Arthritis

Painkillers and non-steroidal anti-inflammatory drugs (NSAIDs)

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Painkillers (sometimes called analgesics) are drugs that help to reduce pain, and are commonly used by people with arthritis to ease their pain until it gets better or during flare-ups. Arthritis Research UK advises that “You don’t need to wait until your pain is severe to use painkillers. Take them as the packet advises or as your doctor suggests... You can also take them before you exercise so you can carry on without causing too much discomfort.” (2015)
Some painkillers have several different names. For example, paracetamol is sometimes called Panadol. Arthritis Research UK has an A-Z of different drug names which may be useful for people who want to find out what kind of medication they are using.
 
The people we talked to mentioned different types of painkillers, including one specific group of painkillers called non-steroidal anti-inflammatory drugs or NSAIDs. This group includes ibuprofen. In this section we first talk about anti-inflammatories and then other painkillers.
 
Anti-inflammatories
Non-steroidal anti-inflammatory drugs (NSAIDs) reduce inflammation, which helps to ease joint pain and stiffness. Many commonly used NSAIDs such as ibuprofen are available to buy over the counter. Others are available on prescription. There are fewer NSAIDs available for people under the age of 16 compared to adults. Young people may require higher doses of NSAIDs and may have to take them more regularly compared to adults.
 
You can read more about NSAIDs on Arthritis Research UK’s website, but keep in mind that the information is for adults and not young people.
 
There are many different types of anti-inflammatory medication. Dan took nabumetone (Relifex). Charlotte Y used to take diclofenac (Voltarol). Charlotte Z, Catherine and Zoe took naproxen. Gemma used to take piroxicam (Feldene) but she was in “tons of pain”. The doctor thought that she had become immune to the medication and gave her naproxen to take instead. Diclofenac was another common type used by those we spoke to. Occasionally people feel sick or get other stomach symptoms when they take NSAIDs, and may need another medication to help protect the stomach. Some of those we talked to took omeprazole to help reduce stomach acid.
Ibuprofen helped reduce Ryan’s joint swelling. He tried the powder version and the tablet version. He preferred the tablet because it did not melt in his mouth and was easier to swallow. When Catherine was younger she only took ibuprofen if she had a bad spell. Jazmin had a phobia of tablets so she took a liquid form of ibuprofen.
 
Some of the people we spoke to had side effects from the ibuprofen. Lu took ranitidine (Zantac) to protect her stomach from the ibuprofen.
When Bradley’s arthritis was at its worst he took 6 ibuprofen tablets a day. He started to take fewer tablets when his methotrexate started to work and his arthritis improved. When Lucy was first diagnosed she was taking ibuprofen but it did not stop her having a stiff neck. Things got better when she started taking methotrexate (a DMARDs) and anakinra (a biologic).
 
Dean discovered that he was allergic to anti-inflammatories when he was in hospital. He developed rashes and his throat closed up. At the time of the interview Dean was on painkillers but not anti-inflammatories. He said his pain was being managed but his swelling and night sweats had not gone down. He wanted a different kind of medication to help with these symptoms.
 
Cat and David Z took the NSAID etoricoxib to reduce their inflammation. David also takes a proton pump inhibitor (like omeprazole or lansoprazole) to help reduce the chance of digestion problems that the medication may cause. He used to get stomach cramps which affected his eating but the proton pump inhibitor has helped “enormously” with these problems.
 
Sarah took indomethacin.
NSAIDs relieve the symptoms of arthritis but they don’t stop it from causing damage to the body. Doctors prescribe a different type of drug called 'disease-modifying anti-rheumatic drugs' or 'DMARDs' to help prevent damage. (See ‘DMARDs – disease-modifying anti-rheumatic drugs’).
 
General painkillers
We spoke to people who were on different types of painkillers. People mentioned paracetamol, co-codamol, tramadol, morphine, and pregablin. Some of the medications could be bought 'over the counter' (in a shop). Others had to be prescribed by a doctor.
 
Some of the people we talked to had tried different painkillers over time. For example, Charlotte Z and Kerrie were given different painkillers by GPs and A&E doctors before they were diagnosed. Kerrie said that her pain was so severe that the medications “didn’t scratch the surface”. Charlotte Z kept returning to the doctor and asking for different painkilling medications.
 
It is important to find out what is causing the pain in the first place so that doctors can prescribe the right treatment. For example, if the pain is being caused by inflammation then an NSAID will reduce the inflammation and relieve the pain. If muscle spasms are causing the pain then massage therapy may help. Often when painkillers don’t work it’s because the type of pain is better managed by another drug or strategy.
 
Sometimes people took more than one painkiller at the same time. For example, both Chantelle and Charlotte Z took paracetamol and tramadol. Some doctors debate the effectiveness of taking these two painkillers at the same time, but the young people we talked to sometimes felt it was beneficial. It is very important to check first with a doctor or pharmacist that it is safe to do this; if you take two different versions of the same type of painkiller you may get too high a dose. Sometimes people took different types of medication alongside the painkillers such as anti-inflammatories, DMARDs (see 'DMARDs'), biologics (see 'Biological therapies') or steroids (see ‘Steroids’).
Jessica’s doctor prescribed paracetamol to take whenever she needed it. If she had a bad day she would take it four times a day. Michelle took different paracetamol medications, such as Solpadeine (which also contains codeine) and Calpol, and found the paracetamol “takes the twinge away from certain pains”.
 
Most painkillers come in tablet form but sometimes people don’t like taking tablets. Jazmin developed a tablet phobia because her methotrexate tablets used to make her sick, so she would only take crushed paracetamol “as a last resort”. Michelle sometimes took soluble paracetamol which dissolves in a glass of water and said it tasted horrible.
 
Painkillers like paracetamol don’t usually have side effects but some stronger painkillers can do. Charlotte Z was given co-codamol in hospital. It made her constipated due to the codeine content. Doctors gave her “disgusting” laxatives to drink so she could go to the toilet. She also used tramadol as a painkiller, which can make people feel sick, and she took omeprazole to help protect her stomach. Sarah said co-codamol made her feel sick so she only took it if she was “desperate”.
 
Kyrun took morphine to help with the pain, which made him drowsy and he slurred his words. It also made him itchy and light-headed. His mum wondered at one point if he had taken illegal drugs.
 
Taking tramadol made Chantelle sleepy, so she took it in the evening so it didn’t interfere with her school. Zoe described tramadol as a “potent painkiller”. She gets very tired when she takes it and said her pupils become “huge” like she is “stoned”. Her friends at school asked her if she had been doing drugs. Charlotte Y found it gave her hallucinations.
It’s important to keep in mind that painkillers are only one form of pain management. Some of the people we spoke to tried to manage their pain by exercising and eating healthily (see ‘Staying fit and healthy’). People paced themselves throughout the day so they didn’t “overdo it” and tried to rest as often as they could (see ‘Fatigue, energy levels and sleep’). Sometimes people distracted themselves from the pain by meeting friends (see ‘Friends and social life’).

Last reviewed August 2015.

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