Pain Medication for Arthritis

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

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:

  • Fentanyl is a synthetic opioid prescribed following surgery for severe pain. It is very potent, and is reported to be up to 100 times stronger than morphine. It require a prescription from a healthcare provider, but is also a common illicit substance, often dangerously mixed with heroin, which can result in fatal overdose.
  • Dilaudid (hydromorphone HCl) is usually given for pain after surgery. It can be given through IV or a pill. In some instances, it can be administered through a patient-controlled analgesia pump (PCA pump). It is considerably stronger than morphine. It also bears the risk of addiction, abuse, and misuse, and can lead to life-threatening respiratory depression. Those on this drug need to be monitored carefully.
  • Opana (oxymorphone) is prescribed to treat moderate to severe pain. It's important to take this exactly as prescribed. It can cause serious, life-threatening breathing problems, which is most likely during the first 72 hours of treatment and at any point when dosage increases. Your healthcare provider will carefully monitor your use of the drug.
  • Oxycontin, Rixicodone, and Percocet (oxycodone) are used for moderate to severe acute and chronic pain. It can come in a liquid, tablets, or capsules.
  • Morphine is administered for both short-term and chronic pain. Its potency is similar to that of oxycodone, and it can be swallowed or injected.
  • Codeine is commonly found in prescription cough syrup, but can be used for mild to moderate pain relief in a tablet combined with Tylenol, known as Tylenol #3. There is still a possibility of misuse, but it is less potent than other opioids.
  • Demerol (meperidine) was common in hospital settings for moderate to severe pain. It is used less frequently today to treat pain due to the fact that the duration of its pain relief is shorter than similar drugs and that it possesses a number of potential dangerous interactions.

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

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:

  • Decadron (dexamethasone) is used for treating chronic conditions. It mimics the effects of glucocorticoids, which are natural steroid hormones produced by the adrenal glands. It's long-acting and about 25 times more potent than its short-acting corticosteroid counterparts. This drug suppresses the immune system and reduces inflammation.
  • Depo-Medrol, Medrol, Methacort, Depopred, Predacorten (methylprednisolone) are corticosteroids that are similar to a natural hormone made by the adrenal glands, supplementing this chemical when your body isn't making enough. It comes in tablets as well as intramuscular and IV forms, and your healthcare provider will devise the best dosing schedule that works for you. Do not take any more or less than prescribed.
  • Rayos, Deltasone, Sterapred, and Liquid Pred (prednisone) are short-acting, potent corticosteroid products. Prednisone is usually prescribed for short-term relief of inflammation and pain. Side effects increase with the dose amount, and can include weight gain, irritability, round face, and fluid retention. Increased blood sugar or diabetes, hypertension, bone mass loss or osteoporosis, and gastritis are also possible.
  • Cortef (hydrocortisone) tablet doses will vary from 20 mg up to 240 mg each day. The dosage 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 like blurred vision, seizure, or unusual mood changes, consult your healthcare provider.

NSAIDs

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:

  • Voltaren (diclofenac) is something you need a prescription for if you want it in its tablet form, otherwise over-the-counter topical forms are available. For osteoarthritis relief, 100 to 150 mg per day in individual doses is recommended, while the recommended dosage 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.
  • Naprosyn (naproxen) is commonly used to treat inflammation and pain as well as menstrual cramps and fevers. Common side effects can include shortness of breath, swelling, and stomach pain.
  • Motrin (ibuprofen) can cause some stomach-related side-effects. Ibuprofen, whether prescribed or over-the-counter, can increase the risk of heart problems. Motrin and Advil are both ibuprofen, and can temporarily relieve minor arthritis pain.
  • Aspirin (acetylsalicylic acid) is one of the most common NSAIDs out there. It can cause abdominal cramps, some pain and discomfort, bleeding, diarrhea, and vomiting. If you are taking more than 3,600 mg of aspirin each day, your healthcare provider might need to monitor your blood salicylate levels.

Acetaminophen

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.

A Word From Verywell

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.

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20 Sources
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read our editorial process to learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.
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