Osteoarthritis: over-the-counter treatments
There are a number of different treatment options available for osteoarthritis — a chronic (ongoing) condition that causes pain and stiffness in affected joints. Over-the-counter treatments can help relieve pain and thus improve function and mobility.
It is important that any medicines you are taking and their dosage be reviewed regularly by your doctor, and as with all medicines, it is important not to exceed the recommended dose and to seek further advice if your pain is not relieved.
Paracetamol is the first choice of treatment for pain relief in mild to moderate osteoarthritis. Two tablets (1 g) 4 to 6 hourly, up to a maximum dose of 4 g daily is the recommended dosage. It should be taken regularly — not just when required — to have the best effect.
Paracetamol is usually well tolerated. Exceeding the recommended dose can cause severe liver damage.
Oral non-steroidal anti-inflammatory drugs (NSAIDs)
Non-steroidal anti-inflammatory drugs (NSAIDs) are medicines that reduce inflammation and relieve pain.
Examples of over-the-counter NSAIDs used in the treatment of osteoarthritis include:
- ibuprofen (e.g. Advil, Nurofen or Herron Blue Ibuprofen);
- naproxen (e.g. Naprogesic); and
- diclofenac (Voltaren Rapid).
Usually NSAIDs are used only after regular paracetamol has been tried first, as they may cause side effects. NSAIDs can be used together with paracetamol, or on their own.
Possible side effects associated with NSAIDs include stomach upset, peptic ulcers, cardiovascular problems (including increased risk of heart attack and stroke, high blood pressure and heart failure), kidney problems and liver damage.
NSAIDs are not recommended for people with stomach ulcers, indigestion or other stomach problems, or people with a history of angina, heart attack or stroke. They should be used with caution in people with asthma, in older people (over 75 years old) and people with serious medical conditions as they may affect kidney function or interact with other medicines.
NSAIDs are best used occasionally, for flare ups or when you know you have a demanding day ahead, rather than on a regular basis.
If simple analgesics and NSAIDs are not adequately controlling pain, combination analgesics, such as paracetamol plus codeine, can be tried. However, opioid medicines such as codeine have side effects including drowsiness and sedation, constipation and nausea.
Older people may be more susceptible to side effects such as sedation.
Topical NSAIDs (such as Feldene Gel, Orudis Gel, Nurofen Gel, Dencorub Anti-inflammatory Gel and Voltaren Osteo Gel) are creams or gels that are usually used for muscular aches and pains. Topical NSAIDs can help provide some relief from osteoarthritis pain in the short term (up to 10 days).
Topical anti-inflammatories are absorbed through the skin and into the bloodstream in small amounts, so it is still important to consider the same precautions as for NSAID tablets.
Rubefacients (heat rubs or creams) help stimulate blood flow and create a sense of warmth, which may contribute to pain relief by masking the sensation of pain. Available rubefacients include capsaicin (brand name Zostrix), Dencorub Pain Relieving Cream, Finalgon Cream, Rubesal, Goanna Heat Cream and Metsal Heat Rub Cream and Gel.
Take care to wash your hands afterwards, and avoid getting the product in your eyes or on broken skin — it can sting.
2. Arthritis Australia. Osteoarthritis (updated Jun 2013). http://www.arthritisaustralia.com.au/images/stories/documents/info_sheets/2013/OsteoArthritis.pdf (accessed Nov 2013).
3. NHS Choices. Osteoarthritis (updated 16 Aug 2012). http://www.nhs.uk/Conditions/Osteoarthritis/Pages/Treatment.aspx (accessed Nov 2013).
4. American College of Rheumatology. Osteoarthritis (updated Feb 2012). http://www.rheumatology.org/practice/clinical/patients/diseases_and_conditions/osteoarthritis.asp (accessed Nov 2013).