Arthritis refers to a group of diseases that cause joint inflammation and chronic pain, limiting the ability to perform daily activities in many cases. A combination of medications is usually used to treat the pain and discomfort caused by arthritis. Here is an overview of the different classifications of pain relievers or traditional medications for treat arthritis painfrom the strongest to the weakest.
Traditional medicines to treat arthritis pain
Opioids are powerful pain relievers (analgesics) that block pain signals to the brain. All natural opioids are derived from the opium poppy plant, but synthetic opioids like fentanyl are made in a laboratory.
They are prescribed by a physician or medical provider to be used as part of a carefully monitored pain management plan. Some opioids like heroin are illegal substances. Opioids can be addictive and, if used incorrectly, can lead to a fatal overdose. (1)
This class of drugs has long had a role in the treatment of surgical and cancer pain. In recent years, they have been increasingly prescribed for chronic arthritis pain. For example, up to 40% of rheumatoid arthritis patients are regular opioid users. (2) However, the use of opioids for this type of pain remains controversial and the benefits of these medications are unclear.
Here is a list of opioids from strongest to weakest:
The Fentanyl is a synthetic opioid prescribed after surgery for severe pain. It is very potent and is reported to be up to 100 times stronger than morphine. (3) Requires a prescription, but is also a common illicit substance, often dangerously mixed with heroin, which can result in fatal overdose.
Dilaudid (hydromorphone HCl) It is usually given for pain after surgery. It can be given intravenously or in pill form.(4)
In some cases, it can be delivered through a patient-controlled analgesia pump (PCA pump). It is considerably stronger than morphine. It also carries the risk of addiction, abuse, and misuse, and can cause life-threatening respiratory depression. Those taking this drug should be carefully monitored.
Opana (oxymorphone) It is prescribed to treat moderate to severe pain. It is important to take this exactly as prescribed. It can cause serious and life-threatening breathing problems, which are more likely to occur during the first 72 hours of treatment and at any time when the dose is increased. Your doctor will carefully monitor your use of the medication. (4)
Oxycontin, Rixicodone, and Percocet (oxycodone) are used for moderate to severe acute and chronic pain. It can come in liquid, tablet, or capsule form.
morphine It is given for both chronic and short-term pain. Its potency is similar to that of oxycodone and it can be ingested or injected.
codeine it is commonly found in prescription cough syrup, but can be used for mild to moderate pain relief in a combination tablet with Tylenol, known as Tylenol #3. The potential for misuse still exists, but it is less potent than other opioids.
Demerol (meperidine) was common in the hospital setting for moderate to severe pain. Today it is used less frequently to treat pain because its duration of pain relief is shorter than that of similar drugs and it has a number of potentially dangerous interactions.
However, it is necessary to know that there is an opioid addiction crisis. In 2018, opioids, primarily synthetic opioids other than methadone, were involved in 46,802 overdose deaths, accounting for 69.5% of all drug overdose deaths nationwide.
Corticosteroids or steroids are a type of medication used to treat inflammation. They are prescribed to treat rheumatologic conditions, including rheumatoid arthritis. They come in different forms. Some can be applied to a specific site of pain, such as joint injections or skin creams, while others, such as oral and intravenous steroids, work systemically. They reduce inflammation and the activity of the immune system. (5)
Below is a list of common corticosteroids from strongest to weakest:
Decadron (dexamethasone) It is used to treat chronic conditions. It mimics the effects of glucocorticoids, which are natural steroid hormones produced by the adrenal glands. It is long-acting and about 25 times more potent than its short-acting corticosteroid counterparts. This medication suppresses the immune system and reduces inflammation. (6)
Depo-Medrol, Medrol, Methacort, Depopred, Predacorten (methylprednisolone) they are corticosteroids that are similar to a natural hormone produced by the adrenal glands, which supplement this chemical when your body does not produce enough. (7) It comes in tablets, as well as intramuscular and intravenous forms, and your doctor will design the best dosing schedule that works for you. Do not take more or less than prescribed.
Ray, Deltasone, Sterapred, and Liquid Pred (prednisone) they are potent, short-acting corticosteroid products. Prednisone is usually prescribed for short-term relief of inflammation and pain. Side effects increase with dosage and may include weight gain, irritability, a round face, and fluid retention. (8) Increased blood sugar or diabetes, hypertension, bone loss or osteoporosis, and gastritis are also possible.
Dosages of Cortef (hydrocortisone) tablets they will range from 20 mg to 240 mg per day. The dose depends on the severity of the condition being treated. The most common side effects include skin discoloration, bruising, increased appetite, and weight gain. If you experience more serious side effects such as blurred vision, seizures, or unusual mood changes, see your doctor.
Nonsteroidal anti-inflammatory pain relievers (NSAIDs) are the most commonly prescribed medications for treat the inflammation and pain of arthritis, bursitis and tendinitis. They can be taken orally or rubbed on the joints. NSAIDs prevent the enzyme cyclooxygenase (COX) from creating prostaglandins, which are hormone-like chemicals that play the biggest role in inflammation. The body produces COX-1, which protects the lining of the stomach, and COX-2, which contributes to inflammation.
Many NSAIDs affect both forms of cyclooxygenase, fighting inflammation but also contributing to stomach bleeding and ulcers. There is a targeted form of NSAIDs, the COX-2 inhibitor, which blocks the enzyme that causes inflammation rather than the one that protects the stomach. Unfortunately, only one is available in the EU market.
Here is an overview of some common NSAIDs, from strongest to weakest:
Voltaren (diclofenac) it’s something you need a prescription for if you want it in tablet form; otherwise, over-the-counter topical forms are available. For the relief of osteoarthritis, 100 to 150 mg per day in single doses is recommended, while the recommended dose for rheumatoid arthritis is 150 to 200 mg per day in divided doses. It comes with some serious side effects, from gastrointestinal bleeding and ulcers to skin reactions. (9)
Naprosin (naproxen) It is commonly used to treat inflammation and pain, as well as menstrual cramps and fever. Common side effects can include shortness of breath, bloating, and stomach pain. (10)
Motrin (ibuprofen) may cause some stomach-related side effects. Ibuprofen, whether prescription or over-the-counter, can increase the risk of heart problems. Motrin and Advil are ibuprofen and can temporarily relieve minor arthritis pain. (eleven)
Aspirin (acetylsalicylic acid) It is one of the most common NSAIDs out there. May cause abdominal cramps, some pain and discomfort, bleeding, diarrhea, and vomiting. If you are taking more than 3,600 mg of aspirin per day, your doctor may need to monitor your blood salicylate levels. (12)
Acetaminophen is a non-opioid pain reliever used for mild to moderate pain. It is also an antipyretic that can lower a person’s fever. This drug is an active ingredient in countless over-the-counter medications and prescriptions, including Excedrin and Tylenol. It is commonly used to relieve arthritis because it does not have the same heart and gastrointestinal risks as NSAIDs. It is seen as a safer alternative. (13)
Unfortunately, acetaminophen is not an anti-inflammatory drug. The reduction in swelling and inflammation that is a characteristic of NSAIDs is not available with acetaminophen.
Acetaminophen products contain warnings of severe liver damage, allergic reaction, and overdose. The Food and Drug Administration (FDA) issued a directive in 2011 to limit acetaminophen in prescription drugs to 325 mg per pill. In addition, they stated that acetaminophen medications must carry a black box warning label that highlights the possibility of serious liver injury. (14)
Final Summary on Traditional Medications to Treat Arthritis Pain
Chronic pain associated with arthritis it can be debilitating and limiting. It can hamper your ability to perform normal daily tasks and get on with your life with ease. That’s why it’s important to find the right treatment for you. While many medications can relieve pain, each has specific recommendations and risks. Whether you’re looking for short-term pain relief or more robust long-term treatment, be sure to discuss with your medical provider what might be the best medication regimen for you.