Brian Mastroianni is a health and science journalist based in New York. His work has been published by The Atlantic, The Paris Review, CBS News, The TODAY Show, Barron's PENTA, Engadget and Healthline, among others.
Anita Chandrasekaran, MD, MPH, is board-certified in internal medicine and rheumatology and currently works as a rheumatologist at Hartford Healthcare Medical Group in Connecticut.
Arthritis refers to a group of diseases that result in joint inflammation and chronic pain. In the United States alone, more than 54 million people are living with arthritis. Zeroing in further, 24 million reported that their ability to carry out daily activities is limited by the condition, while one in four adults said their arthritis has left them with severe pain. Usually, a combination of medications are used to treat the pain and discomfort caused by arthritis. Here is an overview of the different classifications of pain relievers prescribed to treat arthritis pain, from strongest to weakest.
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Opioids are powerful painkillers (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 lab. They are prescribed by a healthcare provider or medical professional to be used as part of a carefully supervised pain management plan. Some opioids like heroin are illegal substances. Opioids can lead to addiction and, if misused, can result in a fatal overdose.
This class of drugs has long had a role in treating surgical and cancer pain. In recent years, they've increasingly been prescribed for chronic pain from arthritis. For example, up to 40% of rheumatoid arthritis patients are regular opioid users. The use of opioids for this type of pain remains controversial, however, and the benefits of these medications are unclear.
Here's a list of opioids from strongest to weakest:
We are living through a national opioid addiction crisis in the United States. In 2018, opioids, mainly synthetic opioids other than methadone, were involved in 46,802 overdose deaths, which accounted for 69.5 % of all drug overdose deaths nationwide.
Corticosteroids, or steroids, are a type of drug used to treat inflammation. They are prescribed to treat rheumatologic conditions, including rheumatoid arthritis. They come in different forms. Some may be applied to a specific site of pain, such as joint injections or skin creams, while others like oral and IV steroids work systematically. They reduce inflammation and the activity of the immune system.
Below is a list of common corticosteroids from strongest to weakest:
Nonsteroidal anti-inflammatory pain medications (NSAIDs) are the most commonly prescribed drugs to treat inflammation and pain from arthritis, bursitis, and tendonitis. They can be taken by mouth or rubbed over joints. NSAIDs prevent the enzyme cyclooxygenase (COX) from creating prostaglandins, which are hormone-like chemicals that play the biggest role in inflammation. The body makes COX-1, which protects your stomach lining, and COX-2, which contributes to inflammation.
Many NSAIDs impact both forms of cyclooxygenase, combating inflammation but also contributing to bleeding in your stomach and ulcers. There is a targeted form of NSAID, COX-2 inhibitor, that block the inflammation-causing enzyme more than the stomach-protecting one. Unfortunately, only one is available in the U.S. market.
Here's an overview of some common NSAIDs from strongest to weakest:
Acetaminophen is a non-opioid analgesic 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 for arthritis relief because it doesn’t possess the same heart and gastrointestinal risks of NSAIDs. It’s seen as a safer alternative.
Unfortunately, acetaminophen isn't an anti-inflammatory medication. The swelling and inflammation reduction that is a feature of NSAIDs is not available with acetaminophen.
Acetaminophen products bear 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. Additionally, they stated that drugs with acetaminophen should feature a black box warning label highlighting the potential for severe liver injury.
The chronic pain associated with arthritis can be debilitating and limiting. It can hinder your ability to carry out normal daily tasks and go about your life with ease. That's why it's important to seek the treatment that's right for you. While many medications can offer pain relief, they each come with specific recommendations and risks. Whether you are looking for short-term pain relief or more robust long-term treatment, be sure to discuss with your medical provider what the best medication regimen might be for you.
Dealing with chronic inflammation? An anti-inflammatory diet can help. Our free recipe guide shows you the best foods to fight inflammation. Get yours today!
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Centers for Disease Control and Prevention. Arthritis.
Centers for Disease Control and Prevention. Opioid basics.
Tehrani M, Aguiar M, Katz JD. Narcotics in rheumatology. Health Serv Insights. 2013 Jun 13;6:39-45. doi: 10.4137/HSI.S10461
Day AL, Curtis JR. Opioid use in rheumatoid arthritis: trends, efficacy, safety, and best practices. Curr Opin Rheumatol. 2019 May;31(3):264-270. doi: 10.1097/BOR.0000000000000602
Ramos-Matos CF, Bistas KG, Lopez-Ojeda W. Fentanyl.
U.S. Food and Drug Administration Package Insert. Dilaudid.
MedlinePlus. Oxymorphone.
Centers for Disease Control and Prevention. Opioid overdose: Drug overdose deaths.
Cleveland Clinic. Corticosteroids.
Zoorob R, Cender D. A different look at corticosteroids.
U.S. Food and Drug Administration. Dexamethasone tablets label.
MedlinePlus. Methylprednisolone.
Johns Hopkins Arthritis Center. Arthritis treated with prednisone.
Arthritis Foundation. NSAIDs.
RXList. Voltaren.
RxList. Naprosyn.
Motrin. Joint pain relief.
Arthritis Foundation. Aspirin (acetylsalicylic acid).
Arthritis Foundation. Taking acetaminophen safely.
United States Food and Drug Administration. FDA drug safety communication: prescription acetaminophen products to be limited to 325 mg per dosage unit; boxed warning will highlight potential for severe liver failure.
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