)
• Longer lasting (twice daily dosing)
• Good for consistent pain

Aspirin

• Not recommended for arthritis due to high doses needed
• More GI side effects than other NSAIDs
• Interacts with many medications

Prescription NSAIDs

Celecoxib (Celebrex)

• COX-2 selective NSAID
• Lower risk of stomach bleeding
• Dose: 100-200 mg once or twice daily
• Higher cardiovascular risk at high doses
• Often covered by insurance

Meloxicam (Mobic)

• Once-daily dosing
• Partially COX-2 selective
• Dose: 7.5-15 mg daily
• Generic available (lower cost)

Diclofenac (Voltaren oral)

• Available as tablets or liquid
• Dose: 50 mg 2-3 times daily
• Also available as topical gel
• Effective but higher GI risk

NSAID Risks

Gastrointestinal

• Stomach ulcers and bleeding
• Risk increases with age, history of ulcers, and prolonged use
• Take with food; consider stomach-protecting medication

Cardiovascular

• Increased risk of heart attack and stroke
• Higher with longer use and higher doses
• Naproxen may have lowest cardiovascular risk

Kidney

• Can worsen kidney function
• Avoid in chronic kidney disease
• Stay well-hydrated

Who Should Avoid NSAIDs

• History of stomach ulcers or GI bleeding
• Chronic kidney disease
• Heart failure
• Recent heart attack or stroke
• Taking blood thinners
• Third trimester of pregnancy

Prescription Pain Medications

Duloxetine (Cymbalta)

A medication originally developed for depression that helps chronic pain:

• FDA-approved for chronic musculoskeletal pain
• Works on pain processing in the brain
• May take 2-4 weeks to show benefit
• Common side effects: nausea, dry mouth, drowsiness
• Must be tapered off (don’t stop suddenly)

Tramadol

A mild opioid-like medication:

• Less addiction potential than stronger opioids
• Still has dependence risk
• Common side effects: drowsiness, nausea, constipation
• Interacts with many medications
• Not recommended as first-line treatment

What About Stronger Opioids?

Guidelines recommend against opioids for chronic arthritis pain:

• High addiction and overdose risk
• Don’t improve function long-term
• Cause tolerance (need increasing doses)
• Many side effects (constipation, drowsiness, falls)
• Reserved for severe cases when all else fails

Choosing the Right Medication

First-Line Recommendations

For mild to moderate osteoarthritis pain:

1. Start with acetaminophen if tolerated
2. Add or switch to topical NSAIDs for localized joint pain
3. Consider oral NSAIDs at lowest effective dose, shortest duration
4. Prescription options if OTC medications inadequate

Consider Your Health History

Safe Use Guidelines

General Principles

• Use the lowest effective dose
• Use for the shortest time needed
• Don’t exceed maximum daily doses
• Don’t combine multiple NSAIDs
• Take with food (NSAIDs)
• Stay hydrated
• Tell your doctor about all medications you take

When to Call Your Doctor

• Black or bloody stools
• Severe stomach pain
• Swelling in legs or feet
• Shortness of breath
• Chest pain
• Unusual fatigue
• Yellowing skin or eyes (jaundice)

Medications Alone Aren’t Enough

Oral medications work best as part of a comprehensive plan:

• Physical therapy addresses underlying muscle weakness
• Weight loss reduces joint stress (if overweight)
• Exercise maintains function and reduces pain
• Injections may provide longer-lasting relief
• Lifestyle changes support overall joint health

Think of medications as a bridge—they reduce pain enough to participate in treatments that provide lasting benefit.

Questions to Ask Your Healthcare Provider

1. Which pain medication is safest given my health conditions?
2. What’s the maximum dose I should take?
3. How long is it safe to take this medication?
4. Should I take anything to protect my stomach?
5. Are there interactions with my other medications?
6. When should I consider other treatments instead of continuing medications?

Related Resources

• Topical Treatments for Joint Pain
• Cortisone Injections Guide
• Physical Therapy for Joint Pain
• Understanding Degenerative Joint Disease